Cancer – KBS (Kansas Board Solutions)
BENEFITS (continued)
Value Plan
Advantage Plan $25/Treatment up to 12 treatments per year
Premier Plan
$25/Treatment up to 12 treatments per year
$50/Treatment up to 12 treatments per year
Hormone Therapy
$50/day up to 100 days/lifetime
$50/day up to 100 days/lifetime
$100/day up to 100 days/lifetime
Hospice
$300/day for first 30 days; $600/day for 31 st day thereafter per confinement $400/day for first 30 days; $600/day for 31 st day thereafter per confinement
$300/day for first 30 days; $600/day for 31 st day thereafter per confinement $400/day for first 30 days; $600/day for 31 st day thereafter per confinement
$400/day for first 30 days; $800/day for 31 st day thereafter per confinement $600/day for first 30 days; $800/day for 31 st day thereafter per confinement
Hospital Confinement
ICU Confinement
$500 per month $2500 lifetime max
$500 per month $2500 lifetime max
$500 per month $2500 lifetime max
Immunotherapy
No Benefit
$100/day up to 30 days per year $100/image up to 2 per year
$150/day up to 30 days per year
Inpatient Special Nursing
Medical Imaging
No Benefit
$200/image up to 2 per year
Outpatient or Ambulatory Surgical Center
No Benefit
$250/day, 3 days per procedure $350/day, 3 days per procedure
Outpatient and Family Member Lodging
No Benefit No Benefit
$75/day, up to 90 days per year $100/day, up to 90 days per year
$25/visit up to 4 visits per month, $400 lifetime max Surgically Implanted: $2,000/device, $4,000 lifetime max Non-Surgically; $200/device, $400 lifetime max Actual Costs up to a $20,000 benefit year maximum Breast TRAM Flap $2,000 Breast reconstruction $500 Breast Symmetry $250 Facial reconstruction $500
$50/visit up to 4 visits per month, $1,000 lifetime max Surgically Implanted: $3,000/device, $6,000 lifetime max Non-Surgically; $300/device, $600 lifetime max Actual Costs up to a $25,000 benefit year maximum Breast TRAM Flap $3,000 Breast reconstruction $700 Breast Symmetry $350 Facial reconstruction $700 $1,500 egg harvesting, $500 egg or sperm storage, $2,000 lifetime max
Physical or Speech Therapy
Surgically Implanted: $2,000/device, $4,000 lifetime max Non-Surgically; $200/device, $400 lifetime max Actual Costs up to a $15,000 benefit year maximum
Prosthetic
Radiation Therapy Chemotherapy and Immunotherapy
No Benefit
Reconstructive Surgery
No Benefit
No Benefit
Reproductive Benefit
Second Surgical Opinion
$200/surgical procedure
$200/surgical procedure
$300/surgical procedure
Biopsy Only: $100 Reconstructive Surgery: $250 Excision of a skin cancer: $375 Excision of a skin cancer with flap or graft: $600
Biopsy Only: $100 Reconstructive Surgery: $250 Excision of a skin cancer: $375 Excision of a skin cancer with flap or graft: $600 Schedule amount up to $4,125 $0.50/mile up to $1,000 per round trip/equal benefit for companion
Biopsy Only: $100 Reconstructive Surgery: $250 Excision of a skin cancer: $375 Excision of a skin cancer with flap or graft: $600 Schedule amount up to $5,500 $0.50/mile up to $1,500 per round trip/equal benefit for companion
Skin Cancer
Surgical Benefit
Schedule amount up to $2,750
No Benefit
Transportation/Companion Transportation
Waiver of Premium
Included
Included
Included
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