| Features | M5 | N2 | L1 | HSA5 |
|---|---|---|---|---|
| Lifetime maximum | $5 million | $2 million | $1 million | $5 million |
| Calendar year maximum | $2 million | $1 million | $100,000, $20,000 for outpatient treatment, $1,000 for outpatient prescription drugs |
$2 million |
| Physician office visit copay | Optional $35 copay; unlimited number of visits | Optional $35 copay; 3 visits per person, per calendar year | $40 copay; 3 visits per person, per calendar year | No copay |
| Deductible range | $0 - $20,000 | $0 - $20,000 | $0 - $5,000 | $1,500 - $5,650 for individuals; $3,000 - $11,300 for families |
| Wellness benefit | $750 | $375 | $200 | $750 |
| Critical illness | $5,000 | $2,500 | No benefit | $5,000 |
| Inpatient confinement copay | No | Yes, $500 | Yes, $500 | No |
| Home health care | Max of 35 visits | Max of 21 visits | Max of 15 visits | Max of 35 visits |
| Ambulance services | Same as any other illness | Same as any other illness | Max of $1,000 per person per calendar year | Same as any other illness |
For PPO plans, benefits/features listed are for in-network charges. Out-of-network benefits differ from in-network benefits. This is a brief description of some important features of the coverage. The product is not available in all states and benefits may vary based on state of residence. Please refer to the product brochure (IHCHS 2000 0608) for additional information. For a full explanation of benefits, exclusions and limitations refer to the Certificate of Coverage (MNL GC 107). The mPowerMed plan is underwritten by Madison National Life Insurance Company, Inc.

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