EXHIBIT 10.6

 

SCHEDULE OF BENEFITS

FOR STANDARD PLAN

 

Benefit Plan 207

 

Major Medical Benefits (Associates and Dependents)

    

Individual Lifetime Maximum

  

$750,000

Maximum Hospital Daily Benefit

  

Semi Private

Charge of semi-private room of which hospital has greatest number will be paid
toward private room.

    

Number of Days per Confinement

  

Unlimited

 

     Utilizing Participating
Provider

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   Utilizing Non-Participating
Provider

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Deductible Amount Per Calendar Year

         

Single

   $0    $0

2 Member Family

   $0    $0

3 or more Member Family

   $0    $0

Percent of Company Participation after Deductible

   100%    100%

Out-of-Pocket Maximum Per Calendar Year (Includes Deductible)

         

Single

   $0    $0

Family

   $0    $0

Hospitalization

         

Number of Inpatient Days

   Unlimited
100%    Unlimited
100%

X-Ray, Lab and Miscellaneous Hospital Services in a:

         

•       Hospital (Inpatient and Outpatient)

         

•       Skilled Nursing Facility

         

•       Outpatient Surgery Facility

         

Pre-Certification Required for All Inpatient Hospital Confinements

   Required No Penalty for
Non Certification    Required No Penalty for
Non Certification

Surgery Services (Including Inpatient and Outpatient)

   100%    100%

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Second Surgical Opinion (Elective Non-Emergency Surgeries)

   100%    100%

Physician Visits

         

Hospital

   100% (No limit)    100% (No limit)

Office

   100%    100%

Radiation Therapy

   100%    100%

Maternity (Includes coverage for dependent daughters)

   100%    100%

Emergency Care

   100%    100%

Mental Health and Alcoholism/Substance Abuse

         

Inpatient/Transitional Treatment

   100%    100%

Outpatient

   100%    100%

Short Term Rehabilitation Therapy

         

Physical

   100%    100%

Occupational

   100%    100%

Speech

   100%    100%

Chiropractic Services

   100%    100%

Preventative Care (Includes x-rays and lab tests in connection with exam)

   100%    100%

Well Baby Care, including immunizations, the first 6 visits will not apply to
the maximum (Birth to 6 years of age)

   100%    100%

Routine Physical Exam (over age 6)

   100%    100%

Pap Smears

   100%    100%

Mammograms

   100%    100%

Tuberculosis Testing (to age 19)

   100%    100%

X-ray and Lab Tests

   100%    100%

Allergy Care

   100%    100%

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Ambulance

   100%    100%

Durable Medical Equipment

   100%    100%

Oral Surgery

   100%    100%

Vision Care Eye Exams (for illness or injury only)

   100%    100%

Lenses

   100%    100%

Frames

   100%    100%

Contact Lenses

   100%    100%

Hearing Exams

   100%    100%

Health Education & Counseling

   Not Covered    Not Covered

Hospice Care

         

Impatient

   100%    100%

Outpatient

   100%    100%

Bereavement Counseling

   Not Covered    Not Covered

Skilled Nursing Home

   100%    100%

Home Health Care

   100%    100%

Family Planing Elective Sterilization

   100%    100%

Prescription Drugs

         

Copay Waived with Drug Card

   $0 Generic/Brand    No Benefit