Injury and Sickness Benefits
Up to $500,000 Maximum Benefit (For Each Injury or Sickness)
Deductible $0
Coinsurance Preferred Providers 100% except as noted below
Coinsurance Out-of-Network 70% except as noted below
The Preferred Provider for this plan is UnitedHealthcare Options PPO.
If care is received from a Preferred Provider, any Covered Medical Expenses will be paid at the Preferred Provider level of benefits. If a Preferred Provider is not available in the Network Area, benefits will be paid at the level of benefits shown as Preferred Provider benefits. If the Covered Medical Expense is incurred due to a Medical Emergency, benefits will be paid at the Preferred Provider level of benefits.
The Policy provides benefits for the Covered Medical Expense incurred by an Insured Person for loss due to a covered Injury or Sickness up to the Maximum Benefit of $500,000 for each Injury or Sickness.
Benefits are subject to the policy Maximum Benefit unless otherwise specifically stated. Benefits will be paid up to the maximum benefit for each service as scheduled below. All benefit maximums are combined Preferred Provider and Out-of-
Network unless otherwise specifically stated. Covered Medical Expenses include: