Inbound Guest
Up to Age 69 years	Plan A	Plan B	Plan C	Plan D	Plan E
INPATIENT	$25,000 Max per Sickness	$45,000 Max per Sickness	$65,000 Max per Sickness	$85,000 Max per Sickness	$120,000 Max per Sickness
Hospital Room & Board Including Laboratory Tests, X-Rays, Prescription Medical and other miscellaneous	Up to $910/day,30 day max	Up to $1,260/day,30 day max	Up to $1,565/day,30 day max	Up to $1,785/day,30 day max	Up to $2,340/day,30 day max
Hospital Intensive Care Unit	Add’l $430/day, 8 day max	Add’l $595/day, 8 day max	Add’l $720/day, 8 day max	Add’l $790/day, 8 day max	Add’l $1020/day, 8 day max
Surgical Treatment	Up to $2,150	Up to $2,970	Up to $3,960	Up to $4,840	Up to $6,600
Anesthetist	Up to $540	Up to $740	Up to $990	Up to $1,210	Up to $1,650
Assistant Surgeon	Up to $540	Up to $740	Up to $990	Up to $1,210	Up to $1,650
Physician’s Non-Surgical Visits	Up to $40/visit, 1/day, 30 visits max	Up to $50/visit, 1/day, 30 visits max	Up to $65/visit,1/day, 30 visits max	Up to $75/visit, 1/day, 30 visits max	Up to $100/visit, 1/day, 30 visits max
Surgery Procedure	Up to $2,150	Up to $2,970	Up to $3,960	Up to $4,840	Up to $6,600
Ambulance Services	Up to $295	Up to $450	Up to $450	Up to $450	Up to $450