The Miramar Group

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Arizona
• Inpatient Alcoholism Treatment is covered up to $3000 per calendar year, $10,000 lifetime.

Arkansas
• Mental and Nervous disorders are covered the same as any other illness.

• Contraceptive drugs are cover as any other medically necessary medication.

• Charges for Alcoholism, Chemical Dependency, and Substance Abuse are excluded, unless the optional Arkansas Alcohol and Drug Dependency Benefit Offer Rider is elected and current.

• The out of network deductible penalty is limited to 125% of the in-network deductible. The 20% reduction in coinsurance still applies.

Illinois
• Inpatient alcoholism is covered the same as any other illness.

• Contraceptive drugs are cover as any other medically necessary medication.

• Charges for TMJ and CMJ are limited to a lifetime maximum of $2,500.

• Charges for Mental and Nervous disorders are excluded, unless the optional Mental Disorders Optional Benefit is elected and current.

• Charges for Outpatient Alcoholism and Chemical Dependency are excluded.

Indiana
• Mental and Nervous disorders are covered the same as any other illness.

• Inpatient Alcoholism is covered the same as any other illness.

Missouri
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Nebraska
• Benefits for TMJ are limited to a lifetime maximum of $2,500.

MANDATED OFFERS

Arkansas
• Arkansas Alcohol and Drug Dependency Benefit Offer
This benefit provides coverage for the treatment of Alcoholism, Drug Dependency, or Substance Abuse. Benefits are limited to $6,000 in any 24-month period, with a lifetime maximum of $12,000.

• Arkansas Musculoskeletal Disorders Benefit Offer (Face, Neck and Head)
This benefit provides coverage for the medically necessary diagnosis and treatment of Temporomandibular Joint Disorder (TMJ) and Craniomandibular Disorder (CMJ) on the same basis as any other musculoskeletal disorder.

Illinois
Mental Disorders Benefit Offer
• This benefit provides coverage for inpatient and outpatient charges for the treatment of Serious and Non-Serious Mental, Emotional, and Nervous Disorders. These charges are covered at 50% up to a maximum of $10,000 per year for Serious Disorders and $10,000 for Non-Serious Disorders.

Missouri
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