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Family deductible
When three covered persons in a family each satisfy their deductible, the deductibles for any
remaining covered family members are deemed satisfied for the remainder of the coverage period.
Covered expenses
All benefits are subject to the selected plan deductible and coinsurance. Covered expenses are
limited by the usual, reasonable and customary charge as well as any benefit-specific maximum.
If a benefit-specific maximum does not apply to the covered expense, benefits are limited by the
coverage-period maximum. Benefits may vary by state.
Covered expenses include treatment, services and supplies for:
• Inpatient physician office visits
• X-ray exams, laboratory tests and analysis
• Mammography, Pap smear and prostate antigen test (covered at specific age intervals; not
subject to deductible)
• Emergency room, outpatient facility or ambulatory surgical center charges
• Surgeon services in the hospital or ambulatory surgical center
• Services when a doctor administers anesthetics not to exceed 20 percent of the primary
surgeon’s covered charges
• Assistant surgeon and surgeon’s assistant services not to exceed 20 percent of the primary
surgeon’s covered charges
• Ground ambulance services not to exceed $500 per occurrence
• Air ambulance services not to exceed $1,000 per occurrence
• Organ, tissue, or bone marrow transplants not to exceed $150,000 per coverage period
• Acquired Immune Deficiency Syndrome (AIDS) not to exceed $10,000 per coverage period
• Blood or blood plasma and their administration, if not replaced
• Oxygen, casts, non-dental splints, crutches, non-orthodontic braces, radiation and
chemotherapy services and equipment rental
Inpatient covered expenses
• Room and board, doctor visits and general nursing care not to exceed the most common
average semi-private room rate
• Intensive care or specialized care unit not to exceed three times the average semi-private
room rate
• Prescription drugs administered while hospital confined
Precertification
Precertification is required prior to each inpatient confinement for injury or illness and outpatient
chemotherapy or radiation treatment, at least seven days prior to receiving treatment. Emergency
inpatient confinements must be pre-certified within 48 hours following the admission, or as soon
as reasonably possible. Precertification may also be conducted for a continued stay review for an
ongoing inpatient confinement. Benefits are not paid for days of inpatient confinement which extend
beyond the number of days deemed medically necessary. Failure to complete precertification will
result in a benefit reduction of 50 percent which would have otherwise been paid unless the covered
person is incapacitated or unable to contact the administrator. Precertification is not a guarantee of
benefits. Precertification is not required in some states.
Brochure Secure Lite 2018 5
When three covered persons in a family each satisfy their deductible, the deductibles for any
remaining covered family members are deemed satisfied for the remainder of the coverage period.
Covered expenses
All benefits are subject to the selected plan deductible and coinsurance. Covered expenses are
limited by the usual, reasonable and customary charge as well as any benefit-specific maximum.
If a benefit-specific maximum does not apply to the covered expense, benefits are limited by the
coverage-period maximum. Benefits may vary by state.
Covered expenses include treatment, services and supplies for:
• Inpatient physician office visits
• X-ray exams, laboratory tests and analysis
• Mammography, Pap smear and prostate antigen test (covered at specific age intervals; not
subject to deductible)
• Emergency room, outpatient facility or ambulatory surgical center charges
• Surgeon services in the hospital or ambulatory surgical center
• Services when a doctor administers anesthetics not to exceed 20 percent of the primary
surgeon’s covered charges
• Assistant surgeon and surgeon’s assistant services not to exceed 20 percent of the primary
surgeon’s covered charges
• Ground ambulance services not to exceed $500 per occurrence
• Air ambulance services not to exceed $1,000 per occurrence
• Organ, tissue, or bone marrow transplants not to exceed $150,000 per coverage period
• Acquired Immune Deficiency Syndrome (AIDS) not to exceed $10,000 per coverage period
• Blood or blood plasma and their administration, if not replaced
• Oxygen, casts, non-dental splints, crutches, non-orthodontic braces, radiation and
chemotherapy services and equipment rental
Inpatient covered expenses
• Room and board, doctor visits and general nursing care not to exceed the most common
average semi-private room rate
• Intensive care or specialized care unit not to exceed three times the average semi-private
room rate
• Prescription drugs administered while hospital confined
Precertification
Precertification is required prior to each inpatient confinement for injury or illness and outpatient
chemotherapy or radiation treatment, at least seven days prior to receiving treatment. Emergency
inpatient confinements must be pre-certified within 48 hours following the admission, or as soon
as reasonably possible. Precertification may also be conducted for a continued stay review for an
ongoing inpatient confinement. Benefits are not paid for days of inpatient confinement which extend
beyond the number of days deemed medically necessary. Failure to complete precertification will
result in a benefit reduction of 50 percent which would have otherwise been paid unless the covered
person is incapacitated or unable to contact the administrator. Precertification is not a guarantee of
benefits. Precertification is not required in some states.
Brochure Secure Lite 2018 5
