Benefit Details

Sickness Benefit Limits

Excess of any other insurance

Aggregate Limit Per Sickness
$1,000
Inpatient Hospitalization limitSubject to aggregate
1st $500 at 100%, balance at 80%included
Semi-private room and boardincluded
Miscellaneousincluded
Outpatient Sickness Limits at 100%
$1,000
Blanket Outpatient Sickness Benefit$1,000
Outpatient Mental Health/Substance Abuse$1,000
Emergency Room$1,000
Diagnostic X-Ray and LabIncluded in Blanket Outpatient Sickness Benefit and Mental Health/Substance Abuse
Physician Office VisitsIncluded in Blanket Outpatient Sickness Benefit and Mental Health/Substance Abuse
Reimbursement for PrescriptionsIncluded in Blanket Outpatient Sickness Benefit and Mental Health/Substance Abuse
The Wellness Access Plan does not include coverage for allergy testing, acne, insomnia, and certain congenital conditions.
Not subject to Aggregate
 
Dental (non-injury)$100
Wellness/preventive$100
Mandatory Accident Benefit (per accident)
 
Mandatory Accident Benefit (per accident)$5,000