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Core Health Platinum level benefits

TA | August 24, 2008

Q: Could you please tell me the hospitalization coverage on this plan (deductible, etc) - any hospital in my area? Covers Doctor visits - how much? Pharmacy?

A: Core Health Insurance is offered at three different benefit levels that directly affect the premium rate. The summary of the highest level of benefits offered under the "Platinum Plan" is pasted below, but see the description online for full details. The benefits are available under any hospital in the U.S. This plan does not cover prescriptions, so we suggest a separate prescription plan; see the options at MedSave.com.

Platinum Plan Summary:

Benefits:

Platinum

Insurance Pays:

Lifetime Maximum:

$1 million

Waiting Period (days) for:      

 

Accident coverage

None
   Sickness coverage 30

*Hospital:

 

   First Day Admission (Semi-private room or ICU/CCU) $1,000
   Semi-Private Hospital Room and Board per day:  $750

   Intensive Care Unit (ICU/CCU) per day:

$1,500

   Combined Maximum number of covered days (per person per policy year): 31

*Surgery

 

   Inpatient

$3,000

   Outpatient

$2,000

   Maximum number of surgeries (per policy year):

1

*Anesthesia:

 

   Inpatient

$600

   Outpatient

$400

   Combined Maximum number of treatments (per policy year):

1

Doctor Office Visits   

$100

   Maximum number of visits (per person per policy year):

5

Wellness Visit    

$50

   Maximum number of visits (per person per policy year): 1

Diagnostic Testing, X-Rays & Laboratory:

 
    Basic:

$100

   Maximum number of visits (per person per policy year) 5

   Advanced Studies:

$1,000
   Maximum number of visits (per person per policy year): 1

Emergency Room

$300

    Maximum number of visits (per person per policy year):

    For Medical Emergency Only

1

Accident Medical Expense

$2,500

    Deductible: $100
    Maximum number treatments (per person per policy year): 1

 

 

Accidental Death & Disbursement

Platinum

Insurance Pays:

Primary Insured Covered up to:

$10,000

Covered Spouse up to:

$5,000

Each Covered Dependant up to:

$2,500

 

THIS IS LIMITED INDEMNITY COVERAGE.  IT IS NOT MAJOR MEDICAL COVERAGE and is not intended to replace other medical coverage. Pre-existing condition: applies only to Hospitalization (including First Day Admission, Semi-Private Hospital Room and Board, and ICU/CCU), Surgery and Anesthesia.  This insurance is underwritten by United States Fire Insurance Company.

 

Plan Descriptions

Hospital:

First Day Admission: You will have coverage up to the amount shown in the benefit schedule of the plan You select. 

Hospital (Standard): You will have coverage up to the amount shown in the benefit schedule of the plan You select, for standard, board, miscellaneous medical Hospital charges, and general nursing services for each day You are Confined to a hospital due to a covered Injury or Sickness.  This benefit is paid in lieu of a benefit payable for Intensive Care/Cardiac Care Confinement.

 

Intensive Care/Cardiac Care Unit: You will have coverage up to the amount shown in the benefit schedule of the plan You select, for each day You are Confined to a Hospital in an Intensive Care or Cardiac Care Unit due to a covered Injury or Sickness.  This benefit is paid in lieu of a benefit payable for a standard Hospital room.

 

Maximum Benefit for ALL First Day Admission, Hospital and Intensive Care/Cardiac Care Unit Confinements is 31 days per person per Policy Year.

 

Surgery:  You will have coverage up to the amount shown in the benefit schedule of the plan You select, for surgery performed while Confined to a Hospital or in an Outpatient Surgery Facility resulting from a covered Injury or Sickness.  Limited to 1 surgery (Inpatient or Outpatient) per person per Policy Year.

 

Anesthesia: When a covered surgical procedure is performed, You will have coverage up to the amount shown in the benefit schedule of the Plan You select, for anesthesia and its administration during the surgery.  Limited to 1 (Inpatient or Outpatient) per person per Policy Year.

 

Doctor's Office Visits: You will have coverage up to the amount shown in the benefit schedule of the plan You select, for a Medically Necessary Doctor Visit due to a covered Injury or Sickness, visits will also be for newborn well-care and routine health examinations and immunizations for children aged 5 and under.  Limited to 5 visits per person per Policy Year.

 

Wellness Visits: You will have coverage up to the amount shown in the benefit schedule of the plan You select, for a routine health examination.  Limited to 1 visit per person per Policy Year.

 

Diagnostic Testing:

Basic: You will have coverage up to the amount shown in the benefit schedule of the plan You select, for x-rays, laboratory and other diagnostic tests, ordered or performed by a Doctor that are Medically Necessary due to a covered Injury or Sickness.  Limited to 5 sittings per person per Policy Year.

 

Advanced Studies:  You will have coverage up to the amount shown in the benefit schedule of the plan You select, for Medically Necessary EEG's, EKG's, CT Scan's and MRI's.

 

Emergency Room: You will have coverage up to the amount shown in the benefit schedule of the plan You select, for Medical treatment received by a Doctor in a Hospital Emergency Room for a Medical Emergency due to a covered Injury or Sickness.  Limited to 1 visit per person per Policy Year.

 

Accident Medical Expense Benefit:  You will have coverage up to the amount shown in the benefit schedule of the plan You select, for an accidental Injury that requires Medically Necessary care. Initial treatment for the Injury must be received within 30-days of the date of the Injury.  Limited to 1 treatment per person per Policy Year and subject to a $100 deductible.

   

Accidental Death & Dismemberment:  You or Your beneficiary will be paid, up to the amount shown in the benefit schedule of the plan You select, for a covered Injury that results in death or dismemberment.  Dismemberment is paid as a percentage of the amount shown in the benefit schedule, please see dismemberment table for specific benefits and limits.

 

New York State Mandated Benefits:  Residents of New York will be provide with extra state mandated benefits.  Click here for a description.

THIS IS LIMITED INDEMNITY COVERAGE.  IT IS NOT MAJOR MEDICAL COVERAGE and is not intended to replace other medical coverage.

1 There is a 30-day waiting period for Sickness

2 A 12-month Pre-existing Condition Limitation applies to the following benefits:  Hospital, including First Day Admission, Hospital Standard room, Intensive Care/Cardiac Care Unit, Surgery and Anesthesia.

·         Please see Exclusions and Limitations

·         Underwritten by United States Fire Insurance Company

 


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