Plan Administrator: INF Healthcare | AM Best Rating : "A++" | Underwriter: CHUBB American Insurance Company.
MEDICAL EXPENSE BENEFITS
We will pay Medical Expense Benefits for Covered Expenses that result directly, and from no other cause, from a Covered Accident or Sickness. These benefits are subject to a Deductible of $500 per person for each Injury and each Sickness. The Policy Maximum for all Accident and Sickness Benefits is $150,000 (Age 69 & under) and $75,000 (Ages 70-99). Benefits are also subject to the following:
Co-Insurance Limits:
In-Network: 80% of covered Network charges up to the overall maximum benefit.
Out-of-Network: 60% of covered Network charges up to the overall maximum benefit. Deductible per individual sickness or injury: $500.
Policy Maximum Benefits per individual sickness or injury: $150,000 - Age 69 and under; $75,000 - Age 70-99.P
Pre-Existing deductible per individual sickness or injury: $1,500.
Pre-Existing Maximum Benefits per individual sickness or injury: $25,000 - Age 69 and under; $20,000 - Age 70-99.
Co-Insurance Limits In-Network: 80% of covered Network charges to the overall maximum benefit.
Out-of-Network: 60% of covered Up to the overall maximum benefit.
Covered Medical Expenses include:
- Hospital semi-private room and board (or room and board in an intensive care unit.
- Hospital ancillary services (including, but not limited to, use of the operating room or emergency room).
- Doctor Non-Surgical Treatment/Examination Expenses (excluding medicines) including the Doctor’s initial visit, each Medically Necessary follow-up visit and consultation visits when referred by the attending Doctor.
- Doctor’s Surgical Expenses. If an Injury or Sickness requires multiple surgical procedures through the same incision, We will pay only one benefit, the largest of the procedures performed. If multiple surgical procedures are performed during the same operative session but through different incisions, We will pay pursuant to the Co-Insurance limits as shown above for the most expensive procedure and 50% of Covered Expenses for the additional surgeries.