| Our North American Individual Medical
Plans are designed for individuals and families who want help
managing their routine medical expenses plus outstanding coverage
for major health care expenses.
|
|
Plan
|
Plan I - WI & IL | Plan II - Illinois Only |
|
Type
|
Indemnity | Full PPO |
|
Deductible
Options
(maximum 2 per family, per year) |
$250 $500 |
$250 $500 $1000 $1500 $2500 $5000 |
|
Coinsurance
Options
|
80/20 to $5,000,
then 100% 50/50 to $5,000, then 100% |
90/10 to $5,000,
then 100% 80/20 to $3,000, then 100% 70/30 to $5,000, then 100% |
|
Doctor
Office Visit Fees Including X-Ray and Lab
(performed in the Doctors office on the same day of service) |
$25 Copay, then 100% | In-Network $20
Copay, then 100% Out-of-Network $30 Copay, then 100% |
|
Outpatient Rx
|
$15 Copay Generic after separate $100 deductible | $15 Copay Generic after separate $100 deductible |
|
Preventive
Care, Including Routine Physicals and Lab Fees
|
$25 Copay, then 100% | In-Network $20
Copay, then 100% Out-of-Network $30 Copay, then 100% |
|
Mammography,
Pap Smear, and PSA Testing
|
Deductible and Coinsurance | Deductible and Coinsurance |
|
Inpatient
Hospital and Surgical Fees Included on the Hospital Bill
|
Deductible and Coinsurance | Deductible and Coinsurance |
|
Outpatient
Surgery and Other Covered Inpatient and Outpatient Fees
|
Deductible and Coinsurance | Deductible and Coinsurance |
|
Emergency
Room Fees
|
Deductible and Coinsurance | Deductible and Coinsurance |
|
Initial
Rate Guarantee
|
12 months | 12 months |
|
Lifetime
Maximum Benefit
(per covered person) |
$2 million | $2 million |
|
Optional
Benefits
|
Maternity Supplemental Accident |
Maternity Supplemental Accident |
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Above outline is for informational purposes only, please review policy for exact plan specifications.
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