Page 12 - Guide
P. 12
2017 Benefits Enrollment
Basic Advantage Total Plan (Indemnity Benefits)
If you are sick, injured, need treatment, or a prescription drug, the Reliance Standard plans provide cash
reimbursement for certain services. You will see in each option the plan is actually paying you, instead of the
provider, for services rendered.
You have 3 options to choose from which are summarized in the table below. It is important to evaluate which
plan design offers the level of beneit to best it your family’s needs.
Inpatient Hospital Beneits Plan 1 Plan 2 Plan 3
Hospital Room and Board Beneits
Daily beneit for the treatment of mental and nervous conditions $100 per day $100 per day $100 per day
Number of daily beneits per coverage year 25 25 25
Daily beneit for the treatment of alcohol abuse $300 per day $500 per day $700 per day
Number of daily beneits per coverage year 30 30 30
Daily beneit for the treatment of substance abuse (other than alcohol) $100 per day $100 per day $100 per day
Number of daily beneits per coverage year 25 25 25
Daily beneit for the treatment of all other covered conditions $300 per day $500 per day $700 per day
Number of daily beneits per coverage year 90 90 90
Hospital Admission Beneit For Speciied Conditions
Daily beneit for cancer (malignant neoplasm) $2,000 per day $4,000 per day $5,000 per day
Number of daily beneits per coverage year 1 1 1
Daily beneit for heart attack (myocardial infarction) $1,500 per day $3,000 per day $4,000 per day
Daily beneit for heart disease 1 $1,000 per day $1,500 per day $2,000 per day
Number of daily beneits per coverage year 1 1 1
Daily beneit for accidental injury $1,000 per day $2,000 per day $3,000 per day
Number of daily beneits per coverage year 1 1 1
Daily beneit for stroke (cerebrovascular accident—CVA) $1,000 per day $1,500 per day $2,000 per day
Number of daily beneits per coverage year 1 1 1
Daily beneit for childbirth $1,000 per day $1,500 per day $2,000 per day
Number of daily beneits per coverage year 1 1 1
Maximum surgery beneit per procedure 2 $750 per day $1,000 per day $1,500 per day
Maximum anesthesia beneit 3 $150 per day $200 per day $300 per day
1 The hospital admission beneit is payable for either heart attack or heart disease during a coverage year, but not both.
2 Beneits for covered inpatient surgery are scheduled and range from $9 to $750 under Plan 1, from $9 to $1,000 under Plan 2, and $9 to $1,500
under Plan 3 based on the speciic surgical procedure performed.
3 Beneits for covered inpatient anesthesia vary and are equal to 20% of the applicable inpatient surgery beneit.
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Basic Advantage Total Plan (Indemnity Benefits)
If you are sick, injured, need treatment, or a prescription drug, the Reliance Standard plans provide cash
reimbursement for certain services. You will see in each option the plan is actually paying you, instead of the
provider, for services rendered.
You have 3 options to choose from which are summarized in the table below. It is important to evaluate which
plan design offers the level of beneit to best it your family’s needs.
Inpatient Hospital Beneits Plan 1 Plan 2 Plan 3
Hospital Room and Board Beneits
Daily beneit for the treatment of mental and nervous conditions $100 per day $100 per day $100 per day
Number of daily beneits per coverage year 25 25 25
Daily beneit for the treatment of alcohol abuse $300 per day $500 per day $700 per day
Number of daily beneits per coverage year 30 30 30
Daily beneit for the treatment of substance abuse (other than alcohol) $100 per day $100 per day $100 per day
Number of daily beneits per coverage year 25 25 25
Daily beneit for the treatment of all other covered conditions $300 per day $500 per day $700 per day
Number of daily beneits per coverage year 90 90 90
Hospital Admission Beneit For Speciied Conditions
Daily beneit for cancer (malignant neoplasm) $2,000 per day $4,000 per day $5,000 per day
Number of daily beneits per coverage year 1 1 1
Daily beneit for heart attack (myocardial infarction) $1,500 per day $3,000 per day $4,000 per day
Daily beneit for heart disease 1 $1,000 per day $1,500 per day $2,000 per day
Number of daily beneits per coverage year 1 1 1
Daily beneit for accidental injury $1,000 per day $2,000 per day $3,000 per day
Number of daily beneits per coverage year 1 1 1
Daily beneit for stroke (cerebrovascular accident—CVA) $1,000 per day $1,500 per day $2,000 per day
Number of daily beneits per coverage year 1 1 1
Daily beneit for childbirth $1,000 per day $1,500 per day $2,000 per day
Number of daily beneits per coverage year 1 1 1
Maximum surgery beneit per procedure 2 $750 per day $1,000 per day $1,500 per day
Maximum anesthesia beneit 3 $150 per day $200 per day $300 per day
1 The hospital admission beneit is payable for either heart attack or heart disease during a coverage year, but not both.
2 Beneits for covered inpatient surgery are scheduled and range from $9 to $750 under Plan 1, from $9 to $1,000 under Plan 2, and $9 to $1,500
under Plan 3 based on the speciic surgical procedure performed.
3 Beneits for covered inpatient anesthesia vary and are equal to 20% of the applicable inpatient surgery beneit.
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