Expressed Per Member, Per Policy Year (Excluding AD&D)
Daily In-Hospital Confinement
When confined to the hospital due to a covered accident or sickness, the carrier will pay up to the $100 benefit maximum for up to 30 days per year.
Preexisting conditions: 12/12 for this feature
Doctor Office Visits
When treated at the doctor’s office for a covered accident or sickness, the carrier will pay up to the $30 benefit maximum, for up to three (3) visits.
Mental Health
| In-patient Confinement: |
Up to $30 per day |
Up to 30 days |
| Out-Patient Visits: |
Up to $30 per visit |
Up to 20 visits |
Accident Medical
Subject to a $100 Policy Year deductible, the carrier pays 80% of charges incurred due to covered injuries up to:
Plan Name |
Maximum |
Plan Name |
Maximum |
Preferred I:
|
$1,500 |
Preferred III: |
$4,000 |
Preferred II: |
$2,500 |
Preferred IV: |
$5,000 |
Accidental Death and Dismemberment (AD&D)
In the unfortunate event of the loss of life or limb in a covered accident, the carrier pays up to:
Plan Name |
Primary |
Covered Spouse |
Covered Dependants |
Preferred I:
|
$5,000 |
$2,500 |
$1,250 |
Preferred II: |
$10,000 |
$5,000 |
$2,500 |
| Preferred III: |
$15,000 |
$7,500 |
$3,750 |
| Preferred IV: |
$25,000 |
$12,500 |
$6,250 |
Dismemberment payment is specific to the type of loss and subject to the same principal amount.
*Insurance features are made available through a group insurance policy issued to SureHealth through the Consumer Health Choice Association. Insurance features are administered by CrossAmerica Health Plans, 100 Eagle Rock Avenue Suite 121, East Hanover, New Jersey 07936 and are underwritten by their affiliated carriers.
|
