Page 52 - Looks Salon Colonial Benefits Brochure Book

Benefit Level 2 Level 3 Level 4
Initial Diagnosis Benefit $4,000 $7,000 $10,000

Progressive Payment Benefit $50/month - $600/year $50/month - $600/year $50/month - $600/year
Health Screening Benefit $50 $75 $100
Air ambulance $2,000 per trip $2,000 per trip $2,000 per trip

Ambulance $250 per trip $250 per trip $250 per trip
Anesthesia - General 25% of surgical procedure 25% of surgical procedure 25% of surgical procedure
Anesthesia - Local $30 per procedure $40 per procedure $50 per procedure
Anti-nausea medication $40/day or per Rx ($160/mo max)$50/day or per Rx ($200/mo max)$60/day or per Rx ($240/mo max)
Blood/plasma/etc. $150 per day ($10,000/yr max) $175 per day ($10,000/yr max) $250 per day ($10,000/yr max)

Bone marrow donor screening $50 $50 $50
Bone marrow/stem cell donation $500 $750 $1,000
Bone marrow/stem cell transplant $4,000 per transplant $7,000 per transplant $10,000 per transplant

Cancer vaccine $50 (once per lifetime) $50 (once per lifetime) $50 (once per lifetime)
Companion transportation $0.50/mi ($1,000 max/RT) $0.50/mi ($1,200 max/RT) $0.50/mi ($1,500 max/RT)
Egg/sperm extraction $700 $1,000 $1,500
Egg/sperm storage $200 $350 $500
Experimental treatment $250/day ($12,500 max) $300/day ($15,000 max) $300/day ($15,000 max)

Family care $40/day ($2,000/yr max) $50/day ($2,500/yr max) $60/day ($3,000/yr max)
Hair/breast/voice box prosthesis $200/year $350/year $500/year
Home health care $75/day $100/day $150/day

Hospice - Initial $1,000 $1,000 $1,000

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