Catastrophic Coverage From Antex = Lower Premiums
Antex, or American National Life Insurance Company of Texas offers one of the best catastrophic hospital insurance coverages in the
market. Antex is a highly rated company within the insurance industry. They have developed a health insurance plan that has become
ever-more poplular because of the high cost of basic health insurance coverage. Antex is a company you can count on.
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Antex offers
an excellent health insurance plan that can help keep your premiums low and still provide you with health insurance coverage for major
problems that could occur. This health insurance plan is NOT designed to pay for your regular doctor visits although there is an outpatient
doctor rider available. Here are the covered expenses:
Professional Ambulance Service - Reasonable and Customary Charges for transportation, air or ground, to the nearest Hospital qualified to provide for the Covered Person’s Medically Necessary Emergency treatment.
Hospital Stay - The Hospital charge for each day a Covered Person is Hospital Confined. Such charge will include those for:
1. Semi-private room confinement, excluding any separate charges such as room, nursing services, maintenance, utilities and similar items;
2. Intensive Care Unit, Burn Unit, Coronary Care Unit and Neonatal Intensive Care Unit confinement, up to three times the Hospital’s average semi-private room rate; and
3. Medically Necessary miscellaneous services and supplies used for the treatment of the Hospital Confined Covered Person .
Services DO NOT include: charges for take-home medicines or drugs, personal or convenience items, or
items that are not intended primarily for use while Hospital Confined.
Doctor Visits - Reasonable and Customary Charges for the Covered Person’s Doctors’ (other than the surgeon) visits when Hospital Confined. For purposes of this provision, a Doctor’s consultation is a visit.
Surgery - Reasonable and Customary Charges made by an operating surgeon. If two or more surgeries are performed through the same incision, We will pay the one providing the greatest benefit under the Group Policy. We will also pay 50% of the benefits otherwise payable for the other surgeries performed through separate incisions during the same operative session. Charges must be incurred while a Covered Person is Hospital Confined or in a Same Day Surgery Facility. Same Day Surgery Facility - Reasonable and Customary Charges for services provided for a Covered Person by a Same Day Surgery Facility on the day surgery is performed. If a Covered Person is retained in the Same Day Surgery Facility for more than 18 hours, charges for use of such facility will be limited to the average semi-private room rate consistent with Reasonable and Customary Charges for Hospitals in the area where the Same Day Surgery Facility is located.
Assistant Surgeon - Actual charges for services provided during a surgical procedure by an Assistant Surgeon, up to 25% of the Reasonable and Customary Charge of the primary surgeon. Charges must be incurred while a Covered Person is Hospital Confined or in a Same Day Surgery Facility.
Second Surgical Opinion - Reasonable and Customary Charges for a Doctor providing a second surgical opinion regarding the recommendation for surgery. If the initial and second surgical opinions conflict, We will pay benefits for a third surgical opinion. The Deductible Amount does not apply to a second or third opinion.
Anesthesia Administration - Reasonable and Customary Charges for the administration of anesthesia by an anesthesiologist to a Covered Person undergoing surgery while Hospital Confined or in a Same Day Surgery Facility. The anesthesiologist must be at the operation solely to provide the anesthesia service. ANTEX will reduce benefits otherwise payable had an anesthesiologist administered anesthesia by 50% if a nurse anesthetist, operating Doctor, or assistant Surgeon administers the anesthesia, including any
incidental fluids, as part of a covered surgical procedure. When both an anesthesiologist and a nurse anesthetist bill for the same operative session, benefits will be limited to the Reasonable and Customary charges otherwise payable had the anesthesiologist been the sole provider of such services. Charges include the administration of general anesthesia and Hospital charges for dental care for the following Covered Persons: (1) a child under the age of five (5); (2) a person who is severely disabled; or (3) a person who has a medical or behavioral condition that requires hospitalization or general anesthesia when dental care is provided. Services may be performed in a participating Hospital, Same Day Surgery Facility, or Doctor’s office.
Eligible Expense and Medical Services Coverage
Subject to the Deductible Amounts, the Group Policy includes the listed Medical Services,
paid at the Reasonable and Customary Charge maximum. Should inconsistencies occur
with the information provided in this brochure, the terms and conditions of the Group
Policy, as amended per state law, will apply.
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Professional Ambulance Service - Reasonable and Customary Charges for transportation, air or ground, to the nearest Hospital qualified to provide for the Covered Person’s Medically Necessary Emergency treatment.
Hospital Stay - The Hospital charge for each day a Covered Person is Hospital Confined. Such charge will include those for:
1. Semi-private room confinement, excluding any separate charges such as room, nursing services, maintenance, utilities and similar items;
2. Intensive Care Unit, Burn Unit, Coronary Care Unit and Neonatal Intensive Care Unit confinement, up to three times the Hospital’s average semi-private room rate; and
3. Medically Necessary miscellaneous services and supplies used for the treatment of the Hospital Confined Covered Person .
Services DO NOT include: charges for take-home medicines or drugs, personal or convenience items, or
items that are not intended primarily for use while Hospital Confined.
Doctor Visits - Reasonable and Customary Charges for the Covered Person’s Doctors’ (other than the surgeon) visits when Hospital Confined. For purposes of this provision, a Doctor’s consultation is a visit.
Surgery - Reasonable and Customary Charges made by an operating surgeon. If two or more surgeries are performed through the same incision, We will pay the one providing the greatest benefit under the Group Policy. We will also pay 50% of the benefits otherwise payable for the other surgeries performed through separate incisions during the same operative session. Charges must be incurred while a Covered Person is Hospital Confined or in a Same Day Surgery Facility. Same Day Surgery Facility - Reasonable and Customary Charges for services provided for a Covered Person by a Same Day Surgery Facility on the day surgery is performed. If a Covered Person is retained in the Same Day Surgery Facility for more than 18 hours, charges for use of such facility will be limited to the average semi-private room rate consistent with Reasonable and Customary Charges for Hospitals in the area where the Same Day Surgery Facility is located.
Assistant Surgeon - Actual charges for services provided during a surgical procedure by an Assistant Surgeon, up to 25% of the Reasonable and Customary Charge of the primary surgeon. Charges must be incurred while a Covered Person is Hospital Confined or in a Same Day Surgery Facility.
Second Surgical Opinion - Reasonable and Customary Charges for a Doctor providing a second surgical opinion regarding the recommendation for surgery. If the initial and second surgical opinions conflict, We will pay benefits for a third surgical opinion. The Deductible Amount does not apply to a second or third opinion.
Anesthesia Administration - Reasonable and Customary Charges for the administration of anesthesia by an anesthesiologist to a Covered Person undergoing surgery while Hospital Confined or in a Same Day Surgery Facility. The anesthesiologist must be at the operation solely to provide the anesthesia service. ANTEX will reduce benefits otherwise payable had an anesthesiologist administered anesthesia by 50% if a nurse anesthetist, operating Doctor, or assistant Surgeon administers the anesthesia, including any
incidental fluids, as part of a covered surgical procedure. When both an anesthesiologist and a nurse anesthetist bill for the same operative session, benefits will be limited to the Reasonable and Customary charges otherwise payable had the anesthesiologist been the sole provider of such services. Charges include the administration of general anesthesia and Hospital charges for dental care for the following Covered Persons: (1) a child under the age of five (5); (2) a person who is severely disabled; or (3) a person who has a medical or behavioral condition that requires hospitalization or general anesthesia when dental care is provided. Services may be performed in a participating Hospital, Same Day Surgery Facility, or Doctor’s office.
Eligible Expense and Medical Services Coverage
Subject to the Deductible Amounts, the Group Policy includes the listed Medical Services,
paid at the Reasonable and Customary Charge maximum. Should inconsistencies occur
with the information provided in this brochure, the terms and conditions of the Group
Policy, as amended per state law, will apply.
Antex, or American National Life Insurance Company of Texas offers one of the best catastrophic hospital insurance coverages in the
market. Antex is a highly rated company within the insurance industry. They have developed a health insurance plan that has become
ever-more poplular because of the high cost of basic health insurance coverage. Antex is a company you can count on.
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