Custom plan designs
Select from one of the three plans below or create one designed specifically for your group client.
Guarantee issue
Designed for groups with 5 or more employees.
Easy to meet participation requirements
No medical questions. No pre-existing condition limitations. No carrier-mandated waiting periods.
Variety of enrollment options
Paper, call center and Web-based enrollment.
| Benefits | Standard Plan | Select Plan | Premier Plan |
|---|---|---|---|
| Doctor's office visit | $50 per visit $300 calendar year max |
$50 per visit $300 calendar year max |
$60 per visit $360 calendar year max |
| Outpatient diagnostic x-ray and lab | Not included | $50 per day $300 calendar year max |
$60 per day $360 calendar year max |
| Advanced studies (MRI, CT, etc.) | Not included | $200 per day $600 calendar year max |
$250 per day $750 calendar year max |
| Preventative care | $50 per visit $150 calendar year max |
$50 per visit $150 calendar year max |
$75 per visit $225 calendar year max |
| Surgical benefit Inpatient Outpatient Outpatient minor Outpatient venipuncture |
Not included | $850 overall max $500 lump sum $250 lump sum $75 lump sum $25 lump sum |
$1,600 overall max $1,000 lump sum $500 lump sum $75 lump sum $25 lump sum |
| Anesthesiology | Not included | $125 lump sum | $250 lump sum |
| Emergency room indemnity benefit for illnesses only | $75 per visit $300 calendar year max |
$100 per visit $400 calendar year max |
$100 per visit $400 calendar year max |
| Inpatient hospital benefit Inpatient intensive care unit Inpatient substance abuse Inpatient mental illness disorder Inpatient skilled nursing facility |
$100 per day $200 per day $50 per day $50 per day $50 per day |
$300 per day $600 per day $150 per day $150 per day $150 per day |
$500 per day $1,000 per day $250 per day $250 per day $250 per day |
| Hospital admission | Not included | $300 per confinement | $500 per confinement |
| Accident coverage | $300 max per occurrence | $500 max per occurrence | $1,000 max per occurrence |
This is a brief description of some important features of coverage. The product is not available in all states and benefits may vary based on state of residence. Please refer to the product brochure for additional information. For a full explanation of benefits, exclusions and limitations refer to the policy (SSL LMB POL 0106). Limited Medical Benefit Insurance Plans are underwritten by Standard Security Life Insurance Company of New York.
