Per Occurence Plans
ATA ASSOCIATION HEALTH PLANS
PER OCCURRENCE PLANS
| $2,500 | $5,000 | $7,500 | |
| Max Per Occurrence | Max Per Occurrence | Max Per Occurrence | |
| Physicians Office Visits | $25 co-pay | $25 co-pay | $25 co-pay |
| Primary/Specialists/Chiropractor | to plan max | to plan max | to plan max |
| E/R Ambulance Service | $250 deductible | $250 deductible | $250 deductible |
| Sickness/Accident – Deductible | Plan pays 80% up to | Plan pays 80% up to | Plan pays 90% up to |
| waived if due to accident or if admitted | plan max | plan max | plan max |
| Per Occurrence Deductible | $300 | $200 | $200 |
| (No annual limit on occurrences | |||
| 12 month pre-existing unless | |||
| proof of current coverage – no | |||
| pre-existing on office visits | |||
| or prescription benefits) | |||
| Hospital In-patient benefit | 80% to plan max | 80% to plan max | 90% to plan max |
| Physician Services | 80 % to plan max | 80% to plan max | 90% to plan max |
| In-Patient | |||
| In or Out-Patient Surgery | 80% to plan max | 80% to plan max | 90% to plan max |
| Additional in-patient | $400 per day | $400 per day | $400 per day |
| only benefit | Up to 30 days | Up to 30 days | Up to 30 days |
| (Paid after the per occurence | confinement | confinement | confinement |
| accident/sickness benefit | |||
| maximum has been paid. This | |||
| is an in-patient benefit only.) | |||
| Lab/X-Ray/MRI/CT Scans/Diagnostic | 80% to plan max | 80% to plan max | 90% to plan max |
| Max benefit of $750 | Max benefit of $1250 | Max benefit of $1500 | |
| Accidental Death Benefit | $10,000 | $10,000 | $10,000 |
| **Per Member only** | |||
| Mental Health/Alcohol/ | 80% to plan max | 80% to plan max | 90% to plan max |
| Drug Rehabilitation | per occurrence | per occurrence | per occurrence |
| **In-Patient Only** | |||
| Other Medical Services | 80% to plan max | 80% to plan max | 90% to plan max |
| ( Home Health Care, Hospice, | Per occurrence | Per Occurrence | Per Occurrence |
| physical therapy, Durable | |||
| Medical Equipment) | |||
| Maternity | 80% to plan max | 80% to plan max | 90% to plan max |
| Per occurrence | Per occurrence | Per occurrence | |
| Prescription Benefits | Wholesale Rate | Wholesale Rate | Wholesale Rate |
| (Express Scripts) | |||
| 50% co-payment for brand name | Less Discount | Less Discount | Less Discount |
| or generic medications up to the | 50/50 Co-pay | 50/50 Co-pay | 50/50 Co-pay |
| maximum per member per year | after discount | after discount | after discount |
| benefit. Member receives Express Scripts discount card after | $750 Annual Max | $1250 Annual Max | $1500 Annual Max |
| benefits are maxed out for the year |
Accident Medical Plan – Additional accident benefit that is over all health plan benefits. All plans include this benefit.
$1000 deductible and up to $25,000 per accident – see policy for details
