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PLAN LIMIT:$1,000,000 (or stated limit below)
ANNUAL PLAN DEDUCTIBLE: $25,000 (*)
CATASROPHIC PLAN OVERVIEW (Once annual deductible is satisfied):
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COVERAGE YEAR MAXIMUM
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PHYSICIAN OFFICE VISIT BENEFIT
(Covered at 100% after deductible has
been met PPO provider) |
$1,000,000
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INITIAL HOSPITAL BENEFIT
(Covered at 100% after deductible has
been met PPO provider) |
$1,000,000
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IN-HOSPITAL INDEMNITY BENEFIT
(Covered at 100% after deductible has
been met PPO provider) |
$1,000,000
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SURGERY BENEFIT
(Covered at 100% after deductible has
been met PPO provider) |
$1,000,000
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DIAGNOSTIC, X-RAY & LAB INDEMNITY BENEFIT
(Covered at 100% after deductible has
been met PPO provider) |
$1,000,000
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PRESCRIPTION DRUG INDEMNITY BENEFIT
(Covered at 100% after deductible has
been met ) |
$5,000
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ANESTHESIA INDEMNITY BENEFIT
(Covered at 100% after deductible has
been met PPO provider) |
$1,000,000
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X-RAY, LAB & ROUTINE TESTING BENEFIT
(Covered at 100% after deductible has
been met PPO provider) |
$1,000,000
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MENTAL & NERVOUS BENEFIT
(Covered at 100% after deductible has
been met PPO provider) |
$25,000
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HOME HEALTHCARE BENEFIT
(Skilled Nursing)
(Private duty skilled nursing - $400/day maximum) |
$25,000 - lifetime maximum
$25,000 - lifetime maximum
$25,000 - lifetime maximum |
ESTIMATED PREMIUMS
(Estimated as of 4-1-06) |
IC ONLY $100.00 / month
IC + ONE $150.00 / month
FAMILY $200.00 / month |
Pre-existing conditions: Will apply to all covered ICs, subject to HIPPA limitations. There is no coverage for a pre-existing condition. This limitation will not apply after a covered person has been insured under this plan for a continuous period of 12 months during which the covered person:
1) Incurs no medical expense in connection with a pre-existing condition.
2) Receives no diagnosis, treatment or advice in connection with the pre-existing condition.
3) Does not consult a doctor in connection with a pre-existing condition. Please consult with one of our benefit counselors for more clarification.
(*) Plan deductible is an aggregate of claims during the policy year. Deductible is calculated on a claims incurred basis. All claims insured thought he limited health plan DO go towards the policy deductible.
(*) Benefits are paid at 100% if you choose an in-network provider from Beech Street and 80% for an out-of-network provider
HOW TO ENROLL:
You can enroll by contacting our Benefit Service Center and speaking with one of our benefit counselors. They will be happy to assist you with any questions you may have about these benefit plans and enroll you in the plan that best suits your needs. Please consult the Benefit Counselor for actual monthly premiums.
TOLL-FREE TELEPHONE NUMBER: 800-559-9846
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