Benefit
Amount
Payable
Hospital
Confinement
Day
of Confinement
1st
to 60th day Medicare
Part A Deductible
61st to 90th
day Daily
Coinsurance Charge (25% of Part A Deductible per day)
Lifetime Reserve Period Daily Coinsurance Charge
(50% of Part A Deductible per day)
After Lifetime Reserve
Period 100% of Hospital
Expenses for an additional 365 days per person
per lifetime
Skilled Nursing Facility
Day of Confinement
1st to 20th
Day Nothing
21st to 100th
Day Daily
Coinsurance Charge (12 ½ % of Part A Deductible per
day)
101st to 365th
Day Nothing
Benefit Amount Payable
Medical Care 20% of
Medicare Eligible Expenses after the Medicare Part B Deductible
Benefit Amount Payable
Hospice Care Medicare
Coinsurance Charges for prescription drugs and inpatient
respite care
Blood Deductible First 3 pints
of blood under Medicare Part A and Medicare Part B
Foreign Medical Treatment 100% of Foreign Medical
Treatment expenses up to 90 days; first
expense must be Incurred within first 180 days of Covered Person’s travel Outside the United States per Calendar
Year
In-Hospital Private Duty
Nursing Maximum Benefit
Amount: Costs up to $30 per 8-hour shift
Maximum
Number of Shifts: 60 Shifts per Calendar
Year
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plan.