 |
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
| |
|
|
888-720-8889 PHONE
888-720-7261 FAX
EMAIL
|
| |
| |
| |
| |
| |
|
| |
| |
| |
|
|
This
Plan is not available in AK, CT, ID, MN, MA, ME, MT,ND, NH, NY, RI, SD, VT, WA,WY. If you are in these states,
please go back
to choose a state again.
|
Benefits
Medical Option
|
Silver
- $63.00 Employee Only
- $124.24 Employee+1
- $169.32 Employee+Family
|
Platinum
- $132.04 Employee Only
- $245.43 Employee+1
- $328.33 Employee+Family
|
| Doctor
or Emergency Room Benefit
|
Member
receives $50 per doctor's office visit. $300 maximum benefit
per person per calendar year. |
Member
receives $75 per doctor's office visit. $450 maximum benefit
per person per calendar year. |
| Hospital
|
$400
p/day for hospital confinement; $800 p/day for Intensive Care;
$400 p/day for Substance Abuse; $200 p/day for Mental Illness. |
$1,000
p/day for hospital confinement; $2,000 p/day for Intensive Care;
$1,000 p/day for Substance Abuse; $500 p/day for Mental Illness. |
| Accidental
Medical Benefit |
Member
receives $500 per accident for charges incurred within 90 days
of an accident. No copayment. |
Member
receives $1,000 per accident for charges incurred within 90
days of an accident. No copayment. |
| Outpatient
DXL |
Member
receives $50 per diagnostic x-ray and lab (DXL) test ordered
or performed by a Doctor; $300 maximum benefit per person per
calendar year. |
Member
receives $60 per diagnostic x-ray and lab (DXL) test ordered
or performed by a Doctor; $300 maximum benefit per person per
calendar year. |
| Surgical
Benefit |
Member
receives up to $800 for surgeries performed by a doctor, according
to surgical schedule. |
Member
receives up to $1,500 for a surgery, up tp $3,000 for a year. |
| Term
Life |
Member
receives $10,000; $5,000 for spouse; $2,500 for children. |
Member
receives $10,000; $5,000 for spouse; $2,500 for children. |
| Drug
Card |
N/A
|
$10
co-pay on Generic Formulary Drugs; Discount on Brand Name
Drugs; |
| Wellness
Care |
Member
receives $75 per visit for routine exams, medical treatment
and injections. $150 Calendar Year Maximum per person |
Member
receives $150 per visit for routine exams, medical treatment
and injections. $150 Calendar Year Maximum per person |
| Survivor
Benefit |
In the event of the employee's
death, his/her dependent's Hospital Indemnity benefits,
if applicable, may continue for up to two years , provided
the plan stays in force.
Sign Me Up
|
In the event of the employee's
death, his/her dependent's Hospital Indemnity benefits,
if applicable, may continue for up to two years , provided
the plan stays in force.
Sign Me Up
|
This plan has a pharmaceutical benefit that is available through K-Mart, Target and RiteAide, (and a list of other pharmacies is available) with discounts starting at 25% up to 60%. Vision services are available through Sears, J.C. Penny and Target.
Want to know more? Please read Case Histories
here.
|
|