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Pool Benefit Plan:
| Pool Benefit Plans |
Plan 1 |
Plan 2 |
Plan 3 |
Plan 4 |
Plan 5 |
Plan 6 |
| Annual Deductible per
person The deductible is the
amount that must be paid before Pool can
pay benefits.
|
$500 |
$1,000 |
$2,000 |
$5,000 |
$7,500 |
$10,000 |
| Percentage paid by
the pool before the out-of-pocket
maximum is reached The percentage
is the maximum allowed of covered
charges* after deductible is paid.
|
80% |
80% |
80% |
N/A |
N/A |
N/A |
| Co-insurance
percentage paid by policyholder before
out-of-pocket maximum is reached
Known as "co-insurance," the percentage
is the maximum allowed for covered
charges* after the deductible is paid.
|
20% |
20% |
20% |
100% |
100% |
100% |
| Percentage paid by
the pool after out-of-pocket maximum is
reached 100% of covered charges*
are paid when the deductible and the
annual co-insurance amounts have been
met.
|
100% |
100% |
100% |
N/A |
N/A |
N/A |
|
Annual out-of-pocket
maximum
The out-of-pocket
amounts include policyholder payment of
the deductible and co-insurance.
|
$2,500 |
$3,500 |
$5,000 |
$5,000 |
$7,500 |
$10,000 |
* Covered charges are the maximum allowable fee
for services or supplies that are benefits under
the Pool policy.
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