(For Retirees Who are Eligible for U.S. Medicare)
Following is a brief summary of your Indemnity Medical Benefit Plan. This is not a complete description of all of your Medical benefits, limitations and exclusions.

 

Benefit Type	Benefit Level
Lifetime Maximum	$1,000,000 with not more than 45 days to be paid for all treatment of mental, psychoneurotic or personality disorders per lifetime.
Calendar Year Deductible	$100 per person.
Inpatient Hospital Services	Not Subject to the Deductible, the Plan will pay: 70% of Medicare's inpatient deductible in any benefit period. 70% of Medicare's copayment from the 60th day through the 90th day of each benefit period. 70% of eligible hospital expenses after the 90th day of confinement for each benefit period. A benefit period starts when a person received covered services as a bed patient in a hospital and ends when a person has not been a bed patient in a hospital or extended care facility for 60 consecutive days.
Outpatient Hospital Services	20% of Medicare allowable after the deductible.
Surgery Primary Surgeon Assistant Surgeon Anesthesiologist	20% of Medicare allowable after the deductible. 20% of Medicare allowable after the deductible. 20% of Medicare allowable after the deductible.
Physician Visits Hospital Visits Office Visits	20% of Medicare allowable after the deductible. 20% of Medicare allowable after the deductible.
Outpatient X-ray and Laboratory	20% of Medicare allowable after the deductible.
Mental, Psychoneurotic and Personality Disorders	Doctor services limited to 20% of reasonable & customary to a maximum payable of $12.50 per visit and 50 visits per calendar year.