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Listed benefits reflect the maximum amount payable per plan year.

 Plan 750Plan 1000Plan 1500Plan 2000
In Hospital Indemnity (No Elimination)$750$1,000$1,500$2,000
Max days per Confinement10103090
Max Benefit Amount per Plan Year$22,500$30,000$50,000$50,000
ER VisitN/AN/A$75$250
Max Visits Per Plan YearN/AN/A11
Physician Office Visit$75$75$100$100
Max Visits Per Plan Year3666
Ground AmbulanceN/AN/A$100$100
Max Trips per Plan YearN/AN/A11
Air AmbulanceN/AN/A$1,000$1,000
Max Trips per Plan YearN/AN/A11
Surgical IndemnityN/AN/AN/AN/A
Inpatient Major$1,000$1,000$1,000$2,500
Outpatient Major$1,000$1,000$1,000$2,500
Outpatient MinorN/AN/A$250$500
Inpatient Major$200$200$250$625
Outpatient Major$200$200$250$625
Outpatient MinorN/AN/A$75$125
Max Inpatient Procedures per Plan Year2222
Max Outpatient Procedures per Plan Year1122
Advanced Diagnostic$100$200$250$250
Max Tests per Plan Year1112
Diagnostic X-Ray and Lab$50$50$50$50
Max Tests per Plan Year1144
Max Screening Tests per Plan Year1111