MaxPlanSM
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| MaxPlanSM |
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| Plan |
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| Deductible | Network | Non-network | |
| $500, $1,000, $1,500, $2,500, $3,500, $5,000, $10,000, $15,000 or $25,000 | $1,000 * | ||
| Office Copay | $35 (Optional) | $70 | |
| Coinsurance Percentage | 100%, 80%, 70% or 50% | 80%, 60%, 50%, 30% | |
| Coinsurance Out-of-Pocket | $0 to $7,500 depending on coinsurance | $1,500 to $12,000 depending on coinsurance | |
| Lifetime Maximum | $3 or $8 Million | $3 or $8 Million | |
| Maternity Coverage | N/A | N/A | |
| Annual Maximum | $0 | ||
| Outpatient Maximum | None. | ||
| Plan Description |
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| Preventive Care / Wellness / Routine Physical | Subject to Plan Deductible and Plan Coinsurance. Benefits for Preventive Medicine Services are limited to a Maximum Calendar Year Benefit of $750 per Covered Person. The maximum will not apply to routine mammograms, pap smears, PSA tests or colorectal cancer examinations. | ||
| 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 | Subject to deductible and coinsurance. | ||
| Prescription Drugs | Generic: $15 copay with no deductible. Brand: $25 copay + 20% coinsurance after $500 deductible. | ||
| Inpatient Services/Hospitalization | Subject to Plan Deductible and Plan Coinsurance | ||
| 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 | Covered charges are subject to the plan deductible and 50% coinsurance for participating providers, 70% coinsurance for non participating providers. $2,500 calendar year maximum | ||
| 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: War or any act of war, whether declared or undeclared, vision care that is routine, except as otherwise covered in the Diabetic Services provision in the Medical Benefits section, care that is routine; any artificial hearing device, cochlear implant, : any diagnosis, supplies, treatment or regimen, whether medical or surgical, for purposes of controlling the Covered Person’s weight or related to obesity or morbid obesity, whether or not weight reduction is Medically Necessary or appropriate, Charges for growth hormone therapy, Charges related to maternity or pregnancy, or routine well newborn care including nursery charges at birth, or non-spontaneous abortion, Genetic testing or counseling, Infertility diagnosis and treatment for males or females. | ||
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Time Insurance Company |
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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).
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