Active Member Catastrophic Benefit
(GHI Members only)
Outline of Benefits
After a $3000 annual family deductible, GHI pays 100% of reasonable and customary charges based on a current profile with a maximum lifetime payment up to $250,000 per person.
Limitations
The first $25,000 is covered for private duty nursing care and 50% thereafter of the remainder with a lifetime cap of $50,000 per person. The cap for in hospital mental health charges is $10,000 per person.
$1000 Reimbursement
The SOC provides a self-funded $1,000 direct reimbursement benefit payable to the member upon attaining $3,000 out of pocket eligible incurred expenses are those medical and hospital charges that are considered reasonable and customary by the plan and not fully reimbursed by GHI. The member must produce a statement of services, explanation of benefits form and cancelled checks. The exclusions and restrictions are the same as the requirement for the catastrophic coverage benefit.