Employee Choice

EMPLOYEE CHOICE ACCIDENT MAX BENEFIT
PLAN YEAR MAX $1,500, $5,000 or $10,000
ANNUAL MAX PER ACCIDENT $1,500, $5,000 or $10,000
INITIAL TREATMENT PERIOD 7 DAYS
DEDUCTIBLE PER ACCIDENT $50

INITIAL VISIT: PRIMARY CARE $150
INITIAL VISIT: URGENT CARE $150
INITIAL VISIT: ER $500
HOSPITAL CONFINEMENT Up to annual MAX


HOSPITAL EXPENSES (supplies, tests, etc) up to annual MAX
DR. FEES Up to annual MAX
ANESTHESIA SERVICES Up to annual MAX
PHYSICIAN FOLLOWUP VISITS (LIMIT 2x/person/accident) $75
AMBULANCE $250

XRAY, IMAGING, LABS $250
DURABLE MED EQUIPMENT $100
PRESCRIPTION DRUGS $500
DENTAL TREATMENT FOR INJURED TEETH $250/tooth ; MAX $500
PHYS. OCCU., or SPEECH THERAPY (LIMIT 10x per individual per accident) $60 first visit ; $30 subsequent
Wellness Benefit (with $5k or $10k plans) $60 per member per year(excludes children)