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
$1,000 to $10,000
$0 Copay
$1,000,000

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

$ 10 Copay

$ 10 Copay

$ 10 Copay




$ 0 Copay

$ 0 Copay

 

PLEASE NOTE:
If you select either the $400 or $800 deductible, your coinsurance will be 25%, not 20%.

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)


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

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.

Carry the card that's recognized and accepted
across Maryland and through-out the United States.