PHYSICIAN OFFICE VISIT/HOSPITAL EMERGENCY ROOM VISIT

If you are injured in a covered accident or have treatment as the result of a covered sickness, you will be paid the benefit for each visit as shown in the Benefit Schedule (included in certificate of coverage) for Physician’s charges, Laboratory fees, X-rays and Injections/Medications. This benefit is limited to 6 visits per person per calendar year. Benefit Amount Per Visit
From $50 - $100

MEDICAL FEES FOR EACH ACCIDENT

If you are injured in a covered accident and receive treatment from a physician within one year after the accident, you will be paid up to the amount shown in the Benefit Schedule for X-Rays, Physician Services, Emergency Room Services, Supplies and Appliances. This benefit is payable if you received initial treatment within 60 days after the accident. Benefit Amount
From $0 - $200

FIRST HOSPITAL ADMISSION BENEFIT

You will be paid this benefit in the amount shown in the benefit schedule, when you are admitted to a hospital and confined as a resident bed patient because of injuries received in a covered accident or because of a covered sickness. In order to receive this benefit for injuries received in a covered accident, you must be admitted to a hospital within 6 months of the date of the covered accident. Benefit Amount
Up to $5,000

DAILY HOSPITAL CONFINEMENT BENEFIT

You will be paid this benefit in the amount shown in the Benefit Schedule for a maximum of up to 30 days, subject to the elimination period if any, when you are confined to a hospital as a resident bed patient as the result of injuries received in a covered accident or because of a covered sickness. In order to receive this benefit for injuries received in a covered accident, you must be confined to a hospital within 6 months of the date of the covered accident. Benefit Amount Per Day
From $30 - $600

INTENSIVE CARE BENEFIT

If you are confined in a hospital intensive care unit due to an injury received in a covered accident or because of a covered sickness, you will be paid the daily benefit amount shown on the Benefit Schedule for a maximum of up to 30 days. In order to receive this benefit for a covered accident, you must be admitted to a hospital intensive care unit within 6 months of the date of the covered accident. This benefit pays in addition to the Daily Hospital Confinement Benefit. Benefit Amount Per Day
From $100 - $1,500

SURGICAL BENEFIT

If you require surgery due to an injury received in a covered accident or because of a covered sickness, and the surgery is performed by a Physician, you will be paid the amount for the Surgical Operation shown opposite the procedure listed in the Schedule of Operations (included in certificate of coverage). The surgery can be performed in a Hospital (on an inpatient or outpatient basis), in an Ambulatory Surgical Center, or in a Physician’s office. Benefit Amount–See Schedule
From $100 - $5,000

ANESTHESIA BENEFIT

When a surgical procedure is performed that is covered under the Surgical Benefit, you will be paid the amount shown in the Schedule Of Operations for anesthesia administered by a Physician in connection with such procedure. Benefits will be 25% of the amount paid under Surgical Benefit. Benefit Amount–See Schedule
From $25 - $1,250

WELLNESS BENEFIT

We will pay the amount shown in the Benefit Schedule per calendar year when you visit a doctor and you are neither injured or sick. Benefit Amount
From 0 - $120

Accidental Death & Dismemberment

The group term life insurance plan will provide your designated beneficiary with the life insurance benefit in the event of your death. Benefit Amount
From $1,000 - $100,000

Included with all ValueMax Hospital Indemnity Plans:

ValueRx Prescription Plan

This plan is designed to save you money on your prescription drug costs and is recognized at most major pharmacies. Our RxSelect Product Guide lists each drug in 1 of 4 tiers. To maximize savings, ask your doctor to review your booklet and prescribe an appropriate drug within the lowest tier possible. Mail order is also available.

Tier 1. Preferred Brand and Generic Drugs:
You pay $10 or less for the scheduled quantity and dose.
Tier 2. Preferred Brand and Generic Drugs:
You pay $20 or less for the scheduled quantity and dose.
Tier 3. Preferred Brand and Generic Drugs:
You pay $40 or less for the scheduled quantity and dose.
Tier 4. Non-preferred Brands and Generics:
You pay 100% of the discounted price.

Lab and Radiology

Adult Wellness Test

Once each calendar year, you and your spouse (if covered) may take advantage of a no-cost Annual Wellness Test valued at over $500 and includes:

Comprehensive Wellness Profile (CWP) - liver, kidney, lipid panels, cbc’s, electrolytes, glucose, bones and minerals
Comprehensive Urinalysis
PSA (men over 40)
Thyroid w/TSH (women)
CellMate Report, an extensive interpretative report analysis of your blood tests results to give your unique biochemistry health status on diet and supplements

PPO Discount

(Plan I includes PPO discounts for Office Visits only)

While all limited benefit plans may seem to be equal, using ValueMax can make a tremendous difference. Using a limited benefits plan that includes PPO administration technology is a major advantage that is not included in many plans.

This value is real…NOT a discount card that is often sold with limited benefit (”mini-med”) plans. When you add a nationwide discount to your limited benefit, the cost of a typical hospital stay may be no more than if you had major medical insurance.

You receive the healthcare you need with a premium that is a fraction of the cost of major medical insurance.

Sample Plan Design Description No. Days
In Hospital Billed Allowed Savings Benefit Net Due
Office Visits 0 $148 $39 $109 $75 $0
Maternity 3 $4,327 $2,600 $1,727 $3,000 $0
ICU 1 $18,032 $999 $17,033 $2,000 $0
Medical Surgery 2 $15,251 $3,527 $11,724 $3,500 $0

This example is based on sample plan designof $1,000 per day in the hospital, a $1,500 surgical benefit, and a $2,000 intensive care benefit. Please note that benefits may vary according to policy design.

Our technology extends our benefits to those employees that need it the most.

ValueMax Patient Advocacy Services

There’s no doubt about it. Finding the right doctor can be a daunting task. That’s why we developed a Patient Advocacy Program.

Designed to complement the health indemnity insurance plan, this non-insurance PPO referral program provides employees access to more than 400,000 participating physicians nationwide through one toll-free telephone call. Simply by calling the hot line, an employee can obtain a list of three Physicians within 10 miles of his or her home who will provide necessary professional services at discounted fees.

Our trained professional staff will contact a provider to explain the ValueMax Benefits plans and benefits. This one-to-one service enables members to receive all their entitled benefits and adds additional providers to the network for other members to access.

The Patient Advocacy Program will also negotiate with hospitals to obtain discounted room and board fees on behalf of employees.

Our service could be the difference in seeing a Physician or getting admitted to the hospital

Hospital
Our services include:

Assisting with admission
Estimating your discounted bill so you are NOT charged 100% prior to admission

Addressing the provider’s expectations while ensuring you receive your benefits Physician’s Office

Office visit charges may be repriced at the point of service via telephone or electronically so that you only pay the portion exceeding your benefit.

With ValueMax, you can receive up to 44% more benefit for your dollar.

Health Benefits Program

The ValueMax hospital indemnity insurance includes membership in a health value program offering typical discounts of 10 to 50 percent on health care for you and your family. You can save on a wide range of health care products and services, including:

Dental
Cleanings
Fillings
Orthodontics
Teeth whitening
Caps and crowns
Vision
Eye Exams
Glasses and contacts
LASIK

Long-Term Care
Nursing and assisted living facilities
Home health care
Durable medical equipment
Wellness
Fitness club memberships
Weight management
Smoking cessation
Nutrition

Alternative Care
Chiropractic
Acupuncture
Massage Therapy
Behavioral Health
Addiction treatment
Family counseling
Hypnotherapy

Hearing
Testing
Hearing devices
Infertility
In-Vitro fertilization

Health Value Program Features and Benefits

Easy access online or by telephone
Participating providers and facilities nationwide
No referrals required, no claim forms, and no maximums
Detailed information on health care professionals’ discount rates, education, office hours, languages spoken and more
Visit any participating provider and pay the discounted rate at the time of service.
Your membership offers savings for you, your spouse, and your dependent children.

Talk to a Nurse Anytime

Included with your benefit is NurseLine, a nurse “hotline” that gives you access to caring registered nurses 24 hours a day, seven days a week, via toll-free telephone number or online Web chat. Call anytime about:

Staying healthy
Caring for injury or illnesses
Understanding a diagnosis
Managing chronic conditions
Medication safety
Exercise and nutrition tips
Questions to ask your doctor
Health care resources

It’s like having a nurse in the family!

The Health Benefits Program is not insurance. You are responsible for the full cost of any services purchased, minus the applicable discount.

NOTE: This is not basic health insurance or major medical coverage and is not designed as a substitute for basic health insurance or major medical coverage. In addition, Hospital Indemnity Plans are exempt from Coordination of Benefits provisions.

The insurance coverage offered through General Electric and Colonial are stand alone insurance products and may be purchased separately. Hospital Indemnity, Accidental Death are underwritten by Professional Insurance Company of California. Accident product underwritten by Colonial