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X-Ray, Lab Tests, Urgent Care, Supplies & More!
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Pays In Addition To Any Other Coverage
|VALUE MED||BENEFITS SCHEDULE||PAYS|
|Doctors Office Visits||Pays up to 10 Doctor Office visits per calendar year for each insured adult and up to 5 per calendar year for all insured children combined. Doctor Office visits are limited to one per week, except in Maryland.||$75 per Visit|
|Outpatient Visits||Pays for X-ray, Lab Tests, Urgent Care, Medical Supplies and & Much More. Pays in the Doctor's Office, Lab or any other Outpatient Facility. Outpatient Benefit maximum per calendar year is $200 per insured and $200 for each covered child.||$100 per vbisit sickness or accident|
|Ambulance Services||Pays ambulance expense per sickness or accident||$200 per sickness or accident|
|Hospital Confinement*||$100 per day, beginning on the 1st day of hospital confinement, up to 365 days||$100 per day|
* Hospital confinement must be medically necessary because of injury or sickness. Our definition of hospital excludes (a) a convalescent home, convalescent, rest or nursing facility; or, (b) a facility or portion thereof used primarily for the care of the aged, the terminally ill, drug or alcoholic rehabilitation, or primarily affording custodial, long-term nursing, convalescent or educational care.
* The benefits may be paid directly to the hospital or other health care facility if an assignment of benefits is made by the policyholder.
** Pre-existing conditions are those medical conditions disclosed or not disclosed on the application which were diagnosed or for which medical advice or treatment was recommended or received from a Doctor within a 12-month period immediately preceding the Effective Date of Your coverage. Any loss due to a pre-existing condition is not covered unless the loss begins more than 12 months* after the Effective Date of coverage. Some states may differ. Please review the policy/certificate carefully.
*** The insurer has the right to increase premium rates of all like policies in your state.
**** Instead of age 19 the following states have higher limits: Indiana age 24, New Mexico age 25, North Dakota age 22 and Utah age 26.
in All Other States Except NY. Group Policy #GP2005 LA Policy Form G0551-LA, ME Policy Form G0551-ME, OR Policy Form G0551-OR, SC Policy Form G0551-SC, MD Policy Form G0551-MD
in AR, ID, IL,KS, MN, MO, NE, NV, NM, ND, OK, SD, TN, TX. Group Policy #UP2005, UT Policy Form U0552-UT, AR Policy Form U0552-AR, OK Policy Form U0552-OK SD Policy Form U0552-SD(R.3/09), WV Policy Form U0552 Guarantee Trust Life Insurance Company is licensed to do business in all states except New York.
You may cancel coverage under this Policy or Certificate within 10 days of receiving it by returning the Policy or Certificate to Us. If it is returned for cancellation, we will refund any premium paid for your coverage. The Policy or Certificate will then be void as of the Effective Date and there will be no coverage. The states of New Hampshire and Oklahoma have a 30-Day Right to Examine Coverage.
any disclaimers here
*ANY DISCLAIMERS HERE.