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Maternity

Maternity

  • Waiting Period: 10 Months from inception of coverage (Conception date must be at least 30 days from inception)
  • Normal Delivery (100%): $6,000.00
  • Caesarean Section: Subject to UCR & Coinsurance
  • Dilation & Curettage (100%): $3,000.00
  • Pre-Natal Maximum (100%, included in Maternity Maximum): $2,500.00

Note: Members Up To Age 59 Only; Subject to deductible & UCRs unless noted

New-Born Care and Congenital Birth Defects

  • Calendar Year Maximum $100,000.00

Note: Subject to UCR and Co-Insurance

Preventative Care Benefits

  • Annual Medical Examination Comprising: Blood Pressure Testing, Respiratory Testing, Complete Urinalysis, Complete Blood Testing, Glucose Testing
  • Annual Lipid Profile
  • Annual Mammogram for Females
  • Annual CA125 Test for Ovarian Cancer (for High Risk Women as recommended by a Physician)
  • Annual Pap Smear
  • Annual Test For Prostate Cancer
  • Annual Glaucoma Test
  • Vaccinations/Immunisations for children up to age 5

Note:

  1. 100% Of UCR; Calendar Year Maximums $1,800.00.
  2. Services must be provided by a Physician; Only 1 Preventative Care Doctor Visit is payable per Year.

Dental Care Benefit

  • Maximum Benefit Calendar Year: $3,500.00
  • Deductible per Calendar Year: $100.00
  • Waiting Period: 3 months

Note: Subject to UCR and Co-Insurance

Vision Care Benefit

  • Maximum Benefit Calendar Year: $1,500.00
  • Contact Lenses (Included in Vision Maximum Benefit): $750.00
  • Deductible: $100.00
  • Co-Insurance: 80%-20%
  • Waiting Period: 3 months

Note: Subject to UCR and Co-Insurance

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