American Medical Security| Physician Charges:* |  -- |
| Office or Hospital Visit | 100% after $30 CoPay per visit |
| Home Health Care Visit | 100% after $50 CoPay per visit |
| Pathology (Lab) Tests Radiology (X-ray) Tests | 100% after $15 CoPay per visit 100% after $50 CoPay per visit |
| Surgery or Anesthesiology Fee | 100% after $75 CoPay per visit |
| Psychiatric Visit & Inpatient & Outpatient | 100% after $75 CoPay per visit (No daily maximum) |
| Hospital and Other Facility Charges:* | -- |
| Inpatient & Intensive Care (Includes pre-admission testing) | 100% after $400 CoPay per confinement |
| Outpatient Care (Includes facility, X-ray lab) | 100% after $400 CoPay per visit |
| One Day Surgery | 100% After $400 CoPay |
| Mammogram - outpatient routine (without facilty charge) | 100% after $50 CoPay |
| Emergency Room (No CoPay if immediately confined) | 100% after $400 CoPay per visit |
| Psychiatric Care Inpatient & Outpatient |
100% after $400 CoPay (No daily Max.) |
| Prescription Drug Benefit: * | -- |
| PCS Drug Card | 100% after $25 CoPay |
| Plan Maximums:* | -- |
| Lifetime Maximum | $2,500,000 |
| Deductible | None |
| Co-insurance (Non-psych) | 100% |
| Out-of-Pocket Maximum (Non-psych & non-PCS) Single: Family: |
$3,500 $7,000 (Accumulated CoPays) |
| Psychiatric Care Maximums Inpatient: Outpatient: | $2,500 per year $500 per year |
| Psychiatric Care Lifetime Maximum | $10,000 |
| Non-PPO Plan Maximums | -- |
| Calendar Year Deductible | $600 (Max. 2 per family) |
| Coinsurance Limits | 70% of $17,500 then 100% |
| Calendar Year Out of Pocket: Single: Family: | $ 5,850 $11,700 |
*
Physician Charges: These are charges from the medical
professionals you receive treatment from. Examples include physicians, physical
therapists, home health care providers, and surgeons.
Hospital & Other Facility Charges: These charges are
from the actual facility where you receive treatment. Examples include hospitals,
surgical centers, and emergency rooms.
Prescription Drug Benefit: Present your Medical Security
identification card to a participating pharmacy and the generic brand is
covered after a CoPayment. If the generic brand is not available, a brand
name drug will be dispensed for the same CoPay.
Employee Assistance Program (EAP): The EAP offers confidential assessment, intervention , and referral services for educational concerns, addiction treatment, mental health needs, domestic issues, financial management, and legal concerns.
Non-PPO Plan Maximums: (Covered non-PPO expenses are reimbursed to the Maximum Allowable Charge.)
This is an outline of benefits used for the sole purpose of educating agents and is not to be used for sales presentations to prospective clients. Contact your regional or district sales office for additional information and marketing supplies.