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SISLink Group Hospital Confinement Insurance
Employees enrolled in the Choice
Plus $5,000 PPO will have the
SISLINK Gap Plan included with no
additional cost. This plan is used to
help
pay
for
out-of-pocket
expenses incurred due to a covered Hospital Confinement
or covered Out-Patient medical procedures. Covered
Expenses Include:
In-Hospital Confinement (The plan covers up to $2,500):
In-patient hospital stays
In-patient surgeries
Physician’s in-hospital charges
Out-Patient (The plan covers up to $2,500):
Hospital emergency room treatment
Out-patient surgery in an out-patient surgical facility,
emergency facility or physician’s office
Diagnostic testing including, but not limited to, x-rays,
diagnostic lab, MRI’s and CT scans
Benefits are limited to four (4) occurrences per family
per calendar year
All eligible expenses must result from the medically
necessary treatment of an Injury or an Illness.
How to file a claim:
Mail, email or fax a copy of your Explanation of Benefits
(EOB) and copy of your itemized bill along with your claim
form to:
SPECIAL INSURANCE SERVICES, INC.
PO BOX 250349
PLANO, TX 75025-0349
Questions? Contact Customer Service by calling
1-800-767-6811 or emailing
customerservice@specialinc.com .