Expressed Per Member, Per Policy Year (Excluding AD&D)
Doctor Office Visits
When treated at the doctor’s office for a covered accident or sickness, the carrier will pay up to the benefit maximum of:
| Plan Name |
Per Visit |
# of Visits |
| Vitality 350 |
Up to $20 |
Up to 7 |
| Vitality 700 |
Up to $30 |
Up to 7 |
Mental Health**
Vitality 350
| In-patient Confinement: |
Up to $20 per day |
Up to 30 days. |
| Out-Patient Visits: |
Up to $20 per visit |
Up to 20 visits |
Vitality 700
| In-Patient Confinement: |
Up to $30 per day |
Up to 30 days. |
| Out-Patient Visits: |
Up to $30 per visit |
Up to 20 visits |
Daily In-Hospital Confinement**
When treated at the doctor’s office for a covered accident or sickness, the carrier will pay up to the benefit maximum of:
| Vitality 350 |
Up to $350 per day |
Up to 60 days |
| Vitality 700 |
Up to $700 per day |
Up to 60 days |
Accident Medical
Subject to a $100 Policy Year deductible, the carrier pays 80% of charges incurred due to covered injuries up to $10,000 for both Vitality 350 and Vitality 700 plans.
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:
- Up to $25,000 for the Primary member
- Up to $12,500 for any covered spouse
- Up to $6,250 for any covered dependant
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.
**Preexisting Conditions: 12/12 for this feature. The carrier will not pay concurrently for Daily In-Hospital and Mental Health In-Patient Confinement. |
