Benefit | Plan A | Plan B | Plan C |
First Occurrence Benefit | $2,000 | $2,000 | $2,000 |
Wellness Benefit | $75 / year | $100 / year | $100/year |
Waiver of Premium | Premium | Premium | Premium |
Hospital Confinement | $100/day | $200/day | $400/day |
Inpatient Drugs and Medicines | $10/day | $10/day | $10/day |
Physicians Attendance | $20/day | $30/day | $30/day |
Ambulance | $100 per confinement | $200 per confinement | $200 per confinement |
Private Duty Nursing Services | $100/day | $100/day | $100/day |
Government or Charity Hospital | $100/day | $100/day | $100/day |
Hospice Care Center | $100/day | $100/day | $100/day |
Hospice Care Team | $100/day | $100/day | $100/day |
Extended Care Facility | $100/day | $100/day | $100/day |
Extended Benefits (after 70 days of hospital confinement) | $100/day | $200/day | $200/day |
Home Nursing | $100/day | $100/day | $100/day |
Inpatient Surgery | $1,500 Schedule | $3,000 Schedule | $3,000 Schedule |
Outpatient Surgery | 150% of inpatient | 150% of inpatient | 150% of inpatient |
Second Surgical Opinion | $200 | $200 | $200 |
Anesthesia | 25% of surgical benefit | 25% of surgical benefit | 25% of surgical benefit |
Ambulatory Surgical Center | $250/day | $250/day | $250/day |
Radiation and Chemotherapy | $5,000 per 12 months | $10,000 per 12 months | $20,000 per 12 months |
Blood, Plasma, and Platelets | $5,000 per 12 months | $10,000 per 12 months | $20,000 per 12 months |
Prosthesis | $2,000 | $2,000 | $2,000 |
Physical or Speech Therapy | $25/day | $25/day | $25/day |
New or Experimental Treatment | $5,000 per 12 months | $10,000 per 12 months | $20,000 per 12 months |
Skin Cancer | Actual charges up to $150 | Actual charges up to $300 | Actual charges up to $300 |
Outpatient Lodging | $50/day | $100/day | $100/day |
Non-Local Transportation | Airfare or $0.50/mile | Airfare or $0.50/mile | Airfare or $0.50/mile |
Family Member Lodging | $50/day | $100/day | $100/day |
Family Member Transportation | Airfare or $0.50/mile | Airfare or $0.50/mile | Airfare or $0.50/mile |
Hospital Intensive Care | N/A | $300/day | $300/day |