Insurance Plans
Example of Avera SELECT Medicare SELECT Supplement Insurance Plan:
Medical Expenses Covered by Plans
|
A |
B |
C |
F |
G |
K |
L |
|
Medicare Part A Coverage
|
| Hospital Inpatient Deductible for Days 1-60 |
No |
Yes |
Yes |
Yes |
Yes |
50% |
75% |
| Coinsurance for Days 61-90 |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
| Coinsurance for Lifetime Reserve Days |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
Coverage for all Medicare-approve charges
after Lifetime Reserve Days have been used
(365 days is maximum lifetime benefit) |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
Post Hospitalization - Skilled Nursing Facility
Coinsurance for Days 21-100 |
No |
No |
Yes |
Yes |
Yes |
50% |
75% |
First three pints of blood each year
(unless already paid for under Part B) |
Yes |
Yes |
Yes |
Yes |
Yes |
50% |
75% |
|
Medicare Part B Coverage
|
| Part B Deductible (per calendar year) |
No |
No |
Yes |
Yes |
No |
No |
No |
| Part B Coinsurance |
Yes |
Yes |
Yes |
Yes |
Yes |
50% |
75% |
| First three units of blood each year (unless already paid for under Part A) and 20% of Medicare-approved charges for additional units on an outpatient basis. |
Yes |
Yes |
Yes |
Yes |
No/Yes |
50% |
75% |
| 100% of Excess Physician Charges, up to maximum limits set by Medicare or state law |
No |
No |
No |
Yes |
Yes |
No |
No |
Foreign Travel Benefit
Medically necessary emergency care beginning during the first 60 days of each trip outside the U.S. subject to a $250 calendar year deductible. This benefit pays 80% of billed charges for Medicare eligible expenses ($50,000 is lifetime maximum benefit.) |
No |
No |
Yes |
Yes |
Yes |
No |
No |
The plans shown above are Avera SELECT Medicare SELECT* Supplement insurance plans, which means you must use a network hospital to receive the benefits of your plan unless: (a) you are traveling, during the first 90 days of travel; (b) the services you need are not available from a network hospital; or (c) if it's an emergency and you are unable to obtain services from a network hospital. Limited benefits will be paid if you otherwise use a non-network hospital. Non-restrictive plans are also available. Please contact Avera SELECT Medicare SELECT* Supplement Insurance sales office for more information. SD-SEL-A (06/10), SD-SEL-B (06/10), SD-SEL-C (06/10), SD-SEL-F (06/10), SD-SEL-G (06/10), SD-SEL-K (06/10), SD-SEL-L (16/10)