Page 53 - Looks Salon Colonial Benefits Brochure Book

Benefit Level 2 Level 3 Level 4
Hospice - Daily $50/day $50/day $50/day

Hospital confinement (£30 days) $150/day $250/day $350/day
Hospital confinement (31+ days) $300/day $500/day $700/day
Lodging $50/day $75/day $80/day

Medical imaging $125/study ($250 max) $175/study ($350 max) $225/study ($450 max)
Outpatient surgical center $200/day ($600 max) $300/day ($900 max) $400/day ($1,200 max)
Private nursing $75/day $125/day $150/day
Prosthetic device/artificial limb $1,500 ($3,000 max) $2,000 ($4,000 max) $3,000 ($6,000 max)
Radiation or chemotherapy - Weekly $500 $750 $1,000

Self-injected chemo (monthly) $200 $300 $400
Pump chemo (monthly) $200 $300 $400
Topical chemo (monthly) $200 $300 $400

Oral hormonal (1–24 mo) $200 $300 $400
Oral hormonal (25+ mo) $100 $150 $200
Oral non-hormonal $200 $300 $400
Reconstructive surgery $40/unit ($2,500 max) $60/unit ($3,000 max) $60/unit ($3,000 max)
Second medical opinion $200 $300 $300

Skilled nursing care $100/day $100/day $150/day
Skin cancer diagnosis $300 $400 $600
Supportive care drugs $100/day ($800/yr) $150/day ($1,200/yr) $200/day ($1,600/yr)

Surgical procedures $50/unit ($3,000 max) $60/unit ($5,000 max) $70/unit ($6,000 max)
Transportation $0.50/mi ($1,000 max/RT) $0.50/mi ($1,200 max/RT) $0.50/mi ($1,500 max/RT)
Waiver of premium Available Available Available

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