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<br />/ /-70 <br />(fir ,)1 <br /> <br /> HumarcYS Current Plan <br />Current Plan Current Plan HUMANA <br />LIFETIME MAXIMUMS <br />Per Individual 1,000,000 Will Match <br />TMJ 80% 5,000 Diaqnostic or Surqical onlv <br />Infertility 80% 5.000 NONE <br />Obesity 5,000 NONE <br />Chemical Dependency 15,000 Same as any other illness up to 3 series. <br />Sleep Disorders 2,500 NONE <br />CALENDAR YEAR MAXIMUMS <br />Routine PAP 1 per year CoPay <br />Routine Mammogram 1 per year Copay <br />Routine PSA 1 per year CoPay <br />Mental/Nervous Disorders-In 45 days 30 Days <br />Mental/Nervous Disorders-Out 60 visits 30 Visits <br />Chemical Dependency 1,000 Same as any other illness <br />Chiropractic (Woods Chiro) 500 max 20 <br />Chiropractic (not Woods Chiro) 750 M 20 $25/visit uo to 20 visits <br />Home Health Care 80% 100 for 2 visits up to 100 visits per calendar year <br />Skilled nursing facility 80% 100 day maximum 50 day max <br />Physical Therapy 80% 2000 80% after deductible <br />Speech Therapy 80% 2000 80% after deductible <br /> 45 days inoatient/50 visits per year <br />Deductible Individual 300 DEPENDS ON PLAN <br />Deductible Family 900 <br />Out of Pocket Individual 1500 1 ! <br /> I <br />Out of Pocket Family 3000 I <br /> ~ <br />Specialty Physicians 80% 1 <br />(Rad, Anesth, Path, ERPhys) \ <br />Primary Care Physicians 25 copay i <br /> i <br />FACILITY CHARGES T <br />Inpatient Hospital 80% I <br /> j <br /> I <br /> i <br />Outpatient Hospital 80% \ <br /> I <br />Outpatient Surgical 80% \ <br /> I <br /> \ <br />Emergency Room 80% ; \ <br /> I <br /> i ~ <br />EMERGENCY CARE i \ <br /> l <br />up to a max of 300 per case 100% i <br /> \ <br /> ; <br /> i \ <br />LAB 80% \ <br /> , \ <br /> j i <br /> I <br />IMMUNIZATIONS (Age 6) 100% i i <br /> ~ <br /> I ; <br />Preventive Care - 300 year max 100% 1 <br /> I <br />Physicals 25 copay 1 : <br />Well Child 25 coova i <br /> i , <br /> i <br />MATERNITY 80% <br />AMBULANCE 80% <br />