CoreMed Plan
|
| CoreMed Plan |
|
| Plan |
|
||
| Deductible | Network | Non-network | |
| $500, $1,000, $1,500, $2,000, $3,500, $5,000 or $10,000 | $1,000 * | ||
| Office Copay | $35 (Optional) | $70 (Optional) | |
| Coinsurance Percentage | 80%, 70% or 50% | 60%, 50%, 30% | |
| Coinsurance Out-of-Pocket | $0 to $7,500 depending on coinsurance | $1,500 to $12,000 depending on coinsurance | |
| Lifetime Maximum | $2 or $6 Million | $2 or $6 Million | |
| Maternity Coverage | N/A | N/A | |
| Annual Maximum | $0 | ||
| Outpatient Maximum | None. | ||
| Plan Description |
|
||
| Preventive Care / Wellness / Routine Physical | Covered charges are subject to the plan deductible and coinsurance. $500 calendar year maximum. Pap smears, mammograms and PSA tests do not apply toward maximum. | ||
| Doctor's Office Visits | Subject to deductible and coinsurance. An office visit copay is available as an optional benefit. Call us to learn more. | ||
| Outpatient Lab Tests & X-rays | Subject to deductible and coinsurance. | ||
| Outpatient Surgical | Outpatient Facility Fee Options: $0 or $200 per outpatient surgical service. Remaining charges are subject to deductible and coinsurance. ($0 outpatient facility fee must be paired with a $0 inpatient facility fee. $200 outpatient facility fee can be paired with either a $200 or $750 inpatient facility fee.) | ||
| Prescription Drugs | Generic: $15 copay with no deductible. Brand: $25 copay + 20% coinsurance after $500 deductible. | ||
| Inpatient Services/Hospitalization | Inpatient Facility Fee Options: $0, $200 or & 750 per day up to 3 days per confinement. Remaining charges are subject to deductible and coinsurance. ($0 inpatient facility fee must be paired with a $0 outpatient facility fee. The $200 or $750 inpatient facility fees must be paired with a $200 outpatient facility fee.) | ||
| Emergency Room Services | $75 access fee (waived if admitted) then covered charges are subject to the plan deductible and coinsurance. | ||
| Ambulance Services | Professional ground or air transportation in an ambulance for a Covered Person who needs Emergency Treatment for a Sickness or an Injury to the nearest Acute Medical Facility that can treat the Sickness or Injury. The ambulance service must meet all applicable state licensing requirements. Subject to Plan Deductible and Plan Coinsurance. | ||
| Rehabilitation Services | Inpatient: Subject to Plan Deductible and Plan Coinsurance. Benefits are limited to a Calendar Year Maximum Benefit of 90 days per Covered Person. Outpatient: Subject to Plan Deductible and Plan Coinsurance. Benefits are limited to an Outpatient Physical Medicine Services Calendar Year Maximum Benefit of $3000 per Covered Person. Chiropractic care is covered under this provision. | ||
| Chiropractic Services | Subject to Plan Deductible and Plan Coinsurance. Benefits are limited to an Outpatient Physical Medicine Services Combined Calendar Year Maximum Benefit of $3000 per Covered Person | ||
| Mental Nervous/Substance Abuse | Plan does not provide benefits. | ||
| Complications of Pregnancy | Covered charges are covered the same as any other illness | ||
| Calendar Year Maximum | None. | ||
| Plan Exclusions | Exclusions consist of the following but are not limited to: Charges for treatment of Behavioral Health or Substance Abuse, Charges that are related to or a complication of a Pre-Existing Condition, War or any act of war, whether declared or undeclared, Charges for growth hormone therapy, Genetic testing or counseling, genetic services and related procedures for screening purposes, Infertility diagnosis and treatment for males or females. | ||
|
Time Insurance Company |
|
|
|
|
|
|
|
Assurant Health is the brand name used for products underwritten and issued by Time Insurance Company, Milwaukee, WI. California license number 08109 (Time Insurance Company).
© 2006 Assurant. All rights reserved. Legal Notice | Privacy Policy
| |