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WHAT WE OFFER
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In Hospital Plan

CMSM coverage includes In-Hospital and medical expenses incurred in Lebanon, in accordance with the terms and conditions, specific technical limitations and exclusions stipulated in this Mutual Healthcare Plan.

The Principal adherent chooses upon adhesion/membership renewal one ‎hospitalization class for all the family members with no distinction, regardless the ‎family members relationship.‎

OUR BENEFITS
General Conditions
  • All treatments of health conditions that cannot be 
    undergone on Ambulatory basis providing that is medically
    indicated, Usual, Reasonable, Customary and accepted by 
    the Lebanese Ministry of Public ‎Health (MOH) and FDA approved.
  • Emergency Room Treatments of sudden sickness ‎that 
    can’t be delayed and some procedures undergone in 
    the ER room as well.
  • Clinical Procedures are covered.
  • In as Out Procedure such as endoscopic procedures, 
    Radiotherapy, Excision of lymph node, biopsies, etc.
  • One day room unit: Small surgeries and ‎other treatments 
    such as chemotherapy, etc.
  • ALL laparoscopic surgical procedures covered for Usual Procedures
  • Pre-Operative Tests if medically indicated, and require a 
    pre-requisite to anesthesia.
  • Physical Therapy treatments related to a covered 
    hospitalized case, if delivered at ‎hospital.
  • Homecare services, require the attending physician’s 
    prior approval.
  • Work related accidents are covered up to USD 5,000 per 
    accident.
  • Genetic cases up to USD 20,000 per year.‎

Maternity Coverage

- Normal Delivery or Cesarean Section in Mutual Class-MUT up to the 4th month of pregnancy (or 17 weeks) at the date of membership.
- Epidural.
- Newborn baby’s nursery as of birth for a maximum period of ten (10) days only.
- Intensive Care Neonatal or Incubator stay (ICN), CMSM will covers only the difference of NSSF/ MOH share on reimbursement basis.
- Screening tests are covered for new born CMSM babies up to USD 100 only.
- Baby male’s circumcision.

MORE
CONGENITAL CASES for new born babies up to (12) twelve years old.

CARDIO VASCULAR TREATMENTS such as Open Heart Surgery, Coronarography, and other Cardio-Vascular treatments require three (3) months waiting period.

PROSTHESIS per organ case per surgery:
  • Up to USD 8,000 in class MUT.
  • Up to USD 10,000 in class A.
  • Up to USD 15,000 for post traumatic.
  • INFERTILITY covered up to :
    • Class A: USD 2,000 per year.
    • Class MUT: USD 1,500 per year.
  • VARICOCELE: Covered/ If related to infertility it will be covered:
    • Class A: up to USD 2,000.
    • Class MUT: up to USD 1,500. 
  • DIALYSIS Sessions for Acute Renal Failure only during initial admission till discharge.
  • ARTERIO VENOSTOMY is covered up to USD 1,500 once per year.
  • NOSE RELATED SURGERIES.
  • COSMETIC AND PLASTIC SURGERIES:
    Following an accident within upmost 6 (six) months of the accident and before the membership expiry date.
  • BREAST RECONSTRUCTION Following a Mastectomy due to breast cancer:
    • Class A: up to USD 2,000.
    • Class MUT: up to USD 1,500.
  • ALL RELATED SLEEP APNEA PROCEDURES: covered up to USD 1,500 per year.
  • BLOOD TRANSUFION PREPARATION TESTS & PROCEDURES: Covered if medically indicated.
  • WEIGHT CONTROL PROCEDURES, GASTROPLASTY, ANY TREATMENT FOR OBESITY: Covered up to USD 3,000 per year if medically indicated and as per BMI and subject to SMO if necessary. Follow up tests and complications to be included within the limitation.
  • COVID-19 HOSPITALIZATION AND COMPLICATIONS: Covered up to USD 10,000 per year. No coverage for non-vaccinated people, 2 minimum vaccination doses are required.
Ambulatory Plan

CMSM Ambulatory Healthcare plan (AM) is an optional plan, not requiring
In-Hospital confinement’s admission, covers diagnostic tests and
ambulatory treatments within a wide network of healthcare providers all
over Lebanon’s territories.

OUR BENEFITS
General Conditions

o Adherents and/or Beneficiaries are entitled to ten (10) transactions per year.
o New Adherents and/or Beneficiaries, after three (3) months of enrollment date, are entitled only to five (5) transactions in first year.
o Coverage limit 85% per transaction cost.
o Specific In-hospital exclusions and limitations are covered by AM plan.

Online Diagnotic Tests
  • Audiogram
  • Cardiac Ultrasound
  • Electrocardiogram - EKG
  • Electroencephalogram - EEG
  • VCT 64
  • Calcium Score
  • Laboratory tests
  • Radiology
  • Stress test
  • Ultrasounds
  • COVID-19 related tests: Covered within limitation applied on Covid-19 diseases excluding PCR and rapid test


     
     

Diagnostic Tests Subject to TPA's Prior approval

o Abdominal-Pelvic Ultrasound
o Electromyogram - EMG
o Evoqued response
o Holter monitoring
o MRI, C.T. Scan and PET scan after six (6) months of enrollment date
o Nuclear medicine tests
o Ocular Angiography
o Testicular Pelvic Echo Doppler
o Thallium Myocardial Scintigraphy
o Tuberculin test

Other Features

o Genetic Tests are covered up to 500$ per year.
o Osteodensitometry is covered for adherents/beneficiaries aged fifty (50) years and above
once per Membership Schedule year.
o Pre-Marital tests are covered on reimbursement basis with a Certificate/proof documents
of marriage.
o Toxoplasmosis tests are covered four (4) times per pregnancy if results are showing lack of
immunity.

Routine Check UP

o Mammography and Breast Ultrasound
o Osteodensitometry as of forty five (45) years old
o PSA Total and Free
o Vitamin D

Treatments

o Ambulatory treatments are covered based on medical indication and International Medical Guidelines
o Argon Laser
o Laser Photocoagulation
o Physiotherapy
o Kinesitherapy

Travel Coverage

This plan covers Adherents and/or Beneficiaries worldwide when travelling for personal or leisure reasons not exceeding a period of 31 consecutive days. This plan does notcover any trip for professional or therapeutic reason.

OUR BENEFITS
Coverage Limit

o Travel Information Service (Free of charge)
o Referral to Medical Correspondents Abroad (Free of charge)
o Long Distance Medical Advice (Free of charge)
o Delivery of Urgent Messages (Free of charge)
o Evacuation & Repatriation (Up to USD 50,000)
o Repatriation of Mortal Remains (Up to USD 50,000)
o Medical Expenses and Hospitalization Abroad (Up to USD 50,000)
o Transportation to Join Member (Round Trip Ticket)
o Return of Dependent Children (One-Way ticket)

Terms and Conditions of coverage

o CMSM shall cover only reasonable medical emergency expenses as well as resulting hospitalization costs, up to the limit of USD 50,000, per person per claim according to the minimal and standard conditions of hospitalization of the country where adherent/beneficiary is being treated.
o CMSM shall cover emergency expenses following an accident or sudden illness (as defined above) as well as resulting hospitalization costs.

Documents required in accordance with the Assistance Company’s agreement to covering the occurred
accident or sudden illness, ‎adherent/beneficiary must submit the original copies of the
following supporting documents:

  • Accidents official Police Report.
  • Passports copy and entry visa (if any).
  • Complete medical file prepared by the doctor who witnessed the accident, or by the hospital where the treatment was performed.
  • Prescriptions.
  • Medical and hospital.
Clergy Medical Plan

CMSM offers a specific medical plan for the Clergy in Lebanon that includes benefits such as:

  • In Hospital for any medical case that requires hospitalization.
  • Ambulatory for all laboratory, radiology tests as well as
    physiotherapy sessions.
  • Prescription Medicines for chronic medicines and acute
    treatments over the year (optional).

Enrolment to this Clergy Medical Plan cannot be considered final without prior
approval from CMSM based on the underwriting process results.

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