Corresponding benefit in
sample plans document |
Benefit Description |
| Doctor Office Visit |
Doctor’s Office Visits Indemnity Benefit - due to Illness, Accident or Medical Emergency |
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Benefit is payable per visit, per covered person. Routine exams, immunizations and Preventive Care are not covered under this benefit. Benefit maximum is 4 or 6 visits per calendar year. |
| Outpatient Diagnostic, X-ray and Lab |
Outpatient Diagnostic, X-ray and Lab Indemnity Benefit |
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Benefit is payable per day, payable per covered person, when Hospital Confinement is not required. Routine exams, preventive lab tests and X-rays are not covered under this benefit. Benefit maximum is equal to 3 or 6 tests per calendar year. |
| Advanced Studies |
Advanced Studies Indemnity Benefit |
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Benefit is payable per day of testing per covered person. MRI’s, CT scans and other advanced diagnostic tests are covered under this benefit. Benefit maximum is 3 per calendar year. |
| Preventive Care |
Preventive Care Indemnity Benefit |
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Benefit payable per visit, per covered person. Routine exams, immunizations and other Preventive Care as defined in the coverage are covered under this benefit. Benefit maximum is 3 visits per calendar year. |
| Surgical Benefit |
Inpatient, Outpatient, Outpatient Minor and Outpatient Venipuncture Surgical Indemnity Benefit |
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No benefit will be paid for dentistry or oral surgery. |
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Inpatient |
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Benefit is payable for one procedure per year or two or more within the same surgical session. |
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Outpatient |
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Benefit is payable for one procedure per year or two or more within the same surgical session other than Outpatient Minor Procedures and Outpatient Venipuncture. |
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Outpatient Minor |
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$75 benefit is payable at a flat benefit level for one procedure per year or two or more within the same surgical session. |
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Outpatient Venipuncture |
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$25 benefit is payable at a flat benefit level for one procedure per year. |
| Anesthesiology |
Anesthesiology Indemnity Benefit |
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Coverage includes Inpatient, Outpatient, Outpatient Minor and Outpatient Venipuncture Surgical benefit, an amount equal to 25% of the surgical benefit will be paid for anesthesiology. One time benefit. |
| Emergency Room Indemnity Benefit for Illness Only |
Emergency Room Visit |
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Benefit is payable for a covered person who has an ER visit as a result of a non-occupational illness which does not result in a hospital admission. Benefit maximum is 4 visits per calendar year. |
| Daily In-Patient Hospital Benefit |
Daily In-Hospital and Skilled Nursing Facility Indemnity Benefit |
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Daily In-Hospital Benefit |
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Benefit payable per day, up to a lifetime maximum of 500 days of confinement (except for Substance Abuse, Mental Illness Disorder, and In-patient Skilled Nursing Facility). |
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Intensive Care Unit |
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Double the Daily In-Hospital Benefit will be paid, up to a maximum of 30 days per calendar year. |
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Mental Illness Disorder |
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50% of the Daily In-Hospital Benefit will be paid, up to a maximum $5,000 per calendar year. Lifetime maximum $30,000. |
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Substance Abuse |
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50% of the Daily In-Hospital Benefit will be paid, up to a maximum of 30 days per calendar year. Lifetime maximum $30,000. |
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In-patient Skilled Nursing Facility |
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50% of the Daily In-Hospital Benefit will be paid. Maximum benefit per covered person per period of confinement is 60 days. The confinement is covered only if it follows a covered Hospital stay of at least 3 days. |
| Hospital Admission |
First Day Hospital Admission Indemnity Benefit |
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This benefit pays an additional amount equal to one times the hospital benefit for each hospital stay. |
| Accident Coverage |
Accident Expense Benefit |
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Up to 100% of charges incurred are payable within 90 days of an Accidental Bodily Injury. Benefit is payable per accident. |
| AD&D Only (Employee) |
Accidental Death and Dismemberment Benefit |
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The AD&D benefits reduce by 35% of the original amount upon attainment of Age 65, and by an additional 35% each five year period thereafter. |
| First Health Network |
First Health Network |
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The First Health Network provides access to one of the nation's largest and most respected networks. By going to a First Health provider members can reduce their out of pocket expenses and stretch benefit dollars. More than 490,000 provider locations across all 50 states. Visit www.yourmedbenefits.com to search providers online. |
| Health Savings Program |
Health Savings Program - this benefit is not underwritten by Standard Security Life Insurance Company |
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Discounts on Vision*, Hearing, Chiropractic*, Vitamins & Nutritional Supplements. Access to Counseling (EAP) and 24-Nurseline. *Not available to residents of Vermont. |
| Tier'd RX Program |
Prescription Program - this benefit is not underwritten by Standard Security Life Insurance Company |
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The Tier'd Pricing Pharmacy Plan saves money and takes the guess work out of paying for prescription medications. This program segments brand name and generic drugs into three price classifications making it easier for members to consult with their physician to find the most effective medication at the lowest cost. Discounts also apply to drugs not listed in one of the following tiers as well as maintenance medications purchased through the mail order program. |
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Preferred brand and generic drugs available for $10 or less (tier 1), $20 or less (tier 2), $40 or less (tier 3) for the scheduled quantity or dose. Mail order pharmacy included. |
