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Designed specially for the professional trucker.

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About OOIDA		Benefits & Programs	Other


Benefit Description PALIC Group Scheduled Benefit Plan includes:	Bronze	Silver	Gold	Platinum	Platinum Plus

PHYSICIAN OFFICE VISIT Max 6 visits per calendar year, per covered person	$50 per visit $300 calendar year maximum	$60 per visit $360 calendar year maximum	$60 per visit $360 calendar year maximum	$75 per visit $450 calendar year maximum	$75 per visit $450 calendar year maximum

EMERGENCY ROOM SICKNESS VISIT	$75 per visit $300 calendar year maximum	$75 per visit $300 calendar year maximum	$75 per visit $300 calendar year maximum	$75 per visit $300 calendar year maximum	$75 per visit $300 calendar year maximum

OUTPATIENT DIAGNOSTIC LAB & X-RAY TESTS • When Hospital Confinement is not required • Per covered person per calendar year • Lab (glucose test, urinalysis, CBC) • X-Ray (chest, broken bones) • Advanced Studies -EEG, CT Scan, MRI (for Platinum Plus only)	$50 per visit $300 calendar year maximum	$50 per visit $300 calendar year maximum	$70 per visit $300 calendar year maximum	$100 per visit $450 calendar year maximum	$50 Lab per visit (up to 3 visits) $150 X-Ray per visit (up to 2 visits) $1,000 for Advanced Studies $1,450 calendar year maximum

WELLNESS BENEFIT • Annual physical exam, well child, PSA, mammograms, well child immunizations, medical treatment, & cancer screenings • Not sick or injured	$50 per visit $150 calendar year maximum	$50 per visit $150 calendar year maximum	$75 per visit $150 calendar year maximum	$150 per visit $150 calendar year maximum	$100 per visit $300 calendar year maximum

DAILY HOSPITAL CONFINEMENT BENEFIT • Up to 60 days per calendar year • Due to a covered accident or covered sickness • Must be admitted as an inpatient into a hospital room	$800 benefit first day $400 each additional day while confined to a hospital	$1,200 benefit first day $600 each additional day while confined to a hospital	$1,600 benefit first day $800 each additional day while confined to a hospital	$2,000 benefit first day $1,000 each additional day while confined to a hospital	$2,000 benefit first day $1,000 each additional day while confined to a hospital

INTENSIVE CARE BENEFIT • Up to 30 days per calendar year • If you are confined in a hospital intensive care unit due to an injury received in a covered accident or because of a covered sickness (Pays in addition to the Confinement Benefit)	$800 per day Up to $24,000 maximum per year in ICU	$1,200 per day Up to $36,000 maximum per year in ICU	$1,600 per day Up to $48,000 maximum per year in ICU	$2,000 per day Up to $60,000 maximum per year in ICU	$2,000 per day Up to $60,000 maximum per year in ICU

SURGICAL SCHEDULE • Inpatient/Outpatient • See schedule of surgical procedures in the Certificate of Coverage	$2,000 calendar year maximum Scheduled amount, for most costly procedure in surgical session	$3,000 calendar year maximum Scheduled amount, for most costly procedure in surgical session	$5,000 calendar year maximum Scheduled amount, for most costly procedure in surgical session	$12,500 calendar year maximum Scheduled amount, for most costly procedure in surgical session	$12,500 calendar year maximum Scheduled amount, for most costly procedure in surgical session

ANESTHESIA BENEFIT 25% of the amount paid under the surgical benefit	Max up to $500 for anesthesia	Max up to $750 for anesthesia	Max up to $1,250 for anesthesia	Max up to $3,125 for anesthesia	Max up to $3,125 for anesthesia

SUBSTANCE ABUSE Up to 30 days per calendar year and must be diagnosed and admitted as an inpatient in a substance abuse unit	$200 per day $6,000 maximum per calendar year	$300 per day $9,000 maximum per calendar year	$400 per day $12,000 maximum per calendar year	$500 per day $15,000 maximum per calendar year	$500 per day $15,000 maximum per calendar year

SKILLED NURSING Up to a maximum of 60 days per stay in a skilled nursing facility following a covered hospital stay of at least 3 days	$200 per day $12,000 maximum per calendar year	$300 per day $18,000 maximum per calendar year	$400 per day $24,000 maximum per calendar year	$500 per day $30,000 maximum per calendar year	$500 per day $30,000 maximum per calendar year

MENTAL ILLNESS Up to 60 days per calendar year and must be diagnosed and admitted as an inpatient into a mental illness unit	$200 per day $12,000 maximum per calendar year	$300 per day $18,000 maximum per calendar year	$400 per day $24,000 maximum per calendar year	$500 per day $30,000 maximum per calendar year	$500 per day $30,000 maximum per calendar year

DURABLE MEDICAL EQUIPMENT Wheelchairs, oxygen equipment, hospital-type beds, diabetic supplies, nebulizers, blood glucose monitors, and more	N/A	N/A	N/A	N/A	$100 per calendar year

OUTPATIENT SURGICAL FACILITY Surgery performed at an outpatient surgical facility center or hospital outpatient surgical facility	N/A	N/A	N/A	N/A	$250 per surgery $500 maximum per calendar year

INPATIENT MISC. EXPENSE Up to 60 days per calendar year for misc. charges related to an inpatient stay in hospital including pharmacy, IV solutions, medical surgical supplies, all inpatient labs, inpatient x-rays and scans, operating room services, blood, physical therapy, respiratory services, etc.	N/A	N/A	N/A	N/A	$250 per day $15,000 maximum per calendar year

INPATIENT DOCTOR VISIT • Choice of doctor, services rendered in an inpatient room in a hospital • Up to 60 days per calendar year	N/A	N/A	N/A	N/A	$50 per day $3,000 maximum per calendar year

MAJOR ORGAN TRANSPLANT • Necessary removal and insertion of heart, lung, liver, pancreas or kidney at a transplant center	N/A	N/A	N/A	N/A	$20,000 maximum per calendar year

AMBULANCE SERVICES Emergency ground, air and water ambulance transportation	N/A	N/A	N/A	N/A	$250 per service $1,000 calendar year maximum

SPECIFIED ILLNESS BENEFIT First diagnosis lump sum for first diagnosis care due to a heart attack, stroke or cancer	N/A	N/A	N/A	N/A	$5,000 lump sum (Member) $2,500 lump sum (Spouse) $1,250 lump sum (Children)

ACCIDENT COVERAGE Charges incurred within 90 days of an accident	Up to $2,500 per occurrence Subject to $100 deductible per occurrence

GROUP TERM LIFE WITH ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS (Member Only)	Same benefit for Bronze, Silver and Gold plan levels Member - Term Life $5,000 with full benefit amounts AD&D $5,000 Spouse - Term Life $2,500 Children - Term Life $1,250 (over 6 months) Infant $200 (10 days to 6 months)			Same benefit for Platinum and Platinum Plus plan levels Member - Term Life $10,000 with full benefit amounts AD&D $10,000 Spouse - Term Life $2,500 Children - Term Life $1,250 (over 6 months) Infant $200 (10 days to 6 months)

The plan will not pay benefits for any care provided prior to the coverage effective date or if you are confined in a hospital at the time the coverage is effective. Hospital does not include a nursing home, convalescent home or extended care facility. The Insurance benefits described above are offered by Pan-American Life Insurance Company to members of OOIDA. For cost and further details of coverage, including exclusions, any restrictions or limitations, and the terms under which the policy may be continued in force, contact the OOIDA Medical Benefits Group. Reference form number PA-102401-POL OOIDA0606.

These plans are not available in all states, including Massachusetts.

For questions or to enroll, please call the OOIDA Medical Benefits Group at: 800-715-9369