GroupSecureSM Group Health Insurance
GroupSecureSM Group Health Insurance Optional Riders
Optional Benefit Packages
| Benefit | Limit |
| Preventative Package |
Preventative benefits are available after 12 months of coverage and are not subject to Deductible
Dependent children under age 19: $75 per visit (including immunizations), maximum of 3 visits per Calendar Year Employees and Dependents age 30 and above: $250 per Insured Person per Calendar Year Female Insured Persons age 40 and over (or qualifying Woman at Risk as herein defined): $100 per Insured Person per Calendar Year for a screening mammogram |
| Emergency Assistance Package |
Emergency Medical Evacuation: for Insured Persons under the age of 65
Option 1: $50,000 Lifetime Maximum Option 2: $100,000 Lifetime Maximum Option 3: $150,000 Lifetime Maximum Emergency Reunion: $15,000 per Calendar Year Repatriation of Remains: $25,000 Maximum per Insured Person |
| Mental Health Disorders |
$25,000 Lifetime Maximum after 12 months of continuous coverage, subject to the following sub limits:
Outpatient Treatment: 50% of a maximum charge of $100 per visit with a maximum of 52 visits per Calendar Year per Insured Person Inpatient Treatment: $10,000 per Calendar Year per Insured Person |
| Hospital Indemnity | $100 per day, seven day maximum (excluding hospitalization for maternity) |
| Vision Package | After 12 months of continuous coverage and subject to $50 Deductible. Covered up to $150 every 24 months for routine eye exam. Covered up to $100 every 24 months for corrective lenses, contacts or frames |
| Term Life and AD&D | For groups with 10 or fewer employees, group term life insurance is automatically included. For larger groups, term life coverage is optional. Life insurance is available in amounts of $10,000, $25,000, $50,000, or a multiple of salary up to $125,000 |
| Outpatient Precription Benefits | ||
| Option | Benefit | Subjec to Deductible and Coinsurance |
| Option 1 | Drug card (US only): =`> Co-pay generic =}: Co-pay brand name (including mail order) | No* |
| Option 2 | Usual, Reasonable and Customary charges | Yes |
| Option 3 | 50% of Usual Reasonable and Customary charges | Yes |
| Dental Benefits | |||
| Type | Option 1 | Option 2 | Option 3 |
| Plan Maximum | $1,000 | $1,000 | $1,500 |
| Deductible (Max 3 per family) | $100 | $50 | $0 |
| Class A - Preventative and Diagnostic | 100% | 100% | 100% |
| Class B - Basic Dental Procedures | 80% | 80% | 80% |
| Class C - Major Dental Procedures | 50% | 50% | 50% |
| Orthodontia - ($2,000 Life Max) | No Coverage | 50% | 50% |
Outpatient Prescription Drug Card
If this option is selected, each employee will receive a Prescription Drug Card recognized by 98% of the pharmacy outlets in the U.S.
If this option is selected, each employee will receive a Prescription Drug Card recognized by 98% of the pharmacy outlets in the U.S.