National Media Benefits - Secure Care Plan
Major Medical Plan, $1,000/70/50
Covered Benefits: $1,000,000 Lifetime Maximum Benefit Per Individual
| Benefit | Network | Non-Network | |
| Financial | |||
| Deductible | $1,000 Individual / $3,000 Family | $2,000 Individual / $6,000 Family | |
| Coinsurance | 70% | 50% | |
| Coinsurance Limit | $3,000 Individual / $9,000 Family | $5,000 Individual / $15,000 Family | |
| Lifetime Max Benefit | $2,000,000 Per Individual | $2,000,000 Per Individual | |
| Physician Care | |||
| Office Visit | $25 Co-pay | 50% After Deductible | |
| After Hours/Home | 70% After Deductible | 50% After Deductible | |
| Specialty Care | |||
| Office Visits | $35 Co-pay | 50% After Deductible | |
| Diagnostic Testing | 70% After Deductible | 50% After Deductible | |
| Phys,Occ,Speech Therapy | 70% After Deductible | 50% After Deductible | |
| Outpatient Services | 70% After Deductible | 50% After Deductible | |
| Hospital Services | 70% After Deductible | 50% After Deductible | |
| Skilled Nursing Facility | 70% After Deductible | 50% After Deductible | |
| Emergency Room | 70% After Deductible | 50% After Deductible | |
| Home Care | 70% After Deductible | 50% After Deductible | |
| Maternity | Treated as any other medical condition | Treated as any other medical condition | |
| Mental Health |
$5,000
Maximum Per Year, $25,000 Maximum Lifetime
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| Inpatient | 70% After Ded., Max 14 Days/Yr | 50% After Ded., Max 14 Days/Yr | |
| Outpatient | 70% After Ded., Max 15 Visits/Yr $50/Visit | 50% After Ded., Max 15 Visits/Yr $50/Visit | |
| Substance Abuse |
$5,000
Maximum Per Year, $25,000 Maximum Lifetime
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| Inpatient Rehab | 70% After Ded., Max 14 Days/Yr | 50% After Ded., Max 14 Days/Yr | |
| Outpatient Rehab | 70% After Ded., Max 15 Visits/Yr $50/Visit | 50% After Ded., Max 15 Visits/Yr $50/Visit | |
| Wellness Benefit |
100%
after $20 Co-Pay, Up To $200 Per Calendar Year
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| Covered services include: Routine Physicals with X-ray and Lab Tests, Vaccinations and Inoculations, Pap Smears and OB-GYN Exams, PSA/prostate exams, Mammograms, Flu Shots, & Well Baby Care. | |||
| Chiropractic | $15 Max/Visit, $150 Max/Year | $15 Max/Visit, $150 Max/Year | |
| Prescription Drug |
$15
Generic/ $30 Brand / $50 Non-Formulary
$1,500 Annual Limit Per Individual |
NA | |
| Durable Medical Equipment |
90%
After Deductible
$1,500 Annual Maximum |
70% After Deductible | |
| Vision BenefitsHonored at over 6,500 locations nationally, including J.C. Penny Optical, Sears Optical, Pearle Vision, Target Optical, and more. Annual wellness eye exam for $20 co-pay. Discounts up to 60% on frames, 45% on bifocals & up to 20% on contact lenses. | |||
| Medically Underwritten | The American Media Benefits PPO rates are subject to underwriting approval. | ||
| Dependent Children covered to the end of the 18th year. Coverage
will extend through 23rd year with proof of enrollment at an
accredited learning institution.Pre-Certification required or benefits paid
will be reduced. Emergency Room notification is required within 48 hours.
Pre-Certification determines medical necessity only. It is not a commitment
for payment of any incurred claims expense. THE SUMMARY OF PLAN BENEFITS DESCRIBED HEREIN IS FOR ILLUSTRATIVE PURPOSES ONLY.REFER TO THE PLAN DOCUMENT FOR SPECIFIC BENEFITS AND EXCLUSIONS.Rev. 11-23-01 |
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