Plan G

Plan Benefit Tables: Medicare Supplement Plan G

Medicare Part A: Hospital Services per Benefit Period

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.

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