•  Amount you pay toward covered expenses before the plan pays benefits $500, $1,000, $1,500, $2,500, $5,000 or $10,000 Family deductible maximum is two times the deductible and is met collectively by two or more persons may apply.

• Percentage of covered expenses the plan pays after the deductible  100%, 80%, 70% or 50%

• Percentage of covered expenses you pay after the deductible 0%, 20%, 30% or 50%

• After this maximum is met, the plan pays 100% of covered expenses $0 to $7,500 depending on coinsurance  Family coinsurance out-of-pocket maximum is two times the coinsurance out-of-pocket maximum and is met collectively by two or more persons may apply.

• The total maximum amount the plan pays  up to  $8 million may apply, usually $1 million

• Mammograms, Pap smears and PSA screening Covered from the first day—with no annual dollar limit Other preventive services, office visits and immunizations Up to $750 in benefits—available from the first day

• Co-pay, if selected, applies to office visits and immunizations

Office Visits Covered

• $35 co-pay per network office visit—no limit on visits

• Visits for illness, injury and preventive services are eligible

Diagnostic Imaging and Laboratory Services Covered

Outpatient Hospital, Surgical Center or Urgent Care Facility Covered

Professional Ground and Air Ambulance Covered

Emergency Room Covered

• $75 emergency room fee—waived if admitted to the hospital

Health Care Practitioner Services Covered

Outpatient Physical Medicine  Typically up to $3,000 in benefits

Home Health Care Typically up to 160 hours

Inpatient Rehabilitation Facility Typically up to 90 days

Sub-acute Rehabilitation and Skilled Nursing Facilities Typically up to 90 days

Transplants Covered

Behavioral Health and Substance Abuse Typically inpatient and outpatient benefits are paid at 50% up to $2,500

• Coinsurance does not typically apply to the out-of-pocket maximum

Optional Features Optional features are available at an additional cost.

Optional Benefits and Discount Programs
Typically Dental / Vision Discount Card / Rx Card
NOTE: "Discount programs are not insurance"

Other Benefits May Include
• Prescription "Discount" Program
• Dental "Discount" Program
• Vision "Discount" Program

Typical Exclusions and Limitations

Typical Pre-Existing Condition Limitation
Pre-existing conditions are those medical conditions disclosed or not disclosed on the application which were diagnosed or for which medical advice or treatment was recommended or received from a doctor within a 12-month period immediately preceding the Effective Date of coverage. Any loss due to a pre-existing condition is not covered unless the loss begins more than 12 months after the Effective Date of coverage.
Typically the policy will not cover loss resulting from pre-existing conditions during the first year that your policy is in force. A "pre-existing condition" is any sickness or injury diagnosed for which you received medical advice and /or treatment was received from or recommended by a physician within the 90 day period immediately before the effective date of Your coverage, or the effective date of an increase in coverage, whichever is applicable.

Typical Exceptions and Limitations
• war or act of war, whether declared or not ;
• intentionally self-inflicted injury;
• mental illness or nervous disorders without demonstrable organic disease (loss due to Parkinson’s Disease, Alzheimer’s Disease or senile dementia is covered);
• normal pregnancy and childbirth; complications of pregnancy, however,
will be covered as a sickness (this exception does not apply to Montana applicants);
• treatment of an injury that results from your commission of, or attempt to commit a felony, or from you being engaged in an illegal activity (or for Nebraska applicants, an illegal occupation; or for Vermont applicants, treatment of an injury that results from Your participation in a felony);
• cosmetic surgery; cosmetic surgery does not include reconstructive surgery which is incidental because of previous surgery due to trauma, infection, or other disease of the involved part; 
• confinement in a hospital located or care received outside of the territorial limits of the United States of America, its commonwealth partners, or the countries of Canada and Mexico;
• being intoxicated or under the influence of alcohol or a narcotic,  unless administered on the advice of a Physician

Typical Benefit Limitations
• Outpatient Benefit maximum is $1,000.00 per calendar year per covered adult and for each covered child.
• Doctor's office visits are limited to 10 per calendar year for adults, 5 per calendar year for all children combined.
• Doctor's office calls are limited to one call per week