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Last Updated
Friday, February 23, 2001
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Plan Options Available:
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Maternity
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Yes
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Dental
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No
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Life
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Yes
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Disability
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No
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Plan Availability:
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Fortis uses some of the biggest PPO network is each area. PHCS, Sagamore and HealthLink are among some of the networks in Illinois and Indiana.
Read more about MSA's on our web by Clicking here.
See a comparison of a traditional PPO plan to an MSA by Clicking Here
Those buying an MSA, may want to supplement their plan with a specialty
product. Check out the TRI-Rx Plus
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The following summary is NOT a solicitation to sell you insurance. Solicitations can only be made with state, and insurance company,
approved brochures. Information contained in this web may contain generalities or inaccuracies. Please read the brochures and policies for specific limitations and exclusions.
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Preferred 1000 Plans- Underlying MSA
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Calendar Year Deductible-
1 per family
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Individual : $ 1,500 or $ 2,250
Family : $ 3,000, $ 4,000, or $4,500
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Benefit Description
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In Network Benefits
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Out of Network Benefits
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Coinsurance
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100 %
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80%
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Out of pocket max.. plus deductible, (1x per family)
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0
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$ 1,000
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Benefits
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Hospital Facility and Services
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Covers semi private room, if none available, pays Private room rate
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Intensive Care
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Covered at charged rate
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Ambulatory Outpatient surgical Service
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At a hospital or other licensed medical facility
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Emergency Room
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Covered subject to an additional $50 copayment for all emergency room visits. If admitted, copayment will be waived.
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Physician Services
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Treatment for covered
injury or illness including surgery and anesthesia services.
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Office Visits
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Covered subject to family deductible.
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Lab & Xray
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Covered subject to family deductible.
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Ground /Air Ambulance
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For emergency treatment to nearest hospital that can treat.
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Wellness Services
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$500 per covered person per calendar year. .
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Prescription Drug Program
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Covered subject to family deductible
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Mental Nervous Disorder
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- 100% benefit after deductible
- $2500 inpatient max/calendar year.
- $500 outpatient max/calendar year.
- Coverage for family and marriage counseling.
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- Outpatient Rehab Services
- Inpatient rehab
- Home Health Care
- Skilled Nursing facility
- Spine/Neck/Back Treatment
- TMJ
- Organ Transplants
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- Occupational ,physical, speech and cardiac Rehab to $3000 per year.
- 100% coverage for 30 days
- 100% coverage, 160 hours/year.
- 100% coverage . 30 days
- $750 calendar year max.
- $1000 Lifetime max
- $5,000,000 lifetime at designated provider, $100,000 lifetime per organ at non designated provider
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LIFETIME MAXIMUM
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$5,000,000
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Optional Benefits
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Materntity - if selected-
covered as any illness. No coverage if conception takes place prior to being insured for 270 days.
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Maternity services include
- Prenatal Care
- Normal delivery Services
- routine newborn nursery at hospital.
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Accidental injury benefit
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Option of $300, $500, or $1000 per incident.
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- 12 month rate guarantee
- Dependents covered until age 19, or ’til age 24 if full-time student.
- Dependents may convert to individual plans without evidence of insurability if they lose eligibility.
- If no prior coverage, there is a 15-day waiting period for coverage.
- No preexisting condition for any condition disclosed on application and not excluded. Otherwise, 12 months.
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