Co-payments and Deductibles

After you meet your deductible, CPIC Life pays 80% of the allowable amount (up to $5,000) for covered services, except outpatient psychiatric care. CPIC Life pays 100% of the allowable amount for covered services in excess of $5,000.

Please note that CPIC Life pays only 50% for outpatient psychiatric care. (See Covered Expenses.)

In addition to your plan deductible, you will have to pay an emergency room co-payment of $50 per visit for treatments that are not related to an injury. This co-payment does not apply to inpatient admissions.

Deductibles Waived for Accidents 

If you have an accident while your policy is in force, we will waive your plan deductible and emergency room co-payment for covered charges.

Extended Hospital Benefits

When coverage ends, if you are totally disabled from an illness or injury that began while your coverage was in effect, you are eligible for an extension of benefits. You may receive benefits for a period equal to the number of months the policy was enforce - but no more than 90 days beyond the policy's termination date. For example, if your coverage was in effect for six months, you could receive 90 days worth of coverage after the policy ends.

This extension does not apply to a condition related to pregnancy.

Maximum Benefit

You and each of your enrolled family members are covered for a maximum benefit of $2 million during the policy term.

Additional Benefit

Your plan also includes CPIC Life's $50,000 Accidental Death and Dismemberment Insurance Benefit. (This is only available to applicants over age 19.)

CPIC Life covers the following:
Charges for inpatient and outpatient professional services provided by physicians, surgeons, assistant surgeons, anesthetists, and consultants. (CPIC Life's payment is based on the allowable amount. ¹)
Services provided by dentists or oral surgeons to treat tumors or damage to natural teeth caused by an accidental injury sustained after the effective date of coverage.
Services provided by a registered nurse, excluding a close relative.
Hospital charges up to the semi-private room rate, and charges for an intensive care unit, as necessary.
Other necessary charges for supplies furnished and billed by the hospital.
Ambulance charges (surface and air transportation up to a maximum benefit of $1,000 during the policy term).
Rental of wheelchair, hospital bed, or other durable medical equipment, excluding items not primarily medical in nature, such as orthopedic shoes, air purifiers, or exercise bicycles.
Prosthetic devices, including artificial limbs, eyes or larynx, if required to permanently replace a natural body part lost while insured.
X-rays and laboratory examinations for diagnostic purposes, including mammography and Pap Tests for screening, when referred by a physician.
X-ray, radium and isotope therapy.
Prescription drugs.
Oxygen and its administration.
Anesthetics, including administration.
Outpatient physical medicine up to a maximum payment of $1,000 during the policy term.
Mental illness, other severe mental illness and serious emotional disturbances of a child, up to a maximum payment of $40 per visit (reimbursed at 50%), but no more than one visit per week and a maximum of $5,000 per insured during the policy term.
Home Health Care (limited).
TMJ (temporomandibular joint disorders) subject to a $500 maximum benefit. Charges for prosthetic devices and reconstructive surgery provided to restore and achieve symmetry incident to a mastectomy. Treatment of diabetes, including all types of diabetes medication, prescription and non-prescription equipment and supplies, as well as diabetes outpatient self-management training, education and nutrition therapy. Diethylstilbestrol (DES) conditions or exposure. Diagnosis, treatment, and appropriate management of osteoporosis, including all FDA approved technologies, including bone mass measurement technologies as deemed medically appropriate. Testing for and treatment of phenylketonuria (PKU), including formulas and special food products, when prescribed or ordered by the appropriate health care professional. Second Opinions. Medically accepted cancer-screening test. Screening and diagnose of prostate cancer. Charges or expenses for surgery performed to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infections, tumors or disease, in order to improve function or to create a normal appearance, to the extent possible.

Diaphragms and Birth Control Pills.

¹ Allowable amount is defined as any of the following: (a) The amount CPIC Life has determined is an appropriate payment for the service(s) rendered in the provider's geographic area, based on such factors as CPIC Life's evaluation of the value of the service(s) relative to the value of other service(s), market considerations and provider charge patterns. (b) Such other amount as the Shield Select Provider and CPIC Life have agreed will be accepted as payment for the service(s) rendered. (c) The amount CPIC Life determines is appropriate considering the particular circumstances and the services rendered - if an amount is not described in either (a) or (b) above.
 

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