A SmartChoice Claim Example Featuring the Daily Surgical Benefits
Making a smart choice, this 52-year-old male purchased a Central Choice Premier Choice Plan (Defined Benefit coverage) along with Critical Choice (Critical Protection and Recovery). He has heart bypass surgery with a 7-day hospital confinement, three of those in the Intensive Care unit. He also owns an Accident policy.
Daily Room Benefit $500/day X 7 days hospital confinement
Central Choice Premier Choice Policy Design:
=
$3,500
Indemnity Rider first hospital confinement of any given year of $1,000 First Hospital Confinement Rider over first 6 days of “first hospital confinement” of the year Surgical Rider $3,000 per day of a continuous confinement in which one or more surgeries takes place, maximum of 5 days per confinement. Anesthesia $600/day for each day that a surgical benefit is paid.
=
$1,000
= $10,000
5 X $3,000 = $15,000
$600 X 5 days =
$3,000
Intensive Care $2,500 per day in ICU, up to 20 consecutive days.3 X $2,500 =
$7,500
TOTAL CENTRAL CHOICE PREMIER CHOICE BENEFITS PAID
$40,000
Critical Protection and Recovery Critical Illness Policy
First Occurrence Benefit
= $10,000
Monthly Income Benefit 10% of FOB above ( $1,000 ) X 12 months
= $12,000
Hospital Confinement Benefit $300 per day confined for treatment for a covered incident, X 7 = $2,100 (Could also include benefits for Transportation, Lodging, and Air or Ground Ambulance) Monthly Income Benefit 10% of FOB above ( $1,000 ) X 12 months = $12,000 TOTAL CPR BENEFITS PAID $24,100
PAID Accident Plan
No benefits payable for this condition TOTAL BENEFITS FOR PROCEDURE
= $64,100
*The examples shown are hypothetical and may vary depending on plan(s) selected.
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