Benefit Summary
| Benefit / Service | Comprehensive Benefits at a Glance |
|
Annual calendar
year deductible Annual out of pocket maximum Once you meet out of pocket maximum Lifetime benefit maximum |
Choose from $100 to $10,000 |
|
Annual
Child Wellness Exam Annual Adult Wellness Exam Annual OB/GYN Mammography (for preventive care) Three Lifetime EKGS (For members over 50 and if done during routine adult physical exam) Second Surgical Opinions 100% of First $300 of emergency accident care when treatment begins within 72 hours |
$ 10 Copay $ 0 Copay
|
|
PLEASE NOTE: |
|
| 365 Days Hospitalization | 20% coinsurance (after deductible) |
| Inpatient Physician Services | 20% coinsurance (after deductible) |
| Ambulatory & Emergency Services | 20% coinsurance (after deductible) |
| Inpatient/Outpatient surgery | 20% coinsurance (after deductible) |
| Diagnostic Test & X-rays | 20% coinsurance (after deductible) |
| Maternity & Prenatal Care | 20% coinsurance (after deductible) |
| Physician Office Visits | 20% coinsurance (after deductible) |
|
Inpatient
Mental Health and Substance Abuse |
20% coinsurance (after deductible) |
|
Physical
Therapy/Chiropractic Services
(up to 50 visits per year) Radiation and Chemotherapy |
20% coinsurance (after deductible)
|
|
Prescription
Drugs ($500 Annual Benefit Limit per person) |
20% coinsurance (after deductible) |
This outline is intended as a summary only. For complete details, consult your Benefit Guide.
Please note: if you select the $400 or $800 deductible, your coinsurance will be 25%, not 20%.
HOW THE PLAN WORKS
You pay the deductible
(No deductible required for preventive care)
Then Comprehensive Major Medical pays 75% or 80% of the allowed benefit, and you pay 25% or 20% up to your out-of-pocket maximum.
After you meet your out-of-pocket-maximum, the plan pays $100% of the allowed benefit for the rest of the calendar year.
A HEALTH PLAN YOU DESIGN
As a member of the Comprehensive Major Medical plan, you can design a personal health care program that's right for you -- and your budget.
- You select your deductible. The higher the deductible, the lower your monthly premium. And, unlike many other insurance companies, your deductible is applied towards your out-of-pocket maximum. This limits the amount of money you will spend on your health care.
- You select your out-of-pocket maximum. This is the most that each individual on your policy spends towards coinsurance and deductible requirements per year and is based on the deductible you select.
- Preventive care included for just $10 per visit. And there is no deductible to meet.
- Families never pay more than two deductibles even if there are more family members on the policy.
- You have complete freedom to choose your own doctors and hospitals.
Carry the card that's recognized and accepted
across Maryland and through-out the United States.