Unicare of Indiana Saver 2000 Plan Plan Information
Plan Features
Annual Deductible: $2,000 per memeber per year
Out-of-Network Deductible: Does not apply
Annual Out-of-Pocket Maximum: Individual-$3,000 Family-$6,000
Lifetime Maximum: $5,000,000 per member
Preventive Care
Office Visits: 2 office visits per member deductible waived, 3+ visits you pay 100% of billed charges
Pap Smear, Mammogram, cancer screening, PSA screening: 70%
Child Immunizations: Not Covered
Lab and X-Ray: 70% with a maximum of $300 per member per year
Flu shots and routine physicals: Not Covered
Professional and Hospital Services
Surgery, Anesthesia, radiation therapy, and in-hospital doctor visits: 70% limited benefit
Inpatient Hospital Services: 70%
Outpatient Medical Care: 70%
Initial Care for a Medical Emergency: 70%
Physical/Occupational Therapy: $30 maximum per visit with a combined maximum of 12 visits per year
Ambulatory Surgical Center: 70%
Ambulance Service: 70%
Durable Medical Equipment: Not Covered
Presriptions
Generic: 100% after you pay a $10 copay
Brand Name: After payment of a separate $200 deductible, UniCare pays 100% after you pay a $25 copay
Other Unicare of Indiana health insurance plans:
