Vision

Network Provider
Non-Network Provider
Eye Exam
100% up to $40 100% up to $40
Lenses
Standard uncoated plastic lenses, with $10 copay
Single Vision: 100% up to $35
Bifocal: 100% up to $55
Trifocal: 100% up to $90
Standard uncoated plastic lenses, with $10 copay
Single Vision: 100% up to $35
Bifocal: 100% up to $55
Trifocal: 100% up to $90
Frames
$10 copay with $120 allowance $10 copay with $60 allowance
Corrective Contact Lenses

(in lieu of corrective spectacle lenses and frames)

$10 copay with $120 allowance $10 copay with $120 allowance

Dental

BENEFITS – Network Provider
Basic
Premiere
Covered Services
Preventive, diagnostic, restorative and adjunctive services Preventive, diagnostic, restorative, adjunctive, endodontics, periodontics, prosthodontics
Type I
100% No waiting period 100% No waiting period
Type II
50% Six month waiting period 80% Six month waiting period
Type III
Not covered 60% 12 month waiting period
Calendar year deductible
$100 per person Three max per family $50 per person Three max per family
Calendar year maximum
$1,000 per person $5,000 per family $1,200 per person $6,000 per family

 

COVERED SERVICES
TYPE I:

Premiere and Basic plans include the following services with no waiting period:

TYPE II:

Premiere and Basic plans include the following services with a six month waiting period:

TYPE III:

Premiere plan only includes the following services with a 12 month waiting period, unless stated otherwise:

Preventive
X X
Diagnostic
X X
Restorative
X X
Adjuntive
X
Endodontics
X
Oral Surgery
X
Prosthodontics
X
Periodontics
X

Accident

BENEFITS

(per person, per accidental injury)

Option 1 Option 2 Option 3 Option 4
Hospital Confinement

(one per Policy year)

$2,500 $5,000 $7,500 $10,000
Emergency Treatment

(within 72 hours of Injury)

$250

per injury

$500

per injury

$750

per injury

$1,000

per injury

Major Diagnostic Exam

(one per Policy year at hospital or urgent care center)

$250 $500 $750 $1,000
Follow-up Treatment

(up to five visits per Policy year)
OR

Follow-up Physical Therapy

(up to five visits per Policy year)

$50

per visit

$50

per visit

$100

per visit

$100

per visit

$100

per visit

$100

per visit

$100

per visit

$100

per visit

 

Short Term

Our plans offer you comprehensive coverage in the following medical expenses:

URGENT CARE

A medical facility providing immediate, non-routine urgent care for an injury or sickness treated on a walk-in basis.

Unlimited visits

You pay $50 per visit; your medical deductible is waived andremaining expenses apply to coinsurance

EMERGENCY ROOM CARE
  • Unlimited visits
  • Subject to an additional $250 access fee unless admitted to a hospital; costs apply to deductible and coinsurance
 AMBULANCE SERVICE
  • Unlimited trips
  • Maximum benefit of $250 per trip
DOCTOR VISITS
Doctor visits are subject to deductible and coinsurance

 

Standard plans

Build your plan as you wish: select a deductible, a coinsurance option and a coverage time. Easy!

* Based on a health questionnaire

 

Guaranteed emission plans

These types of plans will help you get coverage without the possibility of being denied(1). Start by completing the health questionnaire and then choose the plan that best suits you.

 

Basic
DEDUCTIBLE*
$5,000
COINSURANCE
90% / 10%
OUT-OF-POCKET MAXIMUM
$10,000
COVERAGE TERM
Choose your own coverage term — from 30 days to 3 months
COVERAGE PERIOD MAXIMUM
$100,000

(1) Short-term medical plans do not cover the associated costs with pre-existing conditions.

 

Enhanced
DEDUCTIBLE*
$3,500
COINSURANCE
80% / 20%
OUT-OF-POCKET MAXIMUM
$10,000
COVERAGE TERM
Choose your own coverage term — from 30 days to 3 months
COVERAGE PERIOD MAXIMUM
$100,000

Critical Illness

BENEFIT OPTIONS
$10,000 $20,000 $30,000 $40,000 $60,000 $80,000 $100,000
Qualifying Event paid at 100%

Advanced Alzheimer’s, ALS, life threatening cancer, coma (illnessinduced), heart attack, major organ transplant, stroke, end-stagerena failure.

$10,000 $20,000 $30,000 $40,000 $60,000 $80,000 $100,000
Qualifying Event paid at 25%

Benign brain tumor, cancer in situ, coronary bypass.

$2,500 $5,000 $7,500 $10,000 $15,000 $20,000 $25,000