Schedule of Benefits
Annual maximum benefit allowance
$400.
•
Per calendar year
•
Coverage total includes all services rendered
Annual Maximum benefit period
8 weeks/ 2 months
•
Claim must be made within 1 year of initial diagnosis / treatment period
•
Or within 6 months of any reoccurrence
Benefits Summary
-Benefits will be paid up to the weekly amount scheduled. You
cannot
exceed the maximum coverage period or the annual benefit allowanc
e.
Personal Assistance (see page 3 for detailed information)
Meal Supplements $40 per wk.
•
Maximum allowance $320.
Personal Health / Beauty $25 per wk.
•
Maximum allowance $200.
Personal Nutrition / Food $35 per wk
•
Maximum allowance $280.
Medical Supplies $50 per wk
•
Maximum allowance $400.
Prescriptions Name brands 20% or up to $ 75.
Generic brands 30% or up to $100.
•
Maximum allowance $200 generic / name brands $150.
Insurance Co-pays up to $25 per visit
* Maximum allowance $100.
Rent /Mortgage Assistance (see page 4 for detailed information)
We will assist with these monies if you have to relocate to a least expensive dwelling.
Initial residence deposit
One- time assistance only
•
1-2 bedroom maximum $100.
•
3-4 bedroom maximum $200.
Rent / Mortgage payments 20 % or up to $200.
•
We will assist with the percentage that is not paid by another agency
Utility Assistance (see page 5 for detailed information)
Lights / Gas / Water 20% or up to $100.
•
We will assist with the percentage that is not paid by another agency.
Transportation (see page 6 for detailed information)
Car payments (whichever is greater) 25% or up to $150.
* Car or lease payments (no rentals)
Car Insurance 40% or up to $100.
* Monthly premium payment
Bus /Train (passes may be issued) $15 per wk / max. $60 per mth.
Cabs/ Taxis (tokens may be issued) $15 per wk / max. $60 per mth.
Personal Assistance
The purpose of this service is to assist with personal items such as meal supplements,
health/beauty items, nutrition/food, medical supplies, prescriptions and insurance co-pays.
These items are deemed as necessary to help continue to provide a normal quality of life after
diagnoses.
Listed below you find the types and kinds of items we will assist with:
Meal Supplements- Any meal supplement (liquid or powder) Ex. Ensure
*We will
not pay for dietary meal supplements.
Health /Beauty - Any doctor recommended oils, lotions, creams, shampoos/conditioners
Deodorants, feminine hygiene products
Any hair accessories –wigs, scarves, turbans, hats (casual wear)
*We will
not pay for the following:
facials/manicures/pedicures – stylish
hats/scarves – expensive designer wigs- salon visits-
Nutrition/Food - Meats, fruits/vegetables, grains/breads, juices bought at grocery store
•
We will not pay for food at restaurants or food that prepared and delivered-ex. pizza
Medical supplies – any medical supply needed to assist with the patients recovery.
Ex. Gauges/bandages, syringes, thermometers, saline, etc.
•
We will not pay for items not directly affiliated with your illness.
Prescriptions – Any doctor prescribed medicines, creams or ointments.
Insurance co-pays will be paid up the benefit amount allowance
•
We will not pay for any over-the-counter medication unless recommended by the doctor.
•
If available we suggest generic brand prescriptions
Insurance Co-Pays -Any co-payment amount for regular or preventive care doctor visits.
* We will
not pay for chiropractic
care visits, message therapy or etc. (unless doctor
recommended)
Rent/Mortgage Assistance
The purpose of this service is to assist with in the area rent/mortgage assistance such as relocation
deposit of principal residence or assistance with rent/mortgage payments.
We will assist with these monies if you have to relocate to a least expensive dwelling.
Initial residence deposit
One- time assistance only
•
1-2 bedroom maximum $100.
•
3-4 bedroom maximum $200.
Residence has to be in your name or your name has to be on the lease (special circumstances can
and will be considered).
•
We will not pay for moving companies/supplies or rental trucks.
Rent / Mortgage payments 20 % or up to $200.
•
We will assist with the percentage of the principal payment due that is
not paid by another
agency.
•
We will
not pay late fees, eviction
court costs, damages or repair costs of dwelling.
Utility Assistance
Lights / Gas / Water 20% or up to $100.
•
We will assist with the percentage that is not paid by another agency.
Transportation Assistance
Cabs/bus/Air/Train
•
We will assist with the percentage of airfare not covered by the airline
and/or pay for
emergency discount tickets up to $400.00
•
We will supply Monies for gas to get to and from treatments in a personal
driven car or
pay a volunteer gas mileage to carry patients to and from treatments/ personal errands that
patients is to weak to drive ones self.
•
We will assist with train and or bus fare for patients or family members
in urgent
situations.
