Benefits

This web page is only a summary of benefits and exclusions. Please read the brochure in its entirety before applying for coverage.

After satisfying the deductible amount you've selected, Secure 12x3 STM will pay the coinsurance you've selected for covered expenses, up to a maximum of $750,000 per Insured person per Coverage Period.

The benefits are limited to the usual, reasonable, and customary charge for a covered expense in addition to any specific limits.

Doctor's Office Visit: up to $25 per visit, up to four visits per coverage period. After hte office visit,t he balance of the charge is subject to the plan deductible and coinsurance up to $1,000 per Coverage Period.

In-Hospital Regular Care charges: up to $1,000 per day; includes daily room and board and all miscellaneous charges.

In-Hospital Intensive of Critical Care charges: 3 times the average semi-private room rate up to $1,250 per day; includes daily room and board and all miscellaneous charges.

Outpatient Hospital Surgery & Ambulatory Surgical Center charges: up to $1,000 per day includes the emergency room physician charge, 24 hour surveillance and all miscellaneous charges.

Out-Patient Emergency Room: up to $500 per day, includes the emergency room physician charge, 24 hour surveillance and all miscellaneous charges.

In-Hospital Doctors visits: up to $500 maximum per hospital stay.

Surgeon and Anesthesiologist: up to $2,500 per procedure up to $5,000 maximum per Coverage Period.

Out-Patient or Doctors Office miscellaneous charges: up to $1,000 per Coverage Period

Ambulance Services: up to $250 per emergency.

Organ Transplants: $150,00 maximum per Coverage Period.

AIDS: $10,000 maximum per Coverage Period.

Mammography: covered subject to deductibles, coinsurance and any specific limits.

Pap Smear and Screen: covered subject to deductibles, coinsurance and any specific limits.

Miscellaneous charges where indicated includes: X-rays, scans, laboratory, blood, therapy, oxygen, casts, splints, medicines, injections, chemotherapy and medical supplies.

In addition to your insurance plan, you'll also enjoy acces to discoutns on prescription drugs through our Rx Drug Card in over 42,000 pharmacies nationwide. The Rx Drug Card is not an insurance benefit and therefore there is no deductible, no claim forms and no pre-existing conditions. The Rx Drug Card is intended to help you find low cost medications within the same therapeutic class as a drug you may currently be taking. With this formulary program you pay up to $10 for Generic Drugs, or up to $20 or $50 for Brand Name and Select Generic Drugs or a special discount ont he retail cost of Brand Name Drugs.

This coverage also entitles you to discounts on the following services or purchases: Vitamins, Chiropractic Services, Vision eyeware care, Dental services.

Exclusions

• Pre Existing Conditions
• Any services that are not medically ncessary
• Eye exams, eyeglasses, hearing aids and surgery
• Dental or orthodonic services
• Treatment of foot conditions
• Conditions resulting from an act of war
• Maternity and newborn treatment prior to discharge, any infertility treatments or sterilization treatments
• Spinal manipulation or adjustment
• Services performed by family members or for which a charge would not otherwise be incurred
• Medical care received outside of the United States, Canada, or its possessions
• Services payable by Medicare or Workers' Compensation coverage
• Cosmetic surgery, treatment for acne, hair loss or varicose veins
• Transplant services to the transplant donor
• Routine physical exams and tests, preventive care and immunizations
• Experimental or investigational services
• Learning disorders, attentiond eficit disorder, hyperactivity or autism
• Mental or nervous disorders, depression, or suicide attempt
• Alcohol or drug dependency and disorders
• Obesity treatments
• Sleep disorders
• Over-the-counter medications and prescription drugs
• Participation in school or or organized competitive sports or any high risk sport
• Certain surgeries during the first six months

If you have any questions about these benefits or exclusions, please feel free to call our office at (513) 424-5305 to consult with one of our experienced agents.