Because of the increasing cost of healthcare, the cost of major medical insurance continues to increase. In an effort to control these increases, insurance companies as well as many employer sponsored group major medical plans are issuing policies with higher deductibles, copays and co-insurance requirements. This has resulted in substantially increased “out-of-pocket” costs to many individuals and families when the use of their major medical policies becomes necessary. These increased costs can easily total several thousand dollars. In fact, The First Dollar Plan may even help to reduce your cost of maintaining major medical insurance by allowing you to purchase a major medical policy with a higher deductible and co-insurance requirement – and correspondingly lower premiums.
Detailed information about these and additional covered expenses is listed in the Policy. Not all covered expenses apply in every state, and additional expenses might be covered in your state. Consult the Policy for provisions in your state.
The Outpatient Benefits are paid on a “per person per calendar year” basis, with a family maximum limit of two (2) times the “per person” limit. This maximum applies to the entire family unit, regardless of the number of covered persons within the family unit. The benefit paid for any single family member cannot exceed the “per person” limit. The total calendar year “per person” maximum First Dollar Plan benefit payable, whether paid as Inpatient or Outpatient shall not exceed the maximum Inpatient benefit for the First Dollar Plan selected. This policy does not pay 100% of out-of-pocket expenses. Exclusions, limitations and other provisions may apply. $3,000 Calendar Year Deductible; Co-Insurance = 80%/20%; Maximum Out-of- Pocket – $6,350 The insured is admitted as in-patient to hospital. Total charges for the hospital, tests, physician’s fees, etc. equal $30,000.
*$30,000 minus $3,0000 deductible = $27,000. Co-insurance requires you to pay 20% of the $27,000 up to the total Out-of-Pocket policy maximum of $6,350, which includes the $3,000 deductible. The insured has an out-patient MRI. Total billed MRI charges including facility, radiologist read/consult equal $6,000.
**$6,000 minus $3,0000 deductible = $3,000. Co-insurance requires you to pay 20% of the $3,000 up to the total Out-of-Pocket policy maximum of $6,350, which includes the $3,000 deductible The total calendar year “per person” maximum benefit payable, whether paid as In-Patient or Out-Patient benefits, shall not exceed the total In-Patient benefit for the plan selected. Claims examples are for illustrative purposes only. Each insured person’s coverage may be different based on the plan design and specific situation. All benefits are subject to the exclusions and limitations outlined in both the major medical plan and First Dollar Plan policy and riders. The example listed herein assumes that all incurred charges are covered under both policies, no incurred charges are excluded, and no limitations have been applied. The total calendar year “per person” maximum benefit payable, whether paid as In-Patient or Out-Patient benefits, shall not exceed the total In-Patient benefit for the plan selected. Claims examples are for illustrative purposes only. Each insured person’s coverage may be different based on the plan design and specific situation. All benefits are subject to the exclusions and limitations outlined in both the major medical plan and First Dollar Plan policy and riders. The example listed herein assumes that all incurred charges are covered under both policies, no incurred charges are excluded, and no limitations have been applied. For The Full Details Of Your First Dollar Plan, Please Download the Form Below |