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Benefit Schedules:
Catastrophic | Comprehensive | HSA
Rate Schedules:
Catastrophic | Comprehensive | HSA
Assurant® Comprehensive Plan — Network Benefits
| Plan Design Unless otherwise noted, all deductibles, maximums and benefit amounts are applied per person and are reset each January 1. |
Deductible
Amount you pay toward covered expenses before the plan pays benefits |
$1,500 |
Benefit Percentage
Percentage of covered expenses the plan pays after the deductible |
75% |
Coinsurance
Percentage of covered expenses you pay after the deductible |
25% |
Total Out-Of-Pocket Maximum
After this maximum is met, the plan pays 100% of covered expenses |
Individual: $9,000
(Family total out-of-pocket maximum is $18,000 and is met collectively
by two or more people.) |
Office Visit Copay
You pay your copay and the plan pays 100% of the remaining cost of an
eligible network office visit including examination, consultation, evaluation,
development of a treatment plan, immunizations, and allergy shots |
$35 copay
Optional benefit |
| Copay applies to each of four network office visits per person.
Additional visits are covered subject to the deductible and coinsurance |
Lifetime Benefit Maximum
The total maximum amount the plan pays per person |
$2 million |
| Outpatient Benefits: Subject to the selected deductible and coinsurance unless otherwise noted. |
| Prescription Drugs — Generic |
Retail: $15 copay; Mail in: $30 copay — (no coinsurance) |
| Prescription Drugs — Brand name |
Retail: 50% coinsurance; Mail in: 50% coinsurance |
| Prescription Drugs — Annual maximum |
$2,000 |
| Preventive Services |
Covered |
| Mammograms |
Covered — subject to coinsurance, deductible waived |
| Diagnostic Imaging and Laboratory Services |
Covered |
| Outpatient Hospital, Surgical Center or Urgent Care Facility |
Covered |
| Professional Ground and Air Ambulance |
Covered |
| Emergency Room |
Access fee: $75 copay, then subject to deductible and coinsurance —
$75 copay waived if admitted to the hospital |
| Health Care Practitioner Services |
Covered |
| Outpatient Physical Medicine |
Rehabilitation: 20 visits
Chiropractic: 10 visits
Acupuncture: 10 visits |
| Home Health Care |
Up to 160 hours |
| Inpatient Benefits Benefits: Subject to the selected deductible and coinsurance unless otherwise noted. |
| Inpatient Hospital |
Covered |
| Inpatient Rehabilitation Facility |
Up to 10 days |
| Subacute Rehabilitation and Skilled Nursing Facilities |
Up to 45 days |
| Transplants |
Covered |
| Behavioral Health and Substance Abuse |
Inpatient and outpatient benefits are paid at 50% up to $2,500
• Coinsurance does not apply to the out-of-pocket maximum |
Other Covered Services
- Behavioral Health
- Maternity
- Dental Injuries
- Diabetic Services
- Hospice Care
- Parenteral Drug Therapy
- Reconstructive Surgery
Initial rate guarantee
Your premium rate is locked in for the fi rst 12 months. Have the convenience of knowing what you'll pay in
premium for an entire year.
Worldwide coverage, 24 hours a day
Whether you’re near or far from home — you’re covered.
No referrals necessary to see a specialist
You don’t have to jump through hoops when you need a specialist’s care — simply make an appointment.
Preventive Services
Covered immediately at 100%, preventive services
include immunizations, Pap tests, PSA screening, lipid
profi le tests, barium enemas, and tuberculosis tests— with no annual dollar limit.
Mammograms
Mammograms are covered, even if you haven't yet
met your plan deductible. You pay your coinsurance,
and the plan pays the rest.
Maternity
You get coverage for routine maternity expenses.
Complications of Pregnancy
Includes emergency Caesarean section and any
sickness associated with a pregnancy except
hyperemesis gravidarum.
Additional Coverage for Accidental Injuries
Accident Medical Expense coverage is included with
your Assurant Catastrophic Plan. This coverage pays
the first $2,000 of expenses related to each accident— even if you haven't yet met your plan deductible.
Emergency Room
Includes the services of the facility and supplies. Benefits
for covered emergency services are always paid at the
higher network benefit percentage — even if you are out
of network.
Transplants
After a 12-month waiting period, includes:
- Kidney, cornea, and skin transplants covered
as any other service.
- Transplants such as bone marrow, heart, liver, and
lung covered up to $250,000 when performed through
a network provider. When performed at a designated
transplant provider, transplants are covered up to
$500,000.
- Up to an additional $10,000 toward travel expenses
when a designated transplant provider is selected.
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