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» Brochure
» Reviews
» Compare Plans
|
» Brochure
» Reviews
» Compare Plans
|
» Brochure
» Reviews
» Compare Plans
|
» Brochure
» Reviews
» Compare Plans
|
» Brochure
» Reviews
» Compare Plans
|
» Brochure
» Reviews
» Compare Plans
|
» Brochure
» Reviews
» Compare Plans
|
Inpatient |
Hospital Room & Board |
Up to $910/day, 30 day max |
Up to $1,260/day, 30 day max |
Up to $1,565/day, 30 day max |
Up to $1,725/day, 30 day max |
Up to $2,340/day, 30 day max |
Up to $870/day, 30 day max |
Up to $1,260/day, 30 day max |
Up to $2,050/day, 30 day max |
Hospital Intensive Care Unit |
Additional $430/day, 8 day max |
Additional $595/day, 8 day max |
Additional $720/day, 8 day max |
Additional $790/day, 8 day max |
Additional $1,020/day, 8 day max |
Additional $380/day, 8 day max |
Additional $550/day, 8 day max |
Additional $900/day, 8 day max |
Surgery |
Up to $2,150 |
Up to $2,970 |
Up to $3,960 |
Up to $4,840 |
Up to $6,600 |
Up to $2,285 |
Up to $3,300 |
Up to $5,365 |
Anesthetist |
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Up to $570 |
Up to $825 |
Up to $1,340 |
Assistant Surgeon |
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Up to $570 |
Up to $825 |
Up to $1,340 |
Physician’s Non-Surgical Visits |
Up to $40/visit, 1/day, 30 visits max |
Up to $60/visit, 1/day, 30 visits max |
Up to $65/visit, 1/day, 30 visits max |
Up to $75/visit, 1/day, 30 visits max |
Up to $100/visit, 1/day, 30 visits max |
Up to $45/visit, 1/day, 30 visits max |
Up to $65/visit, 1/day, 30 visits max |
Up to $100/visit, 1/day, 30 visits max |
Private Duty Nurse |
Up to $400 |
Up to $495 |
Up to $550 |
Up to $550 |
Up to $660 |
Up to $375 |
Up to $450 |
Up to $880 |
A Consulting Physician, when requested by attending Physician |
Up to $350 |
Up to $405 |
Up to $465 |
Up to $485 |
Up to $600 |
Up to $330 |
Up to $480 |
Up to $780 |
Pre-Admission Tests within 7 days before Hospital admission |
Up to $750 |
Up to $990 |
Up to $1,100 |
Up to $1,100 |
Up to $1,100 |
Up to $775 |
Up to $775 |
Up to $1,500 |
Outpatient |
Anesthetist |
Up to $500 |
Up to $740 |
Up to $990 |
Up to $1,210 |
Up to $1,650 |
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Surgical Treatment |
Up to $2,150 |
Up to $2,970 |
Up to $3,960 |
Up to $4,840 |
Up to $6,600 |
Up to $2,285 |
Up to $3,300 |
Up to $5,365 |
Prescription Drugs |
Up to $150 Per Coverage Period |
Up to $250 Per Coverage Period |
Up to $125 Per Coverage Period |
Up to $135 Per Coverage Period |
Up to $180 Per Coverage Period |
Up to $250 Per Coverage Period |
Up to $250 Per Coverage Period |
Up to $250 Per Coverage Period |
Physician’s Non-Surgical /Urgent Care Visits |
Up to $50/visit, 1/day, 10 visits max |
Up to $60/visit, 1/day, 10 visits max |
Up to $65/visit, 1/day, 10 visits max |
Up to $75/visit, 1/day, 10 visits max |
Up to $100/visit, 1/day, 10 visits max |
Up to $45/visit, 1/day, 10 visits max |
Up to $65/visit, 1/day, 10 visits max |
Up to $100/visit, 1/day, 10 visits max |
Diagnostic X-rays & Lab Services |
Up to $295 - Additional $250 - One CAT scan, PET scan or MRI |
Up to $405 – additional $250 - One CAT scan, PET scan or MRI |
Up to $465 - Additional $375 - One CAT scan, PET scan or MRI |
Up to $485 - Additional $450 - One CAT scan, PET scan or MRI |
Up to $600 - Additional $500 - One CAT scan, PET scan or MRI |
Up to $330 - Additional $250 - One CAT scan, PET scan or MRI |
Up to $480 – additional $300 - One CAT scan, PET scan or MRI |
Up to $780 - Additional $300 - One CAT scan, PET scan or MRI |
Hospital Emergency Room(all expenses incurred therein) |
Up to $215 |
Up to $295 |
Up to $395 |
Up to $465 |
Up to $660 |
Up to $208 |
Up to $300 |
Up to $480 |
Outpatient Surgical Facility |
Up to $750 |
Up to $900 |
Up to $1,030 |
Up to $1,070 |
Up to $1,320 | Up to $705 |
Up to $1,020 |
Up to $1,660 |
Other |
Ambulance Services |
Up to $295 |
Up to $450 |
Up to $450 |
Up to $475 |
Up to $475 |
Up to $450 |
Up to $450 |
Up to $880 |
Initial Orthopedic Prosthesis/ brace |
Up to $715 |
Up to $990 |
Up to $1,160 |
Up to $1,240 |
Up to $1,560 |
Up to $705 |
Up to $1,020 |
Up to $1,660 |
Dental Treatment |
Up to $360 (Injury to Sound, Natural Teeth) |
Up to $550 (Injury to Sound, Natural Teeth) |
Up to $550 (Injury to Sound, Natural Teeth) |
Up to $550 (Injury to Sound, Natural Teeth) |
Up to $550 (Injury to Sound, Natural Teeth) |
Up to $550 (Injury to Sound, Natural Teeth) |
Up to $550 (Injury to Sound, Natural Teeth) |
Up to $1,075 (Injury to Sound, Natural Teeth) |
Physiotherapy |
Up to $30/visit, 1/day, 12 visits max |
Up to $40/visit, 1/day, 12 visits max |
Up to $40/visit, 1/day, 12 visits max |
Up to $40/visit, 1/day, 12 visits max |
Up to $40/visit, 1/day, 12 visits max |
Up to $40/visit, 1/day, 12 visits max |
Up to $40/visit, 1/day, 12 visits max |
Up to $80/visit, 1/day, 12 visits max |
Emergency Evacuation |
$50,000 |
$50,000 |
$50,000 |
$50,000 |
$50,000 |
$50,000 |
$50,000 |
$50,000 |
Chemotherapy and/or radiation therapy |
Up to $715 |
Up to $990 |
Up to $1,175 |
Up to $1,275 |
Up to $1,620 |
Up to $705 |
Up to $1,020 |
Up to $1,660 |
Acute Onset of a Pre-existing Condition |
$25,000 for Medical Expense Benefits (subject to the sublimits for each benefit shown above) & $25,000 for Emergency Medical Evacuation. |
$45,000 for Medical Expense Benefits (subject to the sublimits for each benefit shown above) & $25,000 for Emergency Medical Evacuation. |
$65,000 for Medical Expense Benefits (subject to the sublimits for each benefit shown above) & $25,000 for Emergency Medical Evacuation. |
$85,000 for Medical Expense Benefits (subject to the sublimits for each benefit shown above) & $25,000 for Emergency Medical Evacuation. |
$120,000 for Medical Expense Benefits (subject to the sublimits for each benefit shown above) & $25,000 for Emergency Medical Evacuation. |
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Return of Mortal Remains |
$25,000, for local cremation or burial $5,000 |
$25,000, for local cremation or burial $5,000 |
$25,000, for local cremation or burial $5,000 |
$25,000, for local cremation or burial $5,000 |
$25,000, for local cremation or burial $5,000 |
$25,000, for local cremation or burial $5,000 |
$25,000, for local cremation or burial $5,000 |
$25,000, for local cremation or burial $5,000 |
International Travel Coverage |
30 days |
30 days |
30 days |
30 days |
30 days |
30 days |
30 days |
30 days |
Common Carrier Accidental death and dismemberment |
Up to $25,000 |
Up to $25,000 |
Up to $25,000 |
Up to $25,000 |
Up to $25,000 |
Up to $25,000 |
Up to $25,000 |
Up to $25,000 |