|
Benefit |
300 |
500 |
1000 |
2000 |
|
Physician
Office Visit:
The Carrier will pay the
Benefit Amount as shown if you seek treatment for a covered
illness or injury. |
When a Doctor Visit is
Medically Necessary due to an Injury or Sickness coverage is
provided up to $30 per visit, 5 visits Maximum per
Individual, 10 visits Maximum per Family, per Policy Year.
In lieu of the $30 daily indemnity maximum, visits to
your Provider Network1 would only require a
$20 co-pay per visit. This benefit is not subject to a
waiting period for pre-existing conditions. |
|
Wellness Exam:
Wellness includes health
appraisals, including doctor examinations and related tests,
routine annual physical examinations conducted by or under
the direction of a doctor, without regard to medical
necessity, in order to detect disease, disability, or other
physical or mental conditions. |
This benefit is payable for a
routine doctor visit for other than treatment of an Injury
or Sickness, up to $30 for a visit, 1 visit Maximum
per person per Policy Year. In lieu of the $30 daily
indemnity maximum, a visit to your Provider Network1
would only require a $20 co-pay.
This benefit is not subject to a waiting period for
pre-existing conditions |
|
Hospitalization
To Lookup a Provider
Click Here |
|
Daily Hospital Confinement:
This benefit is payable for up
to 31 days when a Covered Person is admitted to a hospital
(semi-private room) due to a covered Injury or Sickness |
$300 per day
Maximum of 31
days per year |
$500 per day
Maximum of 31
days per year |
$1,000 per day
Maximum of 31
days per year |
$2,000 per day
Maximum of 31
days per year |
|
ICU/CCU:
This benefit is payable for
2-31 days, when as the result of a Covered Injury or
Sickness, a Covered Person is confined to a Hospital ICU or
CCU unit. This benefit is in lieu of the Daily Hospital
Confinement Benefit |
$1,000 2-31 day |
$1,500 2-31 days |
$2,000
2-31 days |
$2,000
2-31 days |
|
Surgery (Inpatient/Otpatient):
Covered Expenses due to an
Injury or Sickness are payable at a % of the Medicare
Allowance, per covered surgery |
80% |
80% |
100% |
100% |
|
Anesthesia Benefit:
When surgery is performed,
which is the result of a covered Injury or Sickness, a
benefit for Anesthesia is payable at 25% of the Surgery
Benefit |
25%
Up to $250 |
25%
Up to $375 |
25%
Up to $500 |
25% |
|
Emergency Room:
When Medically
Necessary treatment by a Doctor in a Hospital Emergency Room
for a Medical Emergency due to an Injury or Sickness, is
required, coverage is provided for treatment up to $50 per
Policy Year, 1 visit Maximum per covered person |
$50 |
$75 |
$100 |
$100 |
|
Physical Therapy:
When as the
result of a Covered Injury or Sickness, a Doctor certifies
that a Covered Person requires Physical Therapy. Maximum of
10 visits per person per Policy Year |
$25 |
$25 |
$25 |
$25 |
|
Ambulance Benefit:
When as the result of a Covered
Injury or Sickness, a Covered Person requires the services
of a licensed professional ambulance company for
transportation to or from a Hospital. For Medical
Emergencies only. Maximum of one trip per Policy Year |
$100 |
$200 |
$300 |
$300 |
|
Hospice benefit:
This benefit is payable, when a
Doctor certifies that as the result of a Covered Injury or
Sickness, the Covered Persons life expectancy is not more
than 6 months. Maximum of 20 days per Policy Year. |
$100 per day
Maximum of 20 days per Policy Year |
$100 per day
Maximum of 20 days per Policy Year |
$100 per day
Maximum of 20 days per Policy Year |
$100 per day
Maximum of 20 days per Policy Year |
Accident Coverage:
One accident covered per person per policy year. Costs must
be incurred within 30 days of accident or injury. Maximum
one occurrence per policy year |
up to
$2,500 per year / $200 Deductible |
up to
$2,500 per year / $200 Deductible |
up to
$5,000 per year / $100 Deductible |
up to$5,000 per year / $100
Deductible |
|
Critical Illness Included:
The Carrier will pay up to the Benefit Amount if you are
first diagnosed with a covered critical illness |
up to $2,500
primary insured |
up to $5,000
primary insured |
up to $10,000
primary insured |
up to $5,000 for
primary & spouse |
|
Dental Benefit1:
Members enjoy
the savings and predictability of a dental program that provides preventive and
restorative care on a monthly, capitated basis. There's no paperwork, no maximum
or deductible, and no co-payment for diagnostic and preventive services. |
Included in FL |
Included in FL |
Included in FL |
Included in FL |
|
Surgical Trip - Your International Healthcare Network: |
The Surgical Trip network provides you with world class
hospitals, clinics and expert surgeons who offer affordable
“fixed” prices, typically 40% to 90% less than in the US.
Now, you can have peace of mind knowing that you can receive
top quality care for major surgeries including: Orthopedic,
Heart and General Surgeries at affordable prices. Procedures
are performed in internationally accredited hospitals that
include Board Certified Surgeons |
|
Non-Insured Benefits |
|
Diagnostic Benefit Management
and Scheduling Service: |
Members receive access to a
nationwide network of radiology facilities and low pricing
for any MRI, CT Scan or P.E.T. Scan you may need. All you
have to do is call our 800 number and our concierge staff
will schedule the procedure in a facility that is convenient
for you, help you to prepare for your procedure, provide
directions to the facility, co-ordinate with your physician
and place a reminder call to you the night before your test |
|
Retrospective Bill Review
Service: |
For medical bills in excess of
$3000.00, a retrospective review of medical bills is
available to help reduce those bills. The service also
provides for a Second Opinion for diagnostic films and age
of injury reports |
|
Rx Savings Card |
With the Rx Savings Card
members receive discounts on prescriptions through
participating pharmacies. |
|
Optional Riders at
Additional Cost |
|
Critical Illness |
From
$5,000
to $25,000 |
From
$10,000
to $25,000 |
From $15,000
to $25,000 |
From
$10,000
to $25,000 |
|
Accident |
$5,000 |
$5,000 |
$5,000 |
$5,000 |
Max