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The NSC Benefit Structure Guidelines To Customize Your Own Retiree Medical Benefit Plan - Underwritten by A+ Rated Insurance Company
- Prescription Drug carve-out by National Seniors Rx, fully insured with 52,000 Pharmacies & Mail Order
- Choose any Doctor or Hospital
- Employer contribution or voluntary retiree pay all
New Benefits Calendar Year Maximum Benefit
Applies to all benefits collectively. Calendar Year maximums of $0, or an amount between $50,000 and $500,000 in increments of $50,000. Lifetime Maximum Benefit
Applies to all benefits collectively. Lifetime maximums of $0, $1,000,000 or $2,000,000. Calendar Year Deductible
Satisfied first before any other Deductible and this applies to all benefits.
- Option 1 – Applies to all benefits except Inpatient Hospital Confinement Benefits (incl. SNF)
- Option 2 – Applies to all benefits
This will need to be re-satisfied each CY, even if a person is in the same Benefit Period under Part A type expenses.
CY Deductible amounts between $0 and $1,000 in increments of $100.
Inpatient Hospital Confinement Benefit (Part A)
Per Medicare Part A Benefit period. 1 - 60th day
Pay an amount between 0% and 100%, in 25% increments, of the Part A Deductible amount. Additionally have the option of:
a) 0%, 25%, 50% or 75% of the Part A Deductible for the first 10 days of inpatient and then the remaining amount of the Part A Deductible thereafter
b) 0%, 25%, 50% or 75% of the Part A Deductible for the first 30 days of inpatient and then the remaining amount of the Part A Deductible thereafter
61st - 90th day
Pay an amount between 0% and 100%, in 25% increments, of the 25% of Part A Deductible amount. 91st - 150th day — (lifetime reserve days)
Pay an amount between 0%, 50%, or 100% of 50% of Part A Deductible. After Lifetime Reserve for an additional of 365 days — (Underwriting parameters apply)
- Option 1 - Pay an amount between 0% and 100%, in 25% increments of the Eligible Expenses
- Option 2 - Pay an amount between 0% and 100%, in 25% increments, of the Eligible Expenses during the following confinement days after Lifetime Reserve
o Day 1 - 30
o Day 31-70
o Day 71-365
SNF
21st - 100th day
Pay an amount between 0%, 50% or 100%, of the 12.5% of the Medicare Part A Deductible amount. 101st - 365th day
Pay a flat daily amount for the room and board charges up to $250 in increments of $50. Outpatient Expenses (Part B) - Per Calendar Year
Part B Deductible
Pay an amount equal to 0%, 50% or 100% of Part B Deductible Part B Coinsurance
Pay an amount from 0% to 100% of Part B, 20% coinsurance in 10% increments. Additionally have the option of paying an amount from 0% to 90% of Part B, 20% coinsurance in 10% increments up to $500, $1,000, $1,500 or $2,000 OOP then 100%. Excess Outpatient Medical Expense
No Coverage, 80% or 100% of the difference between the actual Medicare Part B charge as billed and the Medicare approved Part B charge. Foreign Medical Treatment
No coverage or 100% up to 90 days, first treatment within 180 days traveled outside the U.S. Foreign Travel Emergency
No coverage or 80% after the deductible to the lifetime maximum with variable Deductibles of $250, $500, $1,000, $2,500, $5,000 with a maximum of $10,000, $25,000, $50,000, $1000,000 or $250,000. Private Duty Nursing
No Coverage of $25, $50, $75 or $100 per each 8-hour shift, for 30, 60, 90 shifts. At-Home Recovery Benefit
Same as Medicare Standard Plan benefit. Preventive Care Benefit
Same as Medicare Standard Plan benefit Cancer Preventive Care Benefits
Included in all plans. Pay the U & C charge for several of the cancer screening preventive care treatments. Hospice Care Benefit
Included in all plans. All coinsurance charges for Medicare approved Hospice Inpatient respite care, drugs and biological. Blood Deductible Benefit
1st 3 pints or equivalent quantities of packed red blood cells, defined under federal regulation, under Medicare Part A and B, except to the extent benefits have been paid by Medicare. 
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