Major Medical Medicare Supplement -- Covered Expenses

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Covered Expenses

Hospital Expenses

After you meet the deductible, the Major Medical Medicare Supplement Plan pays 80% of all reasonable and customary charges for hospital expenses for which you do not receive benefits under Medicare Part A, including your Medicare Part A inpatient hospital deductible and copayments.

Generally, Medicare Part A covers up to 60 days of inpatient hospital care for each period of illness at 100% — after you meet the Part A hospital deductible. (Inpatient psychiatric care under Part A has a calendar year limit of 30 days.) The Part A inpatient deductibles and copayments are subject to change.

Other Covered Expenses

After you meet your deductible, the Major Medical Medicare Supplement Plan pays 80% of reasonable and customary charges for expenses not reimbursed under Medicare, such as:

your Medicare Part B deductible
physicians' office, home and hospital visits
diagnostic X-rays and laboratory tests
radiation therapy and chemotherapy
local ambulance service
surgical dressings, splints and casts
rental of durable equipment for home use
prosthetic devices
private nursing services of a registered nurse
the first three pints of blood (Medicare covers the excess)
physical therapy
treatment of mental and nervous conditions up to 30 days per calendar year (covered at 50% if outpatient).

If your doctor or hospital charges more than what Medicare considers a standard charge for any of these covered treatments and the doctor or hospital has not accepted assignment under Medicare for these expenses, the plan will pay 80% of the difference between what the plan considers reasonable and customary and what Medicare actually reimburses. For example, assume that, after meeting your annual deductible, you receive a treatment for which the doctor's reasonable and customary charge is $30. Also assume that Medicare considers $20 to be a standard charge for this treatment. This means that Medicare's reimbursement will be 80% of $20 — or $16. The Major Medical Medicare Supplement Plan will cover 80% (or $11.20) of the remaining $14 — the difference between reasonable and customary ($30) and the Medicare reimbursement ($16). Your cost will be $2.80.

Expenses Incurred During Foreign Travel
If you and/or your covered spouse incur medical expenses due to illness or injury while temporarily traveling outside the United States, the plan will pay benefits for each covered individual during each trip. After the deductible is met, the plan pays 80% of reasonable and customary charges for medical expenses incurred after leaving the United States (up to the maximum benefit).

Last updated: Thursday April 21 2005

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