Summary of High Option Benefits

 

 

 

Medicare Supplement Part A Benefits  - High Option        Monthly Premium $169.49

 

 

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                                Room and Board Charges up to $75 a day

 

 

Medicare Supplement Part B Benefits – High Option

 

 

Benefit                                                  Amount Payable

 

Medical Care                                       20% of Medicare Eligible Expenses

 

Expenses That Are More

Than Medicare Considers

Reasonable                                           The difference between the Usual and Customary Charge and the Medicare Eligible Expense after the Out-Of-Pocket Expense Amount

 

 

Out-Of-Pocket Expense Amount -  $500.00

 

 

Additional Medicare Supplement Benefits – High Option

 

Benefit                                                  Amount Payable

 

Hospice Care                                       Medicare Coinsurance Charges for prescription drugs and in-patient  respite care

 

Medicare Part B Deductible                  Medicare Part B Deductible

 

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

Traveling 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        

 

Please click here for a Summary Plan Description for this plan.