| Plan Name |
Individual 100 |
Individual 300 |
Individual 500 |
| |
Benefit Details |
Benefit Details |
Benefit Details |
| Class I - Diagnostic and Preventive Services |
| Plan Pays |
100% |
50% |
0% |
| Waiting Period |
No Waiting Period |
No Waiting Period |
N/A |
| Class II - Basic Services |
| Plan Pays |
0% |
50% |
60% |
| Waiting Period |
No Waiting Period |
No Waiting Period |
No Waiting Period |
| Class III - Major Services |
| Plan Pays |
0% |
0% |
60% |
| Waiting Period |
No Waiting Period |
No Waiting Period |
6 Month Waiting Period |
| Annual Deductible |
| Per Person Per Contract Year |
$0 |
$50 for Class II Services |
$50 for Class II and III Services |
| Annual Maxium |
| Per Person Per Contract Year |
Unlimited |
$1,500 |
$2,000 |
