Plan F High Ded

Plan Benefit Tables: Medicare Supplement Plan High Deductible Plan F

Medicare Part A: Hospital Services per Benefit Period

*A benefit period begins on the first day You receive service as an inpatient in a hospital and ends after You have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.

**This high-deductible plan pays the same benefits as Plan F after one has paid a calendar year $2,200 deductible. Benefits from the high-deductible Plan F will not begin until out-of-pocket expenses are $2,200. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. This includes the Medicare deductible for Part A and Part B, but does not include the plan’s separate foreign travel emergency deductible.

Notes

A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.

NOTICE

When your Medicare Part A hospital benefits are exhausted, the issuer stands in place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy’s “Core Benefits.” During this time, the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid.

**This high-deductible plan pays the same benefits as Plan F after one has paid a calendar year $2,200 deductible. Benefits from the high-deductible Plan F will not begin until out-of-pocket expenses are $2,200. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. This includes the Medicare deductible for Part A and Part B, but does not include the plan’s separate foreign travel emergency deductible.

Medicare Part B: Medical Services per Calendar Year

Parts A and B

Other Benefits not covered by Medicare

Notes

Once you have been billed $183 of Medicare-approved amounts for covered services, your Part B deductible will have been met for the calendar year.

NO COST, NO OBLIGATION

Answers To Your Medicare Questions