SUMMARY OF BENEFITS

Description of Benefits OPTION 1 OPTION 2

HOSPITALIZATION
Hospital Room & Board
80% of R&C 80% of R&C
(Semi-Private Room)
No. of visits per disability 120 Visits per Disability 120 Visits per Disability
100% of cost to max 100% of cost to max
Public Hospital Ward
$1,000 per day $1,000 per day
Hospital Miscellaneous 80% of R&C 80% of R&C
Emergency Accident and
80% of R&C 80% of R&C
Outpatient
Doctor’s In-Hospital Visit
$2,000 $2,000
(non-surgical)
No. of visits per disability 120 Visits per Disability 120 Visits per Disability
Intensive Care 80% of Cost, 80% of Cost,
Max $25,000 Max $25,000
SURGERY
Maximum Surgeon’s Fee 80% of R&C 80% of R&C
Maximum Assistant
80% of R&C 80% of R&C
Surgeon’s Fee
Maximum Anaesthetist
80% of R&C 80% of R&C
Fee
OTHER MEDICAL SERVICES
Local Ground Ambulance 80% of R&C 80% of R&C
(#of trips/annum) 2 2
Hearing Aid 80% of cost up to 80% of cost up to
(payable every 3 years) $24,000 per ear, $24,000 per ear,
(Max $48,000) (Max $48,000)
MAJOR MEDICAL BENEFITS
Co-Insurance Payment 80% / 20% 80% / 20%
Local Deductible
$30,000 $30,000
(per person/year)
Radiotherapy 80% of R&C Not Covered
Chemotherapy 80% of R&C Not Covered
Renal Dialysis 80% of R& ot Covered
LIFETIME MAXIMUM $5,000,000 $5,000,000

PARENTAL HEALTH RATE SHEET

Description of Benefits OPTION 1 OPTION 2
MonthlyPremium $3,061.00
per Parent $3,752.00