What benefits are payable under this Cancer insurance plan? The following Level 1 benefits are available. The issued policy controls all benefit amounts.
Covered Services
Level 1 Benefits
Cancer Screening Includes the following tests or procedures for internal cancer for which you are charged: colonoscopy, CA 125 test, chest x-ray, flexible sigmoidoscopy, mammogram, pap smear, biopsy, PSA, CT scans or MRI scans, BRCA testing, or Hemocult stool specimen. This benefit is limited to once per benefit year. $50 Second Surgical Opinion This benefit is payable if you are diagnosed by a doctor with internal cancer requiring surgery and obtain a second surgical opinion. $200 Surgery and General Anesthesia This benefit is payable if you are diagnosed by a doctor with internal cancer requiring surgery. A separate benefit amount is paid for the surgery and for general anesthesia. Benefits vary based on the procedure performed. Combined maximum for any one surgery is $2,000 for Level 1. Surgery for skin cancer and reconstruction is not covered under this benefit. Hospital Confinement A daily benefit is payable for each day you are confined to a hospital for inpatient treatment for internal cancer. Limited to 90 days per period of hospital confinement. In-hospital Blood and Plasma Pays the amount shown for each day you receive blood and/or plasma due to internal cancer treatment while hospital confined. Outpatient Blood and Plasma Pays the amount shown for each day you receive outpatient blood and/or plasma transfusions in a doctor’s office, clinic, hospital, or ambulatory surgical center directly related to internal cancer treatment. Ambulance This benefit is payable for a licensed professional ambulance to transport you to a hospital for inpatient internal cancer treatment. Limited to 2 one-way trips per period of hospital confinement per covered person. In-hospital Doctor Visits Pays the amount shown for you each day you are visited by a doctor other than the operating surgeon while hospital confined for internal cancer treatment. Limited to a maximum of 75 visits. $250
Anesthesia - $50 to $1,815 Surgical - $150 to $5,500
$200 Daily
$50 Daily
$50 Daily
$25 Daily
36
Made with FlippingBook - Online magazine maker