Wisconsin

Medicare Select
Product Forms: MSEL 06 WI (rev)

Benefits and Features
Coverage Plan
Part A deductible
Part A hospital co-payment (61-90 days)
Part A hospital co-payment (91-150 days)
Hospitalization beyond 150 days
Part A blood deductible (3 pints)
Skilled nursing facility co-payment (21-100 days)
Inpatient psychiatric care
Home health care
Part B deductible
Part B 20% of eligible expenses
Part B blood deductible (3 pints)
Part B policy limits per calendar year NO LIMIT
State mandated benefits  

VIEW NETWORK HOSPITAL LIST

Exceptions and Limitations

We will NOT pay benefits for any expenses incurred for which a charge normally is not made when there is no insurance or any expense incurred before the policy date. We will not duplicate any benefit paid by Medicare.

Pre-existing Conditions

Our policies do NOT include a pre-existing conditions limitation.
Renewability Provision - Guaranteed Renewable - Premiums Subject to Change

We guarantee to renew your policy each time you send us the premium. It must be paid on or before the date it is due or during the 31 days that follow. Your policy stays in force during this time. We can change your premium only if we do the same to all policies of this form issued to persons of your class in your state.


MSEL3 WI 11-06