Page 2 - Comparative-Benefits-STM-Plans
P. 2
5 Maximum Benefit After this maximum is $2,000,000 $1,000,000 Remarks
Sl. No Covered Expenses reached, expenses due to Connect STM Connect Value
pre-existing conditions are
not covered.
$2,000,000
Connect Plus
6 Hospital room, board, The amount billed for a The amount billed for a The amount billed for a semi-
and general nursing, semi-private room, or 90% semi-private room, or 90% private room, or 90% of the
including prescription of the private room billed of the private room billed private room billed amount,
drugs administered amount. amount , only if semi- not to exceed $1,000 per
while hospital private room is not offered. day, only for semi-private is
confined. not offered.
8 Intensive Care Unit, Three times the amount Three times the amount Three times the amount
including prescription billed for semi-private billed for semi-private room billed for a semi-private
drugs administered room or three times 90% of or three times 90% of the room, or 90% of the private
while in hospital the private room billed. private room billed. room billed amount, not to
confinement. exceed $12,500 per day.
9 Surgeon's services Deductible and coinsurance Deductible and coinsurance Deductible and coinsurance
10 Anesthesiologist Not to exceed 20% of the Not to exceed 20% of the Not to exceed 20% of the
primary surgeon’s benefits primary surgeon’s benefits primary surgeon’s benefits
11 Inpatient doctor visits Deductible and Deductible and coinsurance, Deductible and coinsurance,
coinsurance, up to $500 up to $500 per visit up to $500 per visit
per visit
12 Outpatient hospital Deductible and Deductible and coinsurance, Deductible and coinsurance,
surgery or ambulatory coinsurance, Up to $2,500 Up to $2,500 per surgery Up to $2,500 per surgery
surgical center per surgery
13 Ground ambulance Not to exceed $500 per Not to exceed $500 per Not to exceed $500 per
services occurrence occurrence occurrence
14 Organ, tissue or Bone Not to exceed $150,000 Not to exceed $150,000 per Not to exceed $150,000 per
marrow transplants per coverage period coverage period coverage period
15 Acquired Immune Not to exceed $10,000 per Not to exceed $10,000 per Not to exceed $10,000 per
Deficiency Syndrome coverage period coverage period coverage period
(AIDS)
16 Blood or blood plasma Deductible and coinsurance Deductible and coinsurance Deductible and coinsurance
and their
Sl. No Covered Expenses reached, expenses due to Connect STM Connect Value
pre-existing conditions are
not covered.
$2,000,000
Connect Plus
6 Hospital room, board, The amount billed for a The amount billed for a The amount billed for a semi-
and general nursing, semi-private room, or 90% semi-private room, or 90% private room, or 90% of the
including prescription of the private room billed of the private room billed private room billed amount,
drugs administered amount. amount , only if semi- not to exceed $1,000 per
while hospital private room is not offered. day, only for semi-private is
confined. not offered.
8 Intensive Care Unit, Three times the amount Three times the amount Three times the amount
including prescription billed for semi-private billed for semi-private room billed for a semi-private
drugs administered room or three times 90% of or three times 90% of the room, or 90% of the private
while in hospital the private room billed. private room billed. room billed amount, not to
confinement. exceed $12,500 per day.
9 Surgeon's services Deductible and coinsurance Deductible and coinsurance Deductible and coinsurance
10 Anesthesiologist Not to exceed 20% of the Not to exceed 20% of the Not to exceed 20% of the
primary surgeon’s benefits primary surgeon’s benefits primary surgeon’s benefits
11 Inpatient doctor visits Deductible and Deductible and coinsurance, Deductible and coinsurance,
coinsurance, up to $500 up to $500 per visit up to $500 per visit
per visit
12 Outpatient hospital Deductible and Deductible and coinsurance, Deductible and coinsurance,
surgery or ambulatory coinsurance, Up to $2,500 Up to $2,500 per surgery Up to $2,500 per surgery
surgical center per surgery
13 Ground ambulance Not to exceed $500 per Not to exceed $500 per Not to exceed $500 per
services occurrence occurrence occurrence
14 Organ, tissue or Bone Not to exceed $150,000 Not to exceed $150,000 per Not to exceed $150,000 per
marrow transplants per coverage period coverage period coverage period
15 Acquired Immune Not to exceed $10,000 per Not to exceed $10,000 per Not to exceed $10,000 per
Deficiency Syndrome coverage period coverage period coverage period
(AIDS)
16 Blood or blood plasma Deductible and coinsurance Deductible and coinsurance Deductible and coinsurance
and their
