3. 2 Unit (Plus) — Full Benefit Schedule

Hospital Benefits — Facility Fees

Inpatient confinement benefits are payable when confined for 24 hours or more.

Benefit	Coverage Period	2 Unit (Plus) Daily Benefit
First Day Hospital Admission Benefit (up to 1 day/CY)	Day 1	$2,000
Hospital Confinement — Sickness	Days 1–3	$6,000 per day
Hospital Confinement — Sickness	Day 4	$4,500 per day
Hospital Confinement — Sickness	Days 5+	$3,000 per day
Hospital Confinement — Injury	Days 1–3	$7,000 per day
Hospital Confinement — Injury	Day 4	$5,500 per day
Hospital Confinement — Injury	Days 5+	$4,000 per day
ICU / Critical Care (up to 16 days/CY)	Days 1–3	$7,000 per day
ICU / Critical Care	Day 4	$5,500 per day
ICU / Critical Care	Days 5+	$4,000 per day
Observation Stay — Sickness	Days 1–3	$6,000 per day
Observation Stay — Sickness	Day 4	$4,500 per day
Observation Stay — Sickness	Days 5+	$3,000 per day
Observation Stay — Injury	Days 1–3	$7,000 per day
Observation Stay — Injury	Day 4	$5,500 per day
Observation Stay — Injury	Days 5+	$4,000 per day
Mental Illness Confinement	Per day	$400 per day
Rehabilitation / Skilled Nursing Facility	Per day	$1,500 per day

Outpatient Surgery & Treatment — Facility Fees

Benefit	Notes	2 Unit (Plus) Amount
Outpatient Surgery — General Anesthesia	CY max for surgical benefits: $50,000	$3,000
Outpatient Surgery — No General Anesthesia	CY max for surgical benefits: $50,000	$1,500
Outpatient Radiation, Chemo & Immunotherapy	Up to $40,000 payable per CY	$1,500 per day

Professional Services

Benefit	Notes	2 Unit (Plus) Amount
Inpatient Physician (Non-Surgical)	Days 1–8: up to 16 days/CY	$120 per day
Inpatient Physician (Non-Surgical)	Days 9+	$60 per day
Surgery in Hospital / ASC	CY max $50,000	2x Surgical Schedule
Assistant Surgeon	CY max $50,000	2x Surgical Schedule
Anesthesia	CY max $50,000	2x Surgical Schedule
Inpatient Pathologist / Radiologist	Per day	$160 per day

Outpatient Benefits

Aggregate Calendar Year Maximum for Outpatient Benefits: $4,000

Benefit	Notes	2 Unit (Plus) Amount
Physician Benefit	Days 1–8 (16 days/CY)	$120 per day
Physician Benefit	Days 9+	$60 per day
Chiropractor Benefit	5 days per CY	$120 per day
Therapy (Physical, Speech, Occupational)	Up to 16 days per CY	$60 per day
Radiology — MRI, PET, CAT, Nuclear	Per day	$480 per day
Radiology — X-Ray & Other Diagnostic	Up to 4 days per CY	$160 per day
Surgery in Physician/Specialist Office	Up to 2 days per CY	$200 per day
Lab Work	Up to 4 days per CY	$80 per day
Injection Benefit	Per day	$20 per day
Emergency Room — Facility Fee	Max 2 ER benefits/CY; max 4 combined ER+UC/CY	$100 per visit
Emergency Room — Professional Service	Max 2 ER benefits/CY; max 4 combined ER+UC/CY	$100 per visit
Urgent Care	Max 4 combined ER+UC per CY	$200 per visit
Ambulance — Ground	Up to 2 per CY	$500
Ambulance — Air	Up to 1 per CY	$1,000
Generic Prescription	Paid per prescription filled (after 12-month pre-ex period)	$10
Brand Name Prescription	Paid per prescription filled (after 12-month pre-ex period)	$20

Preventive Care

Coverage begins 60 days after effective date. Not subject to pre-existing condition exclusion. Subject to outpatient aggregate CY maximum.

Benefit	Frequency	Amount
Mammogram	1 per CY	$250
Colonoscopy (no polyps found) — Policy Years 1–3	Every 3 years	$600
Colonoscopy (no polyps found) — Policy Years 4+	Every 3 years	$750
Preventive Care Services	1 per CY	$125

Plan Maximums & Deductible

Calendar Year Maximum: $500,000 per insured person
Lifetime Maximum: $5,000,000 per policy
Deductible: $5,000 — applies ONLY to certain inpatient confinement benefits (24+ hour stays); max 3 deductibles per policy per CY
No deductible for: ER visits, doctor visits, outpatient procedures, prescriptions, urgent care

Critical Point on the Deductible

The $5,000 deductible is the most common client concern. It ONLY applies if they are admitted to the hospital for 24+ hours. Every other use of the plan — ER visits, doctor visits, outpatient procedures — has NO deductible. This is very different from ACA plans where every dollar spent counts toward the deductible.