|
Subcategory |
BeefitLimits (Applies to Subcategory) |
Benefit |
Low Plan |
High Plan |
|
Hospital Benefits |
||||
|
Admission Benefit |
4 time(s) per calendar year* |
Admission ICU Supplemental Admission (Benefit paid concurrently with the admission benefit when a Covered person is admitted to ICU) |
$500 |
$1,000 |
|
$500 |
$1,000 |
|||
|
Confinement Benefit |
15 days per calendar year ICU Supplemental Confinement will pay an additional benefit for 15 of those days |
Confinement* ICU Supplemental Confinement (Benefit paid concurrently with the admission benefit when a Covered person is admitted to ICU) |
$100 |
$100 |
|
$65 |
$65 |
- No Limitation on Pre Existing conditions
- Benefit Paid Directly- No Coordination of Benefits
- Pregnancy is Covered, NO WAITING PERIOD
- Treatment for Drugs and Alcohol or the result of are NOT COVERED
- Benefit Reduction by 25% at age 65-69, 50% at age 70 or older
Proposed Rates - Low Plan
|
Type |
Monthly |
|
Employee Only |
$5.06 |
|
Employee + Spouse |
$11.06 |
|
Employee+ Children |
$8.44 |
|
Employee + Spouse & Children |
$14.42 |
Proposed Rates - High Plan
|
Type |
Monthly |
|
Employee Only |
$8.35 |
|
Employee + Spouse |
$18.27 |
|
Employee+ Children |
$13.61 |
|
Employee + Spouse & Children |
$23.53 |