Healthcare Schedule of Benefits

Officers and their Dependents

Comprehensive Insurance for Your Employees and Families

General Conditions of Insurance

(Status date: 01.01.2023, Version 1)
 SCHEDULE OF BENEFITS

To be read in conjunction with the Policy Wording. In the event of any differences between this Schedule and
the Policy Wording – the Schedule shall take priority over the wording.

Members
Coverage: Country of Residence Medical Expenses

Geographical Limits: Country of Residence only as shown in the Schedule of

Members and extended to worldwide holiday vacation travel as
set out below.

Category of Members as set out below:

Membership Level

Existing and New Members Immediately upon registration

In-patient Out-patient
Sea time in PIL Rank coverage coverage
annual limit annual limit
Officers $ 15,000 $ 1,000
2 years <= Sea time < 5 years
Ratings and Cadets $ 10,000 $ 500
Officers $ 20,000 $ 1,500
5 years <= Sea time < 10 years
Ratings $ 15,000 $ 1,000
Officers $ 30,000 $ 2,000
Sea time >=10 years
Ratings $ 25,000 $ 1,500

Deductible(s): Outpatient care 20% Outpatient Co-Pay as set out below,

Age Eligibility
Members from 18 to under 71 years old
Spouses from 18 (or local legal age) to under 71 years old
Dependent children from 30 days and under 19 years old
can be covered.

Medical Expenses maximum limit per policy period Up to USD 32,000 per Member
Medical Expenses incurred in the 12 months from the first onset of the medical condition covered by this policy
or until the expiry of this Employer’s benefit plan where all benefits will then cease.

Lifetime limit USD 64,000 per Member

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 Your Data Protection privacy notice

This Privacy Notice describes how AXA XL Underwriting Agencies Limited (together, “we”, “us” or the “Insurer”) collect and use the
personal information of insureds, claimants and other parties (“you”) when we are providing our insurance and reinsurance services.
The information provided to the insurer, together with medical and any other information obtained from you or from other parties about
you in connection with this policy, will be used by the insurer for the purposes of determining your application, the operation of
insurance (which includes the process of underwriting, administration, claims management, analytics relevant to insurance,
rehabilitation and customer concerns handling) and fraud prevention and detection. We may be required by law to collect certain
personal information about you, or as a consequence of any contractual relationship we have with you. Failure to provide this
information may prevent or delay the fulfilment of these obligations.
Information will be shared by the insurer for these purposes with group companies and third party insurers, reinsurers, insurance
intermediaries and service providers. Such parties may become data controllers in respect of your personal information. Because we
operate as part of a global business, we may transfer your personal information outside the United Kingdom and/or European
Economic Area for these purposes.
You have certain rights regarding your personal information, subject to local law. These include the rights to request access,
rectification, erasure, restriction, objection and receipt of your personal information in a usable electronic format and to transmit it to a
third party (right to portability).
If you have questions or concerns regarding the way in which your personal information has been used, please contact:
[email protected].
We are committed to working with you to obtain a fair resolution of any complaint or concern about privacy. If, however, you believe
that we have not been able to assist with your complaint or concern, you have the right to make a complaint to the relevant Data
Protection Authority.
For more information about how we process your personal information, please see our full privacy notice at: https://axaxl.com/privacy-
and-cookies.

For Compass Underwriting Limited privacy policy please see their full privacy notice at https://compassuw.co.uk/privacy-policy.

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 OFFICERS

BENEFITS Applicable to each Member. For each

benefit it will either state the sum insured
or “Covered’. If there is no cover it will
state “Not covered”

I. HOSPITALISATION/INPATIENT For all membership levels with eligibility and

limits as set out under Membership Level
Hospitalisation / Inpatient section:
Room and Board according to type of enrolment Covered – Semi Private Room (flexible –
common sense interpretation)

Services of Physician, Surgeon and Specialist, Inpatient treatment, Covered

Inpatient Medications, Diagnostic Procedures, Intensive Care
Treatment

STANDARD:
Cover for complications arising from pregnancy, to include pre-existing
medical conditions for dependents. Covered

All forms of mental health conditions Not covered

Normal pregnancy or maternity conditions Not covered

II. OUTPATIENT BENEFIT

Standard as set out under Membership
Outpatient Level:

Consultation including specialists evaluation Up to USD2,000 combined per

First aid treatment of injury person per policy period with
20% Co-Pay
Treatment for minor injuries such as lacerations, mild burns, sprain and
strain fractures

Laboratory examinations and all other diagnostic procedures required All sections included.
Outpatient Medication

Minor surgery not requiring confinement Nursing Care - up to six months .

Ill. EMERGENCY BENEFIT

20% Co-Pay for all membership levels:
Emergency care services

Emergency Care in Areas where there are No accredited specialists at Covered

the accredited hospital

Emergency Care in Areas where there are No accredited hospital, 100% Covered
coverage

Emergency care services in Non-accredited hospitals Covered

Unavailability of Room during emergency confinement when room Covered for board difference and
category is not available incremental cost of upgrade to
next available room category.
Ambulance conduction (surface) Covered
Emergency care services in medical facilities in foreign territories while on
Covered
official business for the Policyholder

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 OFFICERS

BENEFITS Applicable to each Member. For each

benefit it will either state the sum insured
or “Covered’. If there is no cover it will
state “Not covered”

Up to USD2,000 combined per person per

IV. SPECIAL MODALITIES OF TREATMENTS policy period with 20% Co-Pay for out-patient
care only. Limits as set out under Membership
levels.

Percutaneous Adrenalectomy, Laparoscopic procedures, Heart Surgery, Covered

Angioplasty

New Diagnostic Procedures Covered

Speech Therapy Covered

Dialysis Covered

Chemotherapy Covered

Radiotherapy Covered

Physical Therapy Covered

All sophisticated diagnostic modalities or methods of treatment for Covered

which there are no comparable conventional or traditional equivalent or
counterparts.

V. OTHER FEATURES Covered – with 20% Co-Pay for outpatient

care only.

Congenital illnesses
Covered
Vaccines

Anti-tetanus Covered

Anti-rabies, anti-venom vaccines Covered

Work related illnesses/injuries Not covered

Dental Benefits
Not covered

Mental disorders
Not covered
Congenital birth defects
Not covered
Vision
Not covered

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 Holiday vacation cover including
whilst traveling with spouse and/or
dependents.
Covered
Holiday vacation cover is extended
to include spouse &/or
dependent(s) whilst travelling
onboard an insured’s vessel with
the seafarer member &/or to or Covered
from the seafarer member’s
contractual vessel.

Business travel for the Senior

Officers (excluding spouse and/or
dependents) whilst attending
officially sanctioned and approved Covered
seminars and/or training events
(excluding those conducted on
board a vessel).

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 CREW

BENEFITS Applicable to each Member. For each

benefit it will either state the sum insured
or “Covered’. If there is no cover it will
state “Not covered”

For all membership levels with eligibility and

I. HOSPITALISATION/INPATIENT limits as set out under Membership Level
Hospitalisation / Inpatient section:

Room and Board according to type of enrolment

Covered – Semi Private Room (flexible –
common sense interpretation)
Services of Physician, Surgeon and Specialist, Inpatient treatment,
Inpatient Medications, Diagnostic Procedures, Intensive Care
Covered
Treatment

Cover for complications arising from pregnancy, to include pre-existing

STANDARD:
medical conditions for dependents
Covered
All forms of mental health conditions
Not Covered
Normal pregnancy or maternity conditions
Not Covered

II. OUTPATIENT BENEFIT

STANDARD:
Outpatient
Up to USD1,500 combined per
Consultation including specialists evaluation
person policy period with 20%
First aid treatment of injury Co-Pay

Treatment for minor injuries such as lacerations, mild burns, sprain and
strain fractures
All sections included.
Laboratory examinations and all other diagnostic procedures required

Outpatient Medication

Minor surgery not requiring confinement Nursing Care – up to six months

Ill. EMERGENCY BENEFIT 20% Co-Pay for all membership levels:

Emergency care services Covered

Emergency Care in Areas where there are No accredited specialists at

the accredited hospital Covered

Emergency Care in Areas where there are No accredited hospital, 100%

coverage Covered

Emergency care services in Non-accredited hospitals

Covered
Ambulance conduction (surface)
Covered for board difference and
Unavailability of Room during incremental cost of upgrade to
emergency confinement when next available room category.
room category is not available
Covered
Emergency care services in medical facilities in foreign territories while on
official business for the Policyholder

7
 CREW

BENEFITS Applicable to each Member. For each

benefit it will either state the sum insured
or “Covered’. If there is no cover it will
state “Not covered”

Up to USD1,500 combined per person per

IV. SPECIAL MODALITIES OF TREATMENTS policy period with 20% Co-Pay for out-patient
care only. Limits as set out under Membership
levels..

Percutaneous Adrenalectomy, Laparoscopic procedures, Heart Surgery, Covered

Angioplasty

New Diagnostic Procedures Covered

Speech Therapy Covered

Dialysis Covered

Chemotherapy Covered

Radiotherapy Covered

Physical Therapy Covered

All sophisticated diagnostic modalities or methods of treatment for

Covered
which there are no comparable conventional of traditional equivalent or
counterparts.

V. OTHER FEATURES Covered –with a 20% Co-Pay for outpatient

care only.

Congenital illnesses

Vaccines
Covered
Anti-tetanus
Covered
Anti-rabies, anti-venom vaccines
Covered
Work related illnesses/injuries
Not covered

Dental Benefits Not covered

Mental disorders Not covered

Congenital birth defects

Not covered
Vision
Not covered

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 Holiday vacation cover including
whilst traveling with spouse and/or
dependents.
Covered
Holiday vacation cover is extended
to include spouse &/or
dependent(s) whilst travelling
onboard a insured’s vessel with the
seafarer member &/or to or from Covered
the seafarer member’s contractual
vessel.

Business travel for the Junior

Officers (excluding spouse and/or
dependents) whilst attending
officially sanctioned and approved Covered
seminars and/or training events
(excluding those conducted on
board a vessel).

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 Website: www.crewsure.com
Email: [email protected]
Telephone: +44 (0) 20 7264 1377

(Status date: 01.1.2023, Version 1.00)

Crewsure Insurance Services (Europe), 112 Jermyn St, St James, London, SW1Y 6LS. We may monitor or record calls for security and to improve our
service. Crewsure Insurance Services (Europe) and Compass Underwriting (Europe) are registered trading names of Security Trust Scandinavia AB
which is registered at Strandvägen 61, 135 62 Tyresö and the London Branch trades from 30 Dukes Place, London EC3A 7LP. Security Trust Scandinavia AB
is authorised and regulated by the Swedish Finansinspektionen under FI identification number 82568 and the London branch is authorised by the
UK’s Financial Conduct Authority under firm registration number 848689.