The following is a description of each of the benefits available under the FringeMark Health Insurance program.

Please review the Plans & Rates information for each of the specific benefit options offered.
When medical care is received, the insured employee pays the provider at the time of the visit (or, if agreed with the provider, upon receipt of a bill for services). Then the insured employee submits a claim under the FringeMark Health Insurance Plan and the plan reimburses the insured employee the stated benefit amount for covered services.

Doctor Office Visits:
Benefits are payable per visit to a doctor's office for treatment of injury or sickness. 5 visits per covered person per calendar year; one of which may be used for for an annual checkup.

Diagnostic Testing or X-ray:
Benefits are payable for as many as 3 visits per covered person per calendar year when doctor-ordered diagnostic tests and x-rays are performed in the doctor’s office or in an outpatient facility. One visit of the three may be used for diagnostic testing or x-rays during an annual checkup

Child Wellness Visits:
Benefits are payable per doctor's office visit for children through age 5 for their “well child” visits including physical examination, developmental assessment, immunizations and vision and hearing screenings.

Hospitalization:
Benefits are payable for each day confined as an inpatient in a hospital up to 100 days per confinement.

When an inpatient in an Intensive Care Unit or Coronary Care Unit, daily benefits are doubled for up to 30 days. If still hospitalized after the 30 day maximum, benefits will return to the “regular” daily benefit amount for the balance of the 100 day maximum per confinement.

When an inpatient for a Mental & Nervous condition or for Alcohol or Drug Abuse, 50% of the daily benefit amount is available up to a maximum of 30 days per confinement.

When hospitalized as an inpatient for at least 3 days and then, within 3 days, transferred to a Convalescent Facility, 50% of the daily benefit amount is available up to a maximum of 60 days per confinement.

Emergency Room:
Benefits are payable for visits to the emergency room when not admitted as an inpatient. 3 visits per covered person per calendar year are available for injury and 1 visit per covered person per calendar year is available for sickness.

Surgery:
Benefits are payable for 1 inpatient surgery and 1 outpatient surgery per covered person per calendar year. Outpatient surgery must be performed in a hospital or outpatient facility; i.e. not in a doctor’s office.

BeneScript Prescription Drug & Vision Care Discount Card:
Participating pharmacies and vision care providers offer discounted prescription drugs and eye care services. Participating providers can be found by checking website links or toll free customer service lines (both found on the Drug Card button) or simply showing your ID card. Since the discount is handled directly with the participating provider, there are no claims to file.

Survivor Benefit :
Dependent coverage will continue -premium free- for up to 18 months after the end of the month in which the insured employee's death occurs.