March 19, 2010

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American Community – Community Flex 60 – TENNESSEE

A comparison of the Community Flex 60 offered by American Community is detailed out below for both Network and Non-Network coverage.

  Network Non-Network
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Network See Provider See Provider
Application Community Flex 60 Application Community Flex 60 Application
Brochure Community Flex 60 Brochure Community Flex 60 Brochure
Copay N/A N/A
Office Visit Office Visits/Urgent Care Centers (Office Visits/Urgent Care Center evaluation and management services): Deductible and benefit percentage Office Visits/Urgent Care Centers (Office Visits/Urgent Care Center evaluation and management services): Non-network deductible and benefit percentage
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 Community Flex 60
Out-of-Pocket Maximum Community Flex 60 Community Flex 60
Lifetime Maximum $5,000,000 per person $5,000,000 per person
Prescription Drugs Prescription Drugs (Value discount drug card for preferred pricing on select generic and brand name prescription drugs at network retail outlets):
  • Retail 31-day supply - Option 1 - Generic Only: 80% copayment, $15 minimum
  • Mail Order 90-day supply - Option 1 - Generic Only: 80% copayment, $35 minimum
 Prescription Drugs (Value discount drug card for preferred pricing on select generic and brand name prescription drugs at network retail outlets):
  • Retail 31-day supply - Option 1 - Generic Only: 80% copayment, $15 minimum
  • Mail Order 90-day supply - Option 1 - Generic Only: 80% copayment, $35 minimum
Emergency Room $250 copay and network deductible and benefit percentage. Copay waived if admitted within 24 hours (Sickness and Injury. Non-emergency not covered) $250 copay and network deductible and benefit percentage. Copay waived if admitted within 24 hours (Sickness and Injury. Non-emergency not covered)
Adult Preventative Care Preventive Care (HPV Immunizations, Bone Density Test, Colorectal Cancer Screening): Deductible and benefit percentage ($1,000 maximum per family member: Immunizations, except for HPV; Lab work; Routine Physical Exams; PSA Testing & PAP Smears; Mammograms Screening) Preventive Care: Not covered
Child Preventative Care Preventive Care: Deductible and benefit percentage Preventive Care: Not covered
Lab / X-Ray X-Ray and Laboratory performed on site: Deductible and benefit percentage X-Ray and Laboratory performed on site: Non-network deductible and benefit percentage
Maternity Maternity (Benefit for policyholder or spouse only, if spouse is covered under the policy):
  • Advantage: Network discounts apply when network providers are used
  • Coverage: $12,000 maternity-specific deductible and paid at network or non-network benefit percentage (90-day waiting period from the effective date. To be covered, pregnancy must begin after the waiting period)
 Maternity (Benefit for policyholder or spouse only, if spouse is covered under the policy):
  • Advantage: Network discounts apply when network providers are used
  • Coverage: $12,000 maternity-specific deductible and paid at network or non-network benefit percentage (90-day waiting period from the effective date. To be covered, pregnancy must begin after the waiting period)
Physical Therapy N/A N/A
Skilled Nursing N/A N/A
Home Health Care N/A N/A
Mental Health Not covered Not covered
Hospital Care
  • Non-Emergency Admission: Deductible and benefit percentage
  • Outpatient Surgery: Deductible and benefit percentage
  • In-Hospital Services: Deductible and benefit percentage
    		•
  • Non-Emergency Admission: $500 copay, then Non-network deductible and benefit percentage
  • Outpatient Surgery: $500 copay, then Non-network deductible and benefit percentage
  • In-Hospital Services: Non-network deductible and benefit percentage
    		•
    Optional Benefits Dental Benefit ($1,000 maximum per person per calendar year):
    • Type 1 procedures: 6-month waiting period and we pay 80%
    • Type 2 procedures: 12-month waiting period, $100 cale
    		 Dental Benefit ($1,000 maximum per person per calendar year):
    • Type 1 procedures: 6-month waiting period and we pay 80%
    • Type 2 procedures: 12-month waiting period, $100 cale