Page 31 - 2021 Team Member Benefit Guide - English
P. 31
800-648-8624
www.slfserviceresources.com
MAX BENEFIT
WHAT IS COVERED
PER PERSON
In Patient Benefits • Hospital confinement due to a covered illness
Pays benefits up to or injury
the amount shown, per • Hospital emergency room treatment $4000
covered person, per
calendar year
Outpatient Benefits • Outpatient treatment due to a covered injury or
Subject to a per family/per sickness at a hospital $2000
calendar year maximum • Outpatient surgical or emergency facility or a not to exceed $4,000
of two individuals diagnostic testing facility or similar facility that per family per year
is licensed to provide outpatient treatment or two individuals
• This includes radiation and chemotherapy. covered in the year
Not Covered • Copays for office visits and prescription drugs
• Expenses not covered by the BCBS Medical
Plan
• Expenses related to mental/nervous disorders
or treatment for substance abuse (even though
such expenses ARE covered by the BCBS $0
Medical Plans)
• Otherwise eligible expenses which are paid
by the Medical Plan at 100%; only expenses
applied to deductible and coinsurance are
reimbursable.
Diana Dacuma, Sales Support Representative 30
30
Longmont, CO
