Inpatient Mental Health | 100% up to 60 days |
Outpatient Mental Health | 75% up to 40 visits/ 60% thereafter |
Ambulatory Surgical Center | 100% |
Ambulance Service | 100% |
Accidental Death and Dismemberment | Deductible is waived. Maximum Benefit Principal Sum up to $10,000 |
Repatriation of Remains | Deductible is waived. Maximum Benefit up to $25,000 |
Medical Evacuation | Deductible is waived. Maximum Lifetime Benefit for all Evacuations up to $250,000 |
Inpatient Mental Health | 80% up to 60 days |
Outpatient Mental Health | 75% up to 40 visits/ 60% thereafter |
Ambulatory Surgical Center | 80% to Coinsurance Maximum then 100% |
Ambulance Service | 80% to Coinsurance Maximum then 100% |
Accidental Death and Dismemberment | Deductible is waived. Maximum Benefit Principal Sum up to $10,000 |
Repatriation of Remains | Deductible is waived. Maximum Benefit up to $25,000 |
Medical Evacuation | Deductible is waived. Maximum Lifetime Benefit for all Evacuations up to $250,000 |
Inpatient Mental Health | 60% up to 60 days |
Outpatient Mental Health | 75% up to 40 visits/ 60% thereafter |
Ambulatory Surgical Center | 60% to Coinsurance Maximum then 100% |
Ambulance Service | 60% to Coinsurance Maximum then 100% |
Accidental Death and Dismemberment | Deductible is waived. Maximum Benefit Principal Sum up to $10,000 |
Repatriation of Remains | Deductible is waived. Maximum Benefit up to $25,000 |
Medical Evacuation | Deductible is waived. Maximum Lifetime Benefit for all Evacuations up to $250,000 |