|
Plan J 2010
or High Deductible Plan
J**
MEDICARE (PART A) -
HOSPITAL SERVICES - PER
BENEFIT PERIOD |
* A benefit period
begins on the first day
you receive service as
an inpatient in a
hospital and ends after
you have been out of the
hospital and have not
received skilled care in
any other facility for
60 days in a row.
**
We do not recommend
The High Deductible plan
J. Plan J
without the high
deductible is very
recommended. This high deductible
plan pays the same or
offers the same benefits
as Plan J after you have
paid a calendar year
$2000
deductible. Benefits
from the high deductible
Plan J will not begin
until out-of-pocket
expenses are
$2000. Out-of-pocket
expenses for this
deductible are expenses
that would ordinarily be
paid by the policy. This
includes the Medicare
deductibles for Part A
and Part B, but does not
include the plan's
separate foreign travel
emergency and
prescription drug
deductibles. |
Service: |
HOSPITALIZATION*
Semiprivate room and
board, general nursing
and miscellaneous
services and supplies: |
|
MEDICARE PAYS |
PLAN PAYS |
YOU PAY |
First 60 days |
All but $1,100 |
$1,100 (Part A
Deductible) |
$0 |
61st through 90th day |
All but $275 a day |
$275 a day |
$0 |
91st day and after: |
|
|
|
While using 60 lifetime
reserve days |
All but $550 a day |
$550 a day |
$0 |
Once lifetime reserve
days are used: |
|
|
|
Additional 365 days |
$0 |
100% of Medicare
Eligible Expenses |
$0** |
Beyond the Additional
365 days |
$0 |
$0 |
All costs |
Service: |
SKILLED NURSING
FACILITY CARE *
You must meet Medicare's
requirements, including
having been in a
hospital for at least 3
days and entered a
Medicare-approved
facility within 30 days
after leaving the
hospital: |
First 20 days |
All approved amounts |
$0 |
$0 |
21st through 100th day |
All
but $137.50 a day |
Up to
$137.50 a day |
$0 |
101st day and after |
$0 |
$0 |
All costs |
Service: |
BLOOD
|
First 3 pints |
$0 |
3 pints |
$0 |
Additional amounts |
100% |
$0 |
$0 |
Service: |
HOSPICE CARE
Available as long as
your doctor certifies
you are terminally ill
and you elect to receive
these services. |
|
All but very limited
coinsurance for
outpatient drugs and
inpatient respite care |
$0 |
Balance |
**NOTICE: When your
Medicare Part A hospital
benefits are exhausted,
the insurer stands in
the place of Medicare
and will pay whatever
amount Medicare would
have paid for up to an
additional 365 days as
provided in the policy's
"Core Benefits." During
this time the hospital
is prohibited from
billing you for the
balance based on any
difference between its
billed charges and the
amount Medicare would
have paid. |
|
Plan J 2010
or High Deductible Plan
J**
MEDICARE (PART B)
- MEDICAL SERVICES - PER
CALENDAR YEAR* |
* Once you have been
billed $155 of
Medicare-Approved
amounts for covered
services (which are
noted with an asterisk),
your Medicare Part B
Deductible will have
been met for the
calendar year.
** The High Deductible
plan J is not
recommended. Plan J
without the high
deductible is very
recommended. This high deductible
plan pays the same or
offers the same benefits
as Plan J after you have
paid a calendar year
$2000
deductible. Benefits
from the high deductible
Plan J will not begin
until out-of-pocket
expenses are $2000.
Out-of-pocket expenses
for this deductible are
expenses that would
ordinarily be paid by
the policy. This
includes the Medicare
deductibles for Part A
and Part B, but does not
include the plan's
separate foreign travel
emergency and
prescription drug
deductibles. |
Service: |
MEDICAL EXPENSES - In
or Out of the Hospital
and Outpatient Hospital
Treatment,
such as Physician's
services, inpatient and
outpatient medical and
surgical services and
supplies, physical and
speech therapy,
diagnostic tests,
durable medical
equipment: |
|
MEDICARE PAYS |
PLAN PAYS |
YOU PAY |
First $155 of Medicare
Approved Amounts* |
$0 |
$155 (Part B Deductible) |
$0 |
Remainder of Medicare
Approved Amounts |
Generally 80% |
Generally 20% |
$0 |
Part B Excess Charges
(Above Medicare Approved
Amounts) |
$0 |
100% |
$0 |
Service: |
BLOOD |
First 3 pints |
$0 |
All costs |
$0 |
Next $155 of Medicare
Approved Amounts* |
$0 |
$155 (Part B Deductible) |
$0 |
Remainder of Medicare
Approved Amounts |
80% |
20% |
$0 |
Service: |
CLINICAL LABORATORY
SERVICES |
Tests for Diagnostic
Services |
100% |
$0 |
$0 |
|
PARTS A & B |
Service: |
HOME HEALTH CARE
Medicare Approved
Services: |
|
MEDICARE PAYS |
PLAN PAYS |
YOU PAY |
Medically necessary
skilled care services
and medical supplies |
100% |
$0 |
$0 |
Durable medical
equipment: |
|
|
|
First $155 of Medicare
Approved Amounts* |
$0 |
$155 (Part B Deductible) |
$0 |
Remainder of Medicare
Approved Amounts |
80% |
20% |
$0 |
Service: |
AT HOME RECOVERY
SERVICES - Not Covered
by Medicare
Home care certified
by your doctor, for
personal care during
recovery from an injury
or sickness for which
Medicare approved a Home
Care Treatment Plan: |
Benefit for each visit |
$0
|
Actual charges up to
$40 per visit
|
Balance
|
Number of visits covered
(must be received within
8 weeks of last Medicare
approved visit) |
0 |
Up to the number of
Medicare approved
visits, not to exceed 7
each week |
Balance |
Calendar year maximum |
$0 |
$1,600 |
Balance |
|
OTHER BENEFITS -
NOT COVERED BY
MEDICARE
|
Service: |
FOREIGN TRAVEL NOT
COVERED BY MEDICARE
Medically necessary
emergency care
services beginning
during the first 60
days of each trip
outside the USA:
|
First $250 each calendar
year |
$0 |
$0 |
$250 |
Remainder of charges |
$0 |
80% to a lifetime
maximum benefit of
$50,000 |
20% and amounts over the
$50,000 lifetime maximum |
Service: |
***PREVENTIVE
MEDICAL CARE
-NOT COVERED BY
MEDICARE
Some annual physical
and preventive tests
and services
administered as
ordered by your doctor
when not covered by
Medicare.
|
First $120 each calendar
year |
$0 |
$120 |
$0 |
Additional charges |
$0 |
$0 |
All costs |
***Medicare benefits are
subject to change.
Please consult the
latest Guide to
Health Insurance for
People with Medicare and
the latest Medicare
Handbook. |