Health ProtectorGuard offers additional benefits for surgical services. Surgical benefits apply whether surgery is performed in a hospital, an outpatient surgical facility, or a doctor’s office/clinic. All plan levels have unlimited days of surgical benefits. The Anesthesiologist benefits are paid each day anesthesia is administered for inpatient or outpatient surgery.
Outpatient Surgical Services Benefits with Health ProtectorGuard
The listing below is simply for Outpatient Surgical Services. A maximum of one payment per a day.
- Choice Value: $500 / Visit – 2 Visits Per a Year
- Choice Plus: $500 / Visit – 2 Visits Per a Year
- Select Value: $1,000 / Visit – 2 Visits Per a Year
- Select Plus: $1,000 / Visit – 3 Visits Per a Year
- Premier Plus: $1,000 / Visit – 3 Visits Per a Year
Inpatient Surgical Benefits with Health ProtectorGuard
Inpatient surgical benefits are paid on a surgical schedule which is based on the type of surgical procedure being performed. Keep in mind this benefit pays in addition to the hospital benefits, ICU, benefits, imaging benefits, etc. These benefits pay at Tier 1, 2, 3, or 4. All plans pay the same for surgical benefits.
Notice: Choice Value, Choice Plus, Select Value, Select Plus, Premier Plus all have the same benefits per a tier.
- Tier 1: $10,000 per surgery, unlimited days per a Year
- Tier 2: $5,000 per surgery, unlimited days per a Year
- Tier 3: $1,000 per surgery, unlimited days per a Year
- Tier 4: $500 per surgery, unlimited days per a Year
Keep in mind a surgeons fee is often far less than many people realize. The daily hospital stay is usually the bulk of a medical bill. This surgical benefit is designed to provide the added benefit for when a patient is in need of surgery. This benefit combines with your hospital benefits, and other plan benefits as well.
Tier 1 Extreme Surgical Conditions
Extreme conditions include significant, non-diagnostic, invasive surgical procedures including open heart surgery, bypass surgery, major organ transplant, and brain surgery.
Tier 2 Major Listed Conditions
Non-diagnostic, open incision, surgical procedures requiring general anesthesia. Procedures may include knee replacement, hip preplacement, rotator cuff repair, removal of tonsils or adenoids, and major organ removal or repair performed on organ within chest, abdomen or pelvic cavity that is not included in Tier 1.
Tier 3 Non-Major Listed Conditions
Surgical Procedures requiring general anesthesia or conscious sedation such as colonoscopy, stent placement, insertion of pacemaker, balloon angioplasty, heart catherization and laparoscopic hernia repair.
Tier 4 Local/minor listed conditions
Surgical procedures requiring local or regional anesthesia such as emergency C-sections and closed treatment of fracture or dislocation.
Assistant Surgeon and Anesthesiologist Coverage
The assistant surgeon benefit is paid for covered surgical services rendered by an assistant surgeon or by a licensed surgical assistant who is performing duties within the scope of his or her license. The benefit is paid per a surgery in conjunction with the Surgeon Benefit (and all the other Health ProtectorGuard benefits that may trigger due to the surgery).
Assistant Surgeon – Surgical Schedule Tiers 1 and 2 only.
- Tier 1: 20% of $10,000 / $2,000 per surgery, unlimited days per a Year
- Tier 2: 20% of $5,000 / $1,000 per surgery, unlimited days per a Year
For inpatient or outpatient surgery, anesthesiologist benefits are paid each day anesthesia is administered.
- Tier 1: 30% of $10,000 per surgery / $3,000 unlimited days per a Year
- Tier 2: 30% of $5,000 per surgery / $1,500 unlimited days per a Year
- Tier 3: 30% of $1,000 per surgery / $300 unlimited days per a Year
- Tier 4: 30% of $500 per surgery / $150 unlimited days per a Year