Medical Plan Maximums

This plan provides each individual with up to $325,000 (effective 1/1/2008) of coverage for covered medical expenses each calendar year. Included within the $325,000 (effective 1/1/2008) maximum are the following benefit maximums. If expenses exceed these maximums, this plan will not pay the additional costs.

1. Allergy testing – Annual maximum of $600.
2. Chemical dependency – Lifetime maximum of $2,500.
3. Chiropractic care – Annual maximum of $750.
4. Home health care – Annual maximum of $5,000 for non-Medicare individuals and $1,500 for Medicare individuals.
5. Hospice care – Maximum of 14 inpatient days for hospice care. Skilled care in the home is limited to 60 visits. Respite care is limited to 120 hours per three-month period.
6. Mental health care (inpatient) – Annual maximum of 15 days.
7. Mental health care (outpatient) – Annual maximum of 30 visits.
8. Neurodevelopmental therapy (children age six and under) – Annual maximum of $1,500.
9. Neuropsychological assessments or tests – Annual maximum of $600 with a lifetime maximum of $1,200.
10. Preventive care (children) – $400 maximum during first year of life (0 months through 11 months), $300 maximum during second year of life (12 months through 23 months) and $200 annual maximum during third through eighteenth year of life (24 months through 18 years).
11. Rehabilitation care (inpatient) – Annual maximum of $24,000.
12. Rehabilitation care (outpatient) – Annual maximum of $2,000.
13. Skilled nursing facility – Annual maximum of $5,000.
14. Transplants (donor organ procurement costs) – Maximum of $25,000 per transplant.