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Limited Medical Indemnity
The TransChoice® Program is a limited benefit hospital indemnity insurance, pays benefits to help cover basic medical expenses.
Benefits
TransChoice® Policy Benefits, a group limited benefit hospital indemnity insurance, pays benefits to help cover basic medical expenses.
| Base Plan Benefits | Plan Pays |
| Daily In Hospital Indemnity Benefit - Maximum of 30 days per confinement |
Freedom Plan - $300 per day
Liberty Plan - $750 per day |
| Additional Benefits | Plan Pays |
| Outpatient Physician Office Visit - Up to 5 visits per calendar year for you and your spouse each, up to 5 visits per calendar year for all children combined |
Freedom Plan - $50 per visit
Liberty Plan - $75 per visit |
| Outpatient Diagnostic X-Ray & Laboratory - Up to 3 days of testing per calendar year, per covered person |
Freedom Plan -
$50 per day
Liberty Plan - $75 per day |
| Surgical & Anesthesia - Pays benefit amount shown in the specified plan surgical schedule for the type of surgery performed; pays 20% of the Surgery Benefit for the administration of anesthesia |
Freedom Plan - $1,000 Plan Surgical Schedule Liberty Plan - $2,000 Plan Surgical Schedule |
| Off-the-Job Accidental Injury - 100% of expenses up to a maximum specified per covered accident, up to 5 covered accidents per covered person per calendar year (off-the-job only) |
Freedom Plan -
$300 Maximum
Liberty Plan - $300 Maximum |
| Critical Illness Benefit & Subsequent Critical Indemnity Benefit - Up to a lump-sum benefit for the initial diagnosis of a covered critical illness and also an additional lump-sum benefit of the same amount for a subsequent and separate covered critical illness |
Freedom Plan -
Up to
$10,000
Liberty Plan - Up to $10,000 |
| Wellness Indemnity Benefit | Both Plans - $25 for physical exams or certain diagnostic tests; 1 visit per calendar year, per insured. 6 month waiting period. |
| Prescription Drug Indemnity Benefit | Both Plans - $10 per prescription for up to 12 prescriptions per calendar year for you and your spouse each, 12 prescriptions per calendar year for all children combined. |
| Additional Coverages | Plan Pays |
| Group Term Life Insurance Policy with Accidental Death & Dismemberment (AD&D) Rider |
Both plans have
this benefit Member: $5,000 Spouse: $2,500 Child(ren) over 6 months: $2,500 (AD&D coverage is not available for dependent children) |
| Non Insurance Discount Programs | |
| Employee Discount Card - Offered by New Benefits, Ltd. |
Both plans have
this benefit This card will provide access to a discount Vision Plan, a Nurses Hotline, Counseling Services and discounts for Hearing Aids. |
| PPO Network - offered by Key Benefit Administrators (KBA) Providers can be located at www.multiplan.com |
Both plans have
this benefit Member and covered dependents will receive contracted savings from the normal fees charged by network physicians, hospitals, and outpatient x-ray and laboratory providers |
| Prescription Drug Discount Card - Offered by Caremark with 55,000 participation providers |
Both plans have
this benefit You can receive a discount of at least 14% off the retail pharmacy price of brand name drugs and up to 60% for generic drugs |
HIPPA Privacy, Woman's Rights and CHIP
Rates
| Freedom Plan | Liberty Plan | |
| Member Only | $84.00 | $126.00 |
| Member + Spouse | $135.00 | $216.00 |
| Member + Child(ren) | $129.00 | $202.00 |
| Member + Family | $180.00 | $293.00 |
- Rates include the $1.00 CARE Membership Fee
*Eligible applicants must be a member in good standing of CARE
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This policy is underwritten by Transamerica Life Insurance Company, Home Office, Cedar Rapids, Iowa. Administration provided by Key Benefit Administrators, Inc. (KBA), Fort Mills, SC
| ©Greater Insurance Service Corp 2009 |