Two options: worldwide or worldwide excluding the U.S. and Canada

Two options: worldwide or worldwide excluding the U.S. and Canada

Two options: worldwide or worldwide excluding the U.S. and Canada

Ranges from $250 to $10,000 per period of coverage, 50% reduction within PPO

Ranges from $250 to $10,000 per period of coverage, 50% reduction within PPO, Carry forward deductible - last 30 days of certificate year

Ranges from $100 to $10,000 per period of coverage, 50% reduction within PPO, Carry forward deductible - last 30 days of certificate year

3x the single

3x the single

2x the single

80% of the next $5,000 of eligible expenses after the deductible, then 100% to the overall maximum per period of coverage

80% of the next $5,000 of eligible expenses after the deductible, then 100% to the overall maximum per period of coverage

90% of the next $5,000 of eligible expenses after the deductible, then 100% to the overall maximum per period of coverage

100%

100%

100%

$600 per day
(maximum of 240 consecutive days per covered event)

Average semi-private room rate

Private room rate

$1,500 per day
(maximum of 180 consecutive days per covered event)

Usual, Reasonable and Customary (URC)

Usual, Reasonable and Customary (URC)

URC

URC

URC

20% of surgery benefit

URC

URC

$250,000
per transplant

$1,000,000
lifetime maximum

$2,000,000
lifetime maximum

Visits/Exams - 25 visits per insured person per period of coverage to the maximum limit as outlined: physician $70; specialist $70; psychiatrist $60; chiropractor $50; surgical intervention consultation $500; X-rays - $250 per exam maximum limit; Lab Tests - $300 per exam maximum limit

URC

URC

URC

URC

URC

URC
subject to an additional $250 deductible if not admitted

URC
subject to an additional $250 deductible if not admitted

URC
subject to an additional $250 deductible if not admitted

URC

URC

URC

$1,500 per covered event
not subject to deductible or coinsurance

URC

URC

$50,000 per period of coverage
not subject to deductible or coinsurance

Limited to policy maximum
not subject to deductible or coinsurance

Limited to policy maximum
not subject to deductible or coinsurance

NA
(Not Applicable)

$10,000
lifetime maximum

$10,000
lifetime maximum

$25,000 lifetime maximum per insured
not subject to deductible or coinsurance

$25,000 lifetime maximum per insured
not subject to deductible or coinsurance

$50,000 lifetime maximum per insured
not subject to deductible or coinsurance

Optional Rider - $50,000 lifetime maximum, maximum of $5,000 for normal delivery, $7,500 for C-section, $200 child wellness benefit for first 12 months - not subject to deductible or coinsurance. Available after 10 months of coverage benefits reduced by 50% for births that occur in11th or 12th month of continuous coverage

Optional Rider - $50,000 lifetime maximum, maximum of $5,000 for normal delivery, $7,500 for C-section, $200 child wellness benefit for first 12 months - not subject to deductible or coinsurance. Available after 10 months of coverage benefits reduced by 50% for births that occur in11th or 12th month of continuous coverage

Same As Any Illness (SAAI)
$1,000 additional deductible, $50,000 lifetime maximum, $200 child wellness benefit for first 12 months.
Available after 10 months of coverage

NA

$300 per occurrence
not subject to deductible or coinsurance

$500 per occurrence
not subject to deductible or coinsurance

Outpatient only - (see Outpatient) Available after 12 months of continuous coverage

$10,000 per period of coverage
up to a $50,000 lifetime maximum. Available after 12 months of continuous coverage

SAAI
$50,000 lifetime maximum. Available after 12 months of continuous coverage

NA

$250 per period of coverage
not subject to deductible or coinsurance Available for those 30 years of age and over after 12 months of continuous coverage

$500 per period of coverage
not subject to deductible or coinsurance Available for those 18 years of age and over after 12 months of continuous coverage

Three visits per period of coverage
maximum $70 per visit. Available for children under 18 years of age after 12 months of continuous coverage

$200 maximum per period of coverage
not subject to deductible or coinsurance Available for children under 18 years of age after 12 months of continuous coverage

$400 maximum per period of coverage
not subject to deductible or coinsurance Available for children under 18 years of age after 12 months of continuous coverage

Extended Care - limited to first 30 days of confinement
Radiation Treatment - URC
Home Nursing Care - limited 30 days per covered event
Hospice Care - limited 30 days per covered event
Prosthetic Devices - all URC

URC

URC

Maximum $40 per visit 30 visit maximum per period of coverage

Maximum $50 per visit

Maximum $50 per visit

NA

NA

Up to $5,000 maximum

NA

URC

URC

NA

NA

Limited to $5,000 per certificate period up to a $20,000 lifetime maximum

NA

NA

Limited to $10,000 lifetime maximum

NA

Acupuncture $150
Aroma Therapy $50
Herbal Therapy $50
Magnetic Therapy $75
Massage Therapy $150
Vitamin Therapy $100
Each per period of coverage

Acupuncture $150
Aroma Therapy $50
Herbal Therapy $50
Magnetic Therapy $75
Massage Therapy $150
Vitamin Therapy $100
Each per period of coverage

NA

NA

Calendar year maximum - $750
Individual deductible - $50
Schedule of benefits -
Class I: 90% Class II: 70%
Class III: 50% Ortho 0%
(6 month waiting period)

$1,000 per period of coverage

URC

URC

NA

$100 per period of coverage

See non-emergency dental benefits

NA

NA

Exams - up to $100 per 24 months
Materials - up to $150 per 24 months

NA

NA

Included

$5,000 per period of coverage up to a $50,000 lifetime maximum. Available after 24 months of continuous coverage

$5,000 per period of coverage up to a $50,000 lifetime maximum. Available after 24 months of continuous coverage

SAAI