| PLAN BENEFITS | DETAILS |
| Physician Office Visit Benefit: The carrier will pay the benefit amount as shown if you seek treatment for a covered illness or injury. | $100 per office visit up to seven per year
(seven per family member). |
| Preventive Care Test Benefit: The carrier will pay the benefit amount shown if you incur charges for one of the preventive care tests listed in the policy’s Certificate Schedule. | $150 per visit, limit of one per year
(one per family member). |
| Hospitalization 1st Day Admission Benefit: The carrier will pay the benefit amount shown for the first day of admission to a hospital as a patient because of a covered sickness or injury. Unlimited re-admission, however there is a 90 day waiting period if you are re-admitted for same illness. | $3,000 for the 1st day of admission
($2,000 1st day admission benefit + $1,000 hospital confinement benefit listed below) |
| Hospitalization Confinement Benefit: The carrier will pay the benefit amount shown if you are admitted and confined to a hospital as a patient because of a covered sickness or injury. Unlimited hospital stays per year, however, you will be limited to 100 total days per year. | Up to $2,000 per day.
Maximum 100 days per year. |
| ICU/CCU Benefit: The carrier will pay the benefit amount shown if you are admitted to a hospital as a patient because of a covered sickness or injury. You are allowed unlimited ICU/CCU stays per year, however, you will be limited to 15 total days per year including first day ICU/CCU stays. | Up to $2,000 per day.
Maximum 15 days per year. |
| Diagnostic Testing & Lab Benefit: The carrier will pay up to the benefit amount for all diagnostic testing (x-rays) and laboratory fees at the reimbursement rate shown. This benefit pays up to a limit of five per year. | $400 paid for up to 5 days per covered person
per calendar year. |
| Surgical Benefit (Inpatient or Outpatient): The carrier will pay the benefit amount shown for required surgery because of a covered procedure. Reimbursements are based on the Medicare/RBRVS benefit schedule. | 100% of Medicare/Medicaid/RBRVS* benefit schedule. Anesthesia Benefit 25% of Surgeons Benefit. |
| AIM Rx Card Benefit: Generic prescription drug card with brand name discounts. | $5 Generic Plan (30 day supply) / $15 Generic Plan (90 day supply) Significant discounts on brand name prescriptions. |
| Critical Illness Benefit: The carrier will pay the benefit amount shown for a covered person (primary applicant and/or spouse) that has been diagnosed with a critical illness. | $5,000 one time benefit.
Coverage for Primary Applicant and Spouse Only. |
| No Lifetime Maximum Benefit Limit |
| Optional Riders: Must purchase separately from the HealthMax Plus Plan. | See Optional Riders. |
“The above may not include certain-state-specific mandate benefits.” The benefits will be administered in accordance with any state-specific extra territorial requirements.
*RBRVS is the methodology used by the Federal Government to determine benefits payable by Medicare/Medicaid. Important: This is a brief description of the plan, for specific coverage; please refer to your policy(s).
DISCLAIMER: Our medical plans are low-cost alternative (Limited Medical), providing medical insurance at fixed amounts, and these limited benefits are paired with medical discount to designated providers. The Limited Benefit Medical Plan offered is a group insurance program. The group insurance benefits vary depending in the plan selected.
This insurance is not a basic or major medical coverage and is not designated as a substitute for basic health insurance or major medical coverage. The plan limitations are disclosed in the certificate of coverage provided in the fulfillment kit which will mailed to the applicant by the effective date of coverage. “For costs and complete details of the coverage, call your insurance agent.”
**This policy has a preexisting conditions limitation. Preexisting conditions are not covered until the policy has been in effect for more than 12 months. A preexisting condition is any condition you have now or had within a six month period prior to the effective date of coverage for each covered person.
The plan is HIPAA compliant. The riders are not HIPAA eligible.
“The benefits represented in this site are contracted through a combination of carriers.” |
