Physician Office
Visit
The Carrier will pay up to
Benefit Amount as shown if you seek treatment
for a covered illness or injury. The Carrier
will also pay one (1) wellness visit per year in
addition to the office visits. Emergency room
visits also apply to this benefit.Hospital Admission and
Confinement Benefit **
The Carrier
will pay up to the Benefit Amount shown if you
are admitted to a hospital as a patient because
of a covered sickness. You are allowed unlimited
hospital stays per year, however, you will be
limited to 30 total days per year including
first day hospital stays.
Diagnostic
Testing & Lab Benefit **
The "Hospital
Intensive Care Benefit" pays the selected
benefit amount for each day of hospital
confinement due to sickness or injury, not to
exceed 60 days per confinement. The benefit is
paid directly to the insured person.
Surgical
Benefit **
The Carrier will pay up to the
Benefit Amount for required surgery because of a
covered procedure. The surgery can be preformed
on an outpatient or in-patient basis.
Reimbursements are based on the 2000 National
Physicians Fee Schedule of Relative Value Unit
schedule.
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Accident Rider
The
Carrier will pay up to the Benefit Amount as
shown per covered accident. There is only one
accident allowed per covered person per year.
This benefit pays a portion of the medical costs
resulting from injury. The costs must be
incurred with 90 days of injury.
Substance Abuse and
Mental Illness
The
Carrier will pay for 24-hour availability with
face-to-face visits with a counselor for both
Substance Abuse and Mental Illness. If a
referral to a facility is warranted by a
counselor, that person will be referred to a
facility contracted at a repriced rate.
Term Life Insurance
This benefit pays a stated amount if an insured
dies. The spouse death benefit is 50% of that
that for the primary insured, child death
benefit(s) are 25% of this amount.
Accidental Death
Benefit
This benefit pays a stated
amount if the primary insured dies as the result
of an injury. | 
