Advantage Plan 2
Ambulance
$300
Knee Brace
$100 $100 $500 $300
Hospital Admission Emergency Room Visit
$1,000 X-Ray
$200 $225
Knee Cartilage Tear 6 Follow-Up Visits
Accident Insurance Rates Employee
Hospital Confinement (1 Day) Medical Resonance Imaging (MRI)
$200 Total cash benefit paid for covered services: $2,925
$26.10 $34.90 $41.00 $49.80
Employee & Spouse Employee & Child
Family
2020-98283 (04/22)
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