Our plan provides the following included benefits.
INPATIENT/OUTPATIENT HOSPITAL INDEMNITY BENEFITS
Benefits are determined by the employer based on the employer’s major medical plan. Available coverage amounts for the employer to select from are: $250, $500, $750, $1,000, $1,250, $1,500, $1,750, $2,000, $2,250, $2,500, $2,750, $3,000, $3,250, $3,500, $3,750, $4,000, $4,250, $4,500, $4,750, $5,000, $5,250, $5,500, $5,750,$6,000, $6,250, $6,500, $7,000, $7,500, $8,000, $8,500, $9,000, $9,500, $10,000, $10,500, $11,000, $11,500, $12,000, $12,500, $13,000, $13,500, $14,000, $14,500, $15,000. We will pay benefits for Covered Charges if a Covered Person: • incurs the Covered Charges while the Covered Person is an Inpatient or outpatient due to an Injury or Sickness; and • the expenses are covered by the Covered Person’s Medical Plan
Pays a benefit for covered charges if a covered person incurs the Covered Charges while the Covered Person is an Inpatient for Injury or Sickness or for Outpatient Treatment due to an Injury or Sickness; and the expenses are covered by the Covered Person’s Medical Plan. This benefit does not include: expenses incurred for an examination of a Covered Person by a Doctor in a Doctor’s Office; expenses incurred for Outpatient Prescription Drugs; or transportation of a Covered Person via air or ground Ambulance. Deductible for inpatient/outpatient is available. Deductible is not available for all amounts, so check with your sales representative if choosing this benefit.
Benefit bucket may be used for Inpatient, Outpatient, or a combination of both.
OUTPATIENT PRESCRIPTIONS DRUGS
Plan Year Maximum Per Covered Person: $100 - $500 in $100 Increments
AMBULANCE BENEFITS
Ground Ambulance Benefit: $150 - $1,000 per day, $150 Increments to $900 and $1,000 Air Ambulance Benefit: 2X the benefit chosen for ground ambulance Plan Year Maximum: 4 transports
DOCTOR’S OFFICE VISIT
Doctor’s Office Visit Benefit: $25-$100 per visit, $25 increments Plan Year Maximum: 4 visits
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