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myBenefits at a Glance

The highlights below are provided as general information. Coverage for eligible costs are based on the contract detail. Reasonable and customary rates will be applied. Select the benefit for additional coverage details.

Ambulance:
Reimbursed at 80% to a maximum of $250 per occurrence.

Prescription Drugs:
Reimbursed at 80% to a maximum of $3,000 per benefit year.
Based on the National Formulary with a generic rider.

Health Practitioners:
The services of paramedical practitioners are reimbursed at 80% to a maximum of $20 per visit. Each service has an overall plan maximum of $300 per benefit year. Practitioners must be registered and licensed in their field of practice.

Medical Equipment & Supplies:
Reimbursed at 80%. A physician's prescription is required. Pre-authorization is suggested.

Dental Coverage:
Exams covered at 80% once per benefit year. Overall plan maximum of $750 per benefit year.

Dental Accident:
Reimbursed at 80% to a maximum of $1,000 per accident.
(services must be performed within 12 months of accident; authorization required)

Travel Insurance:
$2 million of coverage for emergencies and illnesses while traveling.

Tutorial:
After 15 days of confinement due to illness or injury.


NOTE: In the event of any discrepancy between the information herein and our contract with the insurer, the terms of the contract will apply.

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