Agt Ser Main


	Our Medical Savings Account Plans help the self-employed take control of their health care expenses with a tax-free savings account and quality major medical coverage.

Plan	MSA 80	MSA 50
Type	• PPO or Non-PPO	• PPO or Non-PPO
Deductible Options	• Single $1550 • Single $2350 • Family $3100 • Family $4650	• Single $1550 • Single $2350 • Family $3100 • Family $4650
Coinsurance Options	• 80%	• 50%
Doctor Office Visit Fees	• 20% After Deductible	• 50% After Deductible
Outpatient X-Ray and Lab	• 20% After Deductible	• 50% After Deductible
Outpatient Rx	• 20% After Deductible	• 50% After Deductible
Preventive Care, Including Routine Physicals and Lab Fees ($150 maximum per year after 12 months for each adult 19 or older)	• 20% After Deductible	• 50% After Deductible
Mammography, Pap Smear, and PSA Testing	• 20% After Deductible	• 50% After Deductible
Inpatient Hospital and Surgical Fees, Outpatient Surgery, and Other Covered Inpatient and Outpatient Fees	• 20% After Deductible	• 50% After Deductible
Emergency Room Fees	• 20% After Deductible	• 50% After Deductible
Initial Rate Guarantee (subject to benefit and address changes)	• 12 months	• 12 months
Lifetime Maximum (per covered person)	• $5 million	• $5 million
Optional Benefits	• Supplemental Accident • Maternity • Dental	• Supplemental Accident • Maternity • Dental

Above outline is for informational purposes only, please review policy for exact plan specifications.

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