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Members choice
of doctors and hospitals -
click here to view all contracted PPO
networks. |
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Optional Health
Savings Account - Free Administration |
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Member
deductible and coinsurance options |
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12 month, 24
month or 36 month rate
guarantee |
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$25 Million
lifetime maximum
benefit |
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Plans with a
$20, $25, $30, or $40 copay for doctor
visits |
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Wellness
benefits |
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Prescription
Drug Card |
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Optional Dental
& Vision Benefits |
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Optional First
Dollar Benefits |
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Worldwide
coverage, 24 hours a day |
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Office Services |
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History, exam, medical diagnosis and in-office surgery.
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Wellness |
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Exams, immunizations, lab tests, Pap smears, mammograms and PSAs up to $500 in
paid benefits (Benefit varies by plan).
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Lab and X-ray |
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Screening for covered illness or injury.
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Emergency Room |
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$75 access fee (waived if you are admitted to the hospital), then deductible
and coinsurance.

Covered emergency services are always paid at network coinsurance levels.
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Ground/Air Ambulance |
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Emergency transportation to the nearest hospital equipped to provide
appropriate care.
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Physician |
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Diagnosis and treatment for covered illness or injury, including surgery and
anesthesia.
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Hospital |
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The hospital semiprivate room rate and covered ancillary charges.

Intensive Care Unit services have no special limit.
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Organ Transplants |
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Up to the lifetime maximum benefit at a designated provider or a
$100,000 lifetime maximum per transplant at a non-designated provider. Benefits
reduced by 50% if the procedure was not authorized prior to pre-testing,
evaluation and donor search.

Kidney, cornea and skin transplants are covered the same as any other illness.
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Complications of Pregnancy |
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Complications of pregnancy, as defined in the contract, are covered as any
other illness. Covered complications include treatment of ectopic
pregnancy, treatment of gestational diabetes mellitus and medically necessary
Caesarean section.
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Rehabilitation |
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Inpatient: Covered the same as any other illness, with a 180-day
calendar maximum.

Outpatient: occupational, physical and speech therapies, and cardiac
rehabilitation with a $3,000 calendar year maximum.
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Supplies and Equipment |
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Whole blood, prosthetic devices, crutches, basic hospital bed, nonmotorized
wheelchair, braces, oxygen, apnea monitor. Excludes repair or replacement of
equipment.
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Outpatient Treatment of Back/Spine/Neck |
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Covered the same as any other illness, with a $750 calendar year maximum
(nonsurgical).
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Home Health Care |
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Covered the same as any other illness, with a 160-hour calendar year maximum.
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Hospice Care |
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Inpatient or home covered the same as any other illness, with no
limit.
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Skilled Nursing Facility |
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Covered the same as any other illness, with a 30-day calendar year maximum.
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Dental Injury |
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Treatment for injury to sound teeth if the treatment begins within 90 days of
the injury and is completed within 180 days of the injury.
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TMJ/CMJ |
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Covered the same as any other illness, with a $1,000 lifetime maximum.
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Sterilization |
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$500 benefit after you have been insured by the plan for one year.
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Mental Illness/Nervous Disorder/Substance Abuse |
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50% coinsurance after deductible.

$2,500 calendar year maximum (up to $500 of this benefit is available for
outpatient treatment).

Family and marriage counseling are included.
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