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Safe, Secure & Absolutely FreeAmerican Community – Community Flex 60 with Gold Benefits Option – ILLINOIS
A comparison of the Community Flex 60 with Gold Benefits Option offered by American Community is detailed out below for both Network and Non-Network coverage.
| Network | Non-Network | |
|---|---|---|
|
||
| Network | See Provider | See Provider |
| Application | Community Flex 60 with Gold Benefits Option Application | Community Flex 60 with Gold Benefits Option Application |
| Brochure | Community Flex 60 with Gold Benefits Option Brochure | Community Flex 60 with Gold Benefits Option Brochure |
| Copay | In-Network:$30 for Office Visit/$60 for Urgent Care | In-Network:$30 for Office Visit/$60 for Urgent Care |
| Office Visit | In-Network: $30 for Office Visit/$60 for Urgent Care | In-Network: $30 for Office Visit/$60 for Urgent Care |
| Deductible | In-Network:Individual: $3,500, Family: $7,000 | In-Network:Individual: $3,500, Family: $7,000 |
| Coinsurance | In-Network: 60% coinsurance | In-Network: 60% coinsurance |
| Coinsurance Limit | Community Flex 60 with Gold Benefits Option | Community Flex 60 with Gold Benefits Option |
| Out-of-Pocket Maximum | Community Flex 60 with Gold Benefits Option | Community Flex 60 with Gold Benefits Option |
| Lifetime Maximum | $5,000,000 per person | $5,000,000 per person |
| Prescription Drugs | ||
| Emergency Room | ||
| Adult Preventative Care | In-Network: Office visit copay and 100% ($1,000 maximum per family member: Immunizations, except for HPV; Lab work performed in the office; Routine Physical Exams; PSA Test & Pap Smears, and Mammograms (Screening) | In-Network: Office visit copay and 100% ($1,000 maximum per family member: Immunizations, except for HPV; Lab work performed in the office; Routine Physical Exams; PSA Test & Pap Smears, and Mammograms (Screening) |
| Child Preventative Care | In-Network: Office visit copay and 100% ($1,000 maximum per family member: Immunizations, except for HPV; Lab work performed in the office; Routine Physical Exams; PSA Test & Pap Smears, and Mammograms (Screening) | In-Network: Office visit copay and 100% ($1,000 maximum per family member: Immunizations, except for HPV; Lab work performed in the office; Routine Physical Exams; PSA Test & Pap Smears, and Mammograms (Screening) |
| Lab / X-Ray | Deductible, then 60% | Deductible, then 60% |
| Maternity | Community Flex 60 with Gold Benefits Option | Community Flex 60 with Gold Benefits Option |
| Physical Therapy | ||
| Skilled Nursing | Skilled Nursing Facility- Subject to deductible and coinsurance (60 days per family member per Calendar Year) | Skilled Nursing Facility- Subject to deductible and coinsurance (60 days per family member per Calendar Year) |
| Home Health Care | Subject to deductible and coinsurance (20 visits per family member per Calendar Year) | Subject to deductible and coinsurance (20 visits per family member per Calendar Year) |
| Mental Health | Not covered | Not covered |
| Hospital Care | In-Network: |
In-Network: |
| Optional Benefits | ||