Benefit | Details |
---|---|
*Formulary Prescription Drugs (including pre-existing drugs) | 80% to $1,000 |
Dental Care |
|
Accidental Dental | $2,000 / injury |
Private Duty Nursing | 80% to $3,000 |
Preferred Hospital Room | 80% to $5,000 annual maximum |
Custom Made Foot Orthotics & Orthopedic Shoes | $300 |
Health Practitioners | 80% to $600 combined maximum |
Vision Care (eye wear and eye exams) | $150 / 2 years combined maximum |
Hearing Aids | $500 / 5 years |
Ground & Air Ambulance | Unlimited |
Funeral Expenses (accidental death) | $4,000 |
Medical Equipment & Supplies including but not limited to:
|
|
Wheelchairs, Motorized Scooters & Adjustable Beds | 80% to $10,000 combined lifetime maximum |
Artificial Limbs, Eyes & Larynx (includes myoelectric limbs) | $10,000 combined lifetime maximum |
Breast Prosthesis | $325 single / 2 years $650 bi-lateral / 2 years |
Annual Travel |
|