BENEFITS WILL VARY BY STATE AND PLAN SELECTED. 

DOCTOR'S VISITS:  Depending on the plan, you will generally be offered a specific number of covered visits per year, usually between 3 and 7.  The plan reimburses a fixed amount per office visit that is generally between $50 and $100.  Some plans even offer a doctor office visit co-pay such as $20 per visit for the specified number of visits.  This covers visits to a doctor’s office for treatment of a covered sickness or injury. Benefits are paid at the pre-selected fixed dollar amount per visit up to a maximum number of visits per policy year.

DIAGNOSTIC TESTING OR X-RAY:  Coverage for medically necessary diagnostic tests, x-rays and/or laboratory testing performed in a doctor's office or outpatient facility due to a covered sickness or accident are paid at a pre-selected fixed dollar amount per test up to a maximum number of tests per policy year.  This amount usually varies from $75 to $400 depending on the plan.  There are even plans that will cover a set dollar amount annually which allows you to maximize your coverage.

PREVENTATIVE CARE OR WELLNESS BENEFIT:  This benefit is payable, up to the plan maximum, for routine health examinations and immunizations for covered persons.

HOSPITAL CONFINEMENT BENEFIT:  Coverage for confinement in a Hospital as a result of an accident or sickness. Benefits are paid at the amount shown for each day of confinement up to a maximum number of days per plan year. Plans generally range from $250 to $1500 per day, depending on the plan selected.

HOSPITAL ICU/CCU:  This benefit is payable for confinement in an Intensive Care Unit. Benefits are payable up to the Daily Benefit Amount up to a maximum days per year. The daily benefit amount usually ranges from $1000 to $2000 per day.

SURGERY INPATIENT & OUTPATIENT:  Coverage for surgery performed according to the surgical schedule per covered procedure. The surgical schedule by plan is based on the specified percentage of the Medicare allowable RBRVS or based on the plans individual surgical benefit.

ANESTHESIA BENEFIT:  Covers administration of anesthesia if the surgical indemnity benefit is payable. Benefits are paid according to a percentage of the surgical schedule, usually 20-25%.

CRITICAL ILLNESS BENEFIT:  Some plans offer an extra lump sum payout of anywhere between $2,500 and $15,000 if you are diagnosed with a critical illness. The benefit is usually payable for any one of the following: Invasive Cancer, Heart Attack, Major Organ Transplant Surgery, Stroke, Coma, and End Stage Renal Failure.

EMERGENCY ROOM BENEFIT:  Some plans offer an emergency room benefit in the event of an accident or injury. This benefit is payable, up to the plan maximum when, as the result of a covered injury or sickness, a covered person receives medically necessary treatment by a doctor in a hospital emergency room.

RX CARD:  Every plan has an Rx card which offers access to savings at thousands of participating pharmacies nationwide. Benefits will run from co-pays on generics and commonly used inexpensive drugs to discounts on the really expensive brand name drugs.

PPO PLAN NETWORK:  These plans give you access to thousands of doctors associated with national PPO networks.

ACCIDENTAL DEATH AND DISMEMBERMENT: Some plans offer AD&D which pays a defined amount if you are injured in a covered accident and the injury from such accident causes death or dismemberment.  

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