Autograph 5000
Copyright 2008 First Mutual Insurance Group, Inc.
This is a simplified outline of benefits. Please refer to the plan brochure for full outline of benefits, limitations and exclusions.
Features:
Humana One
One of the Strongest Rated Health Carriers in the Nation
PPO Coverage
Humana One
One of the Strongest Rated Health Carriers in the Nation
PPO Coverage
Medical Insurance
Individuals and Families
Group Insurance
Dental Insurance
80% up to $300 (No Deductible)
$35 Co-pay up to six visits per year per person
$35 Co-pay up to six visits per year per person
Co-pay Card options
$75 Co-pay, then 80% after Annual Deductible
80% after Annual Deductible
80% after Annual Deductible
$5000 up to (2) per family
20% up to $2000 per person
$35 Co-pay up to six visits per year per person
$35 Co-pay up to six visits per year per person
Co-pay Card options
$75 Co-pay, then 80% after Annual Deductible
80% after Annual Deductible
80% after Annual Deductible
$5000 up to (2) per family
20% up to $2000 per person
Wellness...................................................
Doctor Visits...............................................
Specialists.................................................
Prescriptions..............................................
Emergency Room.........................................
Outpatient Surgeries/Testing...........................
Inpatient Hospitalization................................
Annual Deductible Choice................................
Co-insurance Maximum out of Pocket..................
Doctor Visits...............................................
Specialists.................................................
Prescriptions..............................................
Emergency Room.........................................
Outpatient Surgeries/Testing...........................
Inpatient Hospitalization................................
Annual Deductible Choice................................
Co-insurance Maximum out of Pocket..................
Erik Marx
(800) 831-2958 ext. 103
(800) 831-2958 ext. 103
