Page 5 - Nationwide_Care Access Plan
P. 5
Benefit examples*
Indemnity benefit example for inpatient confinement
Plan selected: Value
Medical situation: A covered person is admitted to the hospital with pneumonia and acute respiratory failure. Inpatient
confinement is five days, two of which are in the intensive care unit. The condition was not pre-existing.
Claims benefits example (based on covered benefits):
Daily intensive care benefit $6,000 ($3,000 per day x 2 days)
Daily inpatient hospital confinement benefit $6,000 ($2,000 per day x 3 days)
Doctor visits while hospital confined benefit $250 ($50 per day x 5 days)
Benefits payable before per injury or illness deductible $12,250
Less per injury or illness deductible $0
Total benefits paid $12,250
Indemnity benefit example for outpatient benefits
Plan selected: Superior
Per injury or illness deductible selected: $1,000
Medical situation: A covered person undergoes laparoscopic gall bladder surgery. Same-day surgery is performed at an
outpatient hospital surgical facility. The condition was not pre-existing.
Claims benefits example (based on covered benefits):
Outpatient surgery facility benefit $1,200
Outpatient surgeon benefit $1,800
Outpatient assistant surgeon benefit $360
Anesthesiologist benefit $540
Benefits payable before per injury or illness deductible $3,900
Less per injury or illness deductible ($1,000)
Total benefits paid $2,900
*The benefit examples shown above are intended for illustrative purposes only. These examples do not contemplate the provider’s actual charges for services
rendered nor the full extent of the covered person’s out-of-pocket costs.
Using the nationwide MultiPlan network is simple!
Care Access Plan fixed-indemnity benefits are paid the same, regardless of which providers you use. That means you
have the flexibility to use any doctor or hospital in the United States.
If you wish to save even more on out-of-pocket costs, discounts are available through the MultiPlan discount network.
MultiPlan is one of the country’s largest independent PPO networks, with more than 500,000 providers in 50 states.
These providers have agreed to negotiated discounts, which are reflected on your final bill for both covered and non-
covered expenses.
WA MT ND MN ME
OR ID WY SD WI
VT
NE IA MI NY NH
KS MO
IN OH PA NJ CMTARI
WV DMCD DE
NV UT IL
CA AZ KY VA
CO
NM OK AR TN NC
TX MS
SC
LA AL GA
FL
Brochure Care Access Plan L 0518 5
Indemnity benefit example for inpatient confinement
Plan selected: Value
Medical situation: A covered person is admitted to the hospital with pneumonia and acute respiratory failure. Inpatient
confinement is five days, two of which are in the intensive care unit. The condition was not pre-existing.
Claims benefits example (based on covered benefits):
Daily intensive care benefit $6,000 ($3,000 per day x 2 days)
Daily inpatient hospital confinement benefit $6,000 ($2,000 per day x 3 days)
Doctor visits while hospital confined benefit $250 ($50 per day x 5 days)
Benefits payable before per injury or illness deductible $12,250
Less per injury or illness deductible $0
Total benefits paid $12,250
Indemnity benefit example for outpatient benefits
Plan selected: Superior
Per injury or illness deductible selected: $1,000
Medical situation: A covered person undergoes laparoscopic gall bladder surgery. Same-day surgery is performed at an
outpatient hospital surgical facility. The condition was not pre-existing.
Claims benefits example (based on covered benefits):
Outpatient surgery facility benefit $1,200
Outpatient surgeon benefit $1,800
Outpatient assistant surgeon benefit $360
Anesthesiologist benefit $540
Benefits payable before per injury or illness deductible $3,900
Less per injury or illness deductible ($1,000)
Total benefits paid $2,900
*The benefit examples shown above are intended for illustrative purposes only. These examples do not contemplate the provider’s actual charges for services
rendered nor the full extent of the covered person’s out-of-pocket costs.
Using the nationwide MultiPlan network is simple!
Care Access Plan fixed-indemnity benefits are paid the same, regardless of which providers you use. That means you
have the flexibility to use any doctor or hospital in the United States.
If you wish to save even more on out-of-pocket costs, discounts are available through the MultiPlan discount network.
MultiPlan is one of the country’s largest independent PPO networks, with more than 500,000 providers in 50 states.
These providers have agreed to negotiated discounts, which are reflected on your final bill for both covered and non-
covered expenses.
WA MT ND MN ME
OR ID WY SD WI
VT
NE IA MI NY NH
KS MO
IN OH PA NJ CMTARI
WV DMCD DE
NV UT IL
CA AZ KY VA
CO
NM OK AR TN NC
TX MS
SC
LA AL GA
FL
Brochure Care Access Plan L 0518 5
