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Benefits At A Glance |
 Major Medial Insurance Company |
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(click here for out-of-network benefit summary) |
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Unless otherwise stated, all benefits are payable after yearly deductible is met |
$2,550 Family Ded. 100/60% Plan |
$5,000 Family Ded. 100/60% Plan |
$10,000 Family Ded. 100/60% Plan |
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| Annual Deductible |
$2,550 Family |
$5,000 Family |
$10,000 Family |
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| Office Visits - (PPO Physicians and Specialists-includes X-ray and lab work only when performed and billed by the physician's office) |
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| Preventive Care for Babies and Children (through age 5) |
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Preventive
Screenings for Adults (unlimited yearly max) Colonscopy will be paid at 100% after the yearly deductible is met. |
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| Mammograms |
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Covered at 100% - no copay |
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Professional
Services Including surgery, anesthesia, in-hospital physician care, diagnostic X-ray and lab. |
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Inpatient
Hospital Services Surgery, x-ray, in-hospital physician visits, organ/tissue transplants |
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| Maternity |
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| Outpatient Medical Care |
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Short
Term Therapies: Physical/Occupational/Speech Respiratory Therapy, Cardiac and Pulmonary Rehabilitation (no limit on # of visits) Developmental Delay is not covered |
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| Chiropractic Services |
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Mental Health- Available only by purchase of an additional rider for $20.73/month (rider gives 48 O/P Vis & 30 I/P days per yr.) |
Available only by purchasing a Rider | Available only by purchasing a Rider | Available only by purchasing a Rider | |
| Infusion Therapy/Chemotherapy |
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Emergency
Room Care - For Medical Emergency or Serious Accidental Injury (Non emergency use of the emergency room is not a covered benefit) |
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| Urgent Care |
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| Ambulatory Surgical Center |
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Ambulance
Service (Emergency or Medically Necessary Only) |
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| Hospice |
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Home Health
Care - Limited to 30 days, in and out of network combined |
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Durable
Medical Equipment, Prosthetics and Orthoses limited to $2,500 annual max, all combined |
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Skilled
Nursing Facility Limited to 30 days, in and out of network combined |
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| Transplants |
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Prescription
Drugs - Retail Drugs - per prescription (up to a 30-day supply-mail order available) |
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| Tier 1 (Generic Drugs) |
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| Tier 2 (Formulary Brand) |
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| Tier 3 (Non-Formulary Brand) |
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| Tier 4 (self edministered injectables) |
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| Dental ( all care must be received from a DeltaCare provider. |
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| Vision - one exam every 12 months (care must be received from an Avesis provider) |
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Waiting period
for all undisclosed pre-existing conditions is at least one year
from contract effective date. *Refer to your individual certificate of coverage for complete benefit details (As with all insurance providers, not disclosing known prexisting conditions could result in termination of your benefits) |
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Click here for monthly HSA
rates and an individual HSA health insurance quote Click here to have an enrollment kit mailed or emailed to you (be sure to specify which plan you're interested in) |
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CLICK HERE TO DOWNLOAD AND
PRINT AN APPLICATION (Adobe Acrobat reader is necessary to download this file.) Click here to download the free Adobe Acrobat reader |
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 9 Dunwoody Park Suite 136 Atlanta, GA 30338 |
(770) 396-9517 Outside of the Atlanta area, call toll-free: 1-877-711-8376. Email: holly@insurance-now.com |
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