D&L

Insurance Brokers, Inc.





NOW OFFERING TWO PLANS
FREEDOM STM
Administered by: HPA, Inc., Rockford, Illinois
Insured by: Clarendon National Insurance Company

**Covered Medical Expenses**
  • Hospital Charges - medical care and treatment
  • Ambulatory Surgical Center charges
  • Physicians Services for diagnosis, treatment and surgery
  • Intensive Care - up to 3 times the average semi-private room rate
  • Skilled Nursing Facility - up to $30 per day for 30 days
  • X-Ray exams, laboratory tests and analyses
  • X-Ray and radioactive isotope therapy, Anesthesia, oxygen, casts, splints, crutches, braces, surgical dressings, artificial limbs or eyes, rental of necessary medical suplies
  • Blood or blood derivatives and their administration
  • Ambulance Services - $250 per emergency
  • Organ Transplants - Lifetime Maximum $50,000
  • Mental and Nervous Disorders - as a bed-patient; or treated Outpatient at a maximun of $30 per day up to 30 visits - Lifetime Maximum of $5,000
  • Alcoholic and Drug Disorders - lifetime maximum of $1,000
  • Acquired Immune Deficiency Syndrome (AIDS) - lifetime maximum of $10,000
  • Home Health Care - up to 40 visit maximum
  • Mammography, pap smear and screens

*Benefits for Mental, Nervous and Alcohol and Drug Disorders are paid at 50%. The benefit amount shown is the "Maximum Lifetime Benefit per Insured Person".

PRE-ADMISSION CERTIFICATION

This plan requires a Pre-admission Certificate by "Medical Cost Management" prior to eligible in-patient hospitalization or surgery of a Member or Insured Dependent within 48 hours. This is not a guarentee of benefits. If you fail to pre-certify, benefits will be reduced by 50%.

STATE APPROVAL LIST
AZ, AR, CA(use CA app. 6 mo.), CO(use CO app. 6 mo.), CT, DE, D.C.,FL (use FL app.), GA, HI, ID, IL, IN(use IN app. 6 mo.), IA, KY, LA (use LA broc   app. 6.mo.), MI(use MI app.6 mo.), Mississ, MO(use MO app.), NEBASKA, NM, OH, OK, OR, PA, RI, SC(use SC app.), TN, TX(use TX app.), VA, WV, WI, WY.

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FLEX-TERM MED 12X3
Administered by: HPA, Inc., Rockford, Illinois
Insured by: Clarendon National Insurance Company

**Covered Medical Expenses**

  • Hospital Charges - medical care and treatment
  • Ambulatory Surgical Center charges
  • Physicians Services for diagnosis, treatment and surgery
  • Intensive Care - up to 3 times the average semi-private room rate
  • Skilled Nursing Facility - up to $30 per day for 30 days
  • Private Duty Nursing - up to $75 per 8 hour shift. Maximum 90 shifts per coverage period
  • X-Ray exams, laboratory tests and analyses
  • X-Ray and radioactive isotope therapy
  • Anesthesia, oxygen, casts, splints, crutches, braces, surgical dressings, artificial limbs or eyes, rental of necessary medical supplies
  • Blood or blood derivatives and their administration
  • Ambulance Services - $250 per emergency
  • Organ Transplants - Lifetime Maximum $50,000
  • Spinal Manipulation or Adjustment - Lifetime Maximun $1,000
  • Foreign Travel - Lifetime Maximum $25,000 (This benefit is payable after $250 Deductible)
  • Mental and Nervous Disorders - as a bed-patient; or treated Outpatient at a maximun of $30 per    day up to 30 visits - Lifetime Maximum of $5,000
  • Alcoholic and Drug Disorders - lifetime maximum of $1,000
  • Acquired Immune Deficiency Syndrome (AIDS) - lifetime maximum of $10,000
  • Home Health Care - up to 40 visit maximum
  • Mammography, pap smear and screens

*Benefits for Mental, Nervous and Alcohol and Drug Disorders are paid at 50%. The benefit amount shown is the "Maximum Lifetime Benefit per Insured Person".

PRE-ADMISSION CERTIFICATION

This plan requires a Pre-admission Certificate by "Medical Cost Management" prior to eligible in-patient hospitalization or surgery of a Member or Insured Dependent within 48 hours. If you fail to pre-certify, benefits will be reduced by 50%.


STATE APPROVAL LIST
AZ, AR, CT, DE, DC,FL(use FL app.), GA, HI(only through HI GA's), ID, IL, IA, KY, MO(use MO app.), MS, NE, NM, OH, OK, OR, PA, RI, SC, TN, VA, WV, WI, WY



CLICK HERE TO GET A QUOTE









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