Insurance Provider |
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Life Maximum
|
$20,000 |
Unlimited |
Major Medical
|
$20,000 per Accident or Sickness |
$50,000 per Sickness or Injury |
In Network
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|
90% |
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Deductible
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$0
|
$0 |
MAJOR MEDICAL SUPPLEMENT
$200
|
SICKNESS MEDICAL EXPENSE |
Hospital Miscellaneous Expenses: |
1) the cost of an operating room; 2) laboratory tests;
3) X-ray examinations; 4) anesthesia; 5) drugs or medicines
(excluding take home drugs); 6) therapeutic services;
7) pre-admission testing; etc. $600 Maximum
|
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Surgery |
$1,000 Maximum
|
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Physician¡¯s
Visits:
|
One visit per day when a surgery benefitis not paid, up to $40 Per Visit to an $800 Maximum
|
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Anesthetist Services: |
treatment prescribed by a legally qualified psychiatrist or clinical psychologist for mental disorders,
nervous disorders, alcoholism or drug addiction will be covered as any other Sickness/$1,000 Maximum
|
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INJURY MEDICAL EXPENSE |
the services of registered graduate nurse, X-ray service, use of operating room, anesthesia, laboratory service, surgical dressings, medications, physiotherapy, plaster casts, use of wheelchair, crutches, or ambulance, an Aggregate Maximumof $2,000 will be paid.
|
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Dental Injury: |
up to a maximum of
$1,000 per tooth |
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|
MAJOR MEDICAL SUPPLEMENT |
When benefits of at least $2,000 have been paid under the Base Plan, and after a $200 deductible per Sickness or Injury,the Company will pay 70% of the Usual and Customary medical expenses which exceed the benefits paid under the Base
Plan and which are incurred during the Benefit Period. A maximum of $20,000 for all benefits under both the Base Plan and this Major Medical Supplement will be allowed. Hospital room and board benefits are limited to the semi-private rate
|
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Premium
(Annual) |
Student:$948
Spouse:$1,706
Child(ren):$1,314
|
Student:$492
Spouse:$492
Child:$492 |