Comprehensive Major Medical Benefit

This benefit will be payable if you or your dependents, while covered, incur Covered Charges which exceed the Deductible Amount.  This Benefit provides you with coverage of any illness or injury that is not employment related.

Your Benefits

Benefits are payable, as shown in the Schedule of Benefits, for Covered Charges that you, or one of your Dependents, incur within a calendar year, which are in excess of the Deductible.

The Deductible

The Deductible is an "out-of-pocket" expense which you and your Dependents are required to pay before you are entitled to the Comprehensive Major Medical Benefit.  The Deductible Amount per individual is shown in the Schedule of Benefits.

The Deductible applies only once in the calendar year.  Any expenses incurred in the last three (3) months of a calendar year which are used to satisfy the Deductible, in part of in full, will also be applied to reduce the Deductible for the following calendar year.

Common Accident

If two (2) or more covered members in a family are injured in the same accident, only one Deductible has to be met during that calendar year and the following calendar year for Covered Charges which are incurred as a result of the common accident.  Separate Deductibles will still apply to charges not related to the common accident.

Maximum Benefits

The annual maximum amount payable with respect to all illnesses or injuries is $300,000 per individual per calendar year.

The lifetime maximum amount payable with respect to all illnesses or injuries is $750,000 per individual.

Automatic Reinstatement

Major Medical benefit payments made on you or your dependent's behalf reduce the lifetime Maximum Benefit amount.  Each January 1st, the Plan will automatically reinstate the amount of Comprehensive Major Medical Benefits which have been paid during the preceding calendar year, up to a maximum of one thousand dollars ($1,000).  The reinstatement is made without any action required on your part.  However, in no event will the total benefit, including any amount reinstated, exceed the original lifetime maximum at any one time.

Maximum Benefit Reinstatement

If at any time the Maximum Lifetime benefit is not fully restored is not fully restored by the Automatic Reinstatement provision, you or your Dependent may apply for reinstatement of the balance, if at least one thousand dollars ($1,000) in benefits have been paid and you, or your dependent, are not then qualifying for a Comprehensive Major Medical claim.  Evidence of good health must be submitted to the Plan at your own expense.  The new maximum will become effective on the date the Plan acknowledges the evidence as satisfactory.