Optional Benefits

Further customize your health Insurance coverage to meet your specific needs.  Additional premium required

$5 Million Lifetime Maximum Benefit

Upgrade your coverage to $5,000,000 of covered expenses per person.

Enhanced Preventive Care Benefits Package

This option is available with any Preferred network plan except Copay Select^SM

• $35 copay on each preventive care office visit (primary care, OBGYN, etc.
• The following charges for preventive care that are performed in conjunction with the office visit are exempt from the deductible and coinsurance whether performed in the doctor's office or elsewhere:
  • Child (under age 19) and adult immunizations
  • Mammogram, cervical and Pap smears, PSA
  • Urinalysis and blood tests
  • Bone density screens
  • EKG and cardiac stress tests

Prescription Drug Card Benefit

This option is only available with Plan 100^® and Plan 80^SM
With this benefit, you pay:

• Tier 1 drugs: $15 Copay
• Tiers 2-4 - combined $150 per person, per calendar year deductible , then:
  — Tier 2 drugs: $30 Copay
  — Tier 3 drugs: $60 Copay
  — Tier 4 drugs: you pay 25% coinsurance

(Maximum $3,000 per covered person, per calendar year)

Prescription Drug Benefit Buy-Up

This potion is only available with Copay Select ^SM.  Eliminates the $3,000 annual limit.

Two Additional Doctor Office Visits

This is only available with Copay Saver ^SM.

Increase the number of Copay Doctor Office Visits from 2 to 4 per person, per calendar year.

First-Dollar Accident Benefit

This option is only available with Plan 100^®, Plan 80^SM, Saver 80^SM, Copay Select ^SM, and  Copay Saver ^SM

This benefit provides up-front coverage for unexpected injuries and is limited to your choice of $500 or $1,000 of first-dollar coverage for treatment of an injury within 90 days of an accident.  Plan deductible must be greater than or equal to the maximum benefit amount.

HSA Hospital Indemnity Rider

This option is only available with HSA 100^® and HSA Saver^SM.

HSA Hospital Indemnity Rider is designed to help protect against major hospitalization expenses during the early months of coverage when cash hasn't yet accumulated in your savings account.

Maternity Benefit

This option is only available with Plan 100^®, Plan 80^SM, Saver 80^SM, Copay Select ^SM, and  Copay Saver ^SM.

This optional benefit helps cover the costs for routine pregnancy and delivery.  You pay 20%; we pay 80% of covered expenses.  After 4 benefit years, the maximum covered expense amount is $7,500.

No covered expenses will be considered for reimbursement for a pregnancy beginning before the maternity benefit's effective date