March 20, 2010

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American Community – Community Flex 60 – TEXAS

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 In-Network: Deductible, then 60% In-Network: Deductible, then 60%
Deductible In-Network: Individual: $7,500, Family: $15,000 In-Network: Individual: $7,500, Family: $15,000
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 Discount Drug Card Only Discount Drug Card Only
Emergency Room
  • Emergency Injuries- $250 copay and network deductible and coinsurance (Copay waived if admitted within 24 hours).
  • Emergency Sickness- $250 copay the network deductible and coinsurance (Copay waived if admitted within 24 hours).
  • Non-Emergency Injuries & Sickness- Not Covered
    		•
  • Emergency Injuries- $250 copay and network deductible and coinsurance (Copay waived if admitted within 24 hours).
  • Emergency Sickness- $250 copay the network deductible and coinsurance (Copay waived if admitted within 24 hours).
  • Non-Emergency Injuries & Sickness- Not Covered
    		•
    Adult Preventative Care Deductible, then 100% ($1,000 paid limit per person per CY on specific services).
  • Well Child Care (Birth through age 18):
    • Immunizations- Covered at 100% (with no maximum)
    		•
    Child Preventative Care
  • Well Child Care (Birth through age 18):
    • Immunizations- Covered at 100% (with no maximum)
    		•
  • Well Child Care (Birth through age 18):
    • Immunizations- Covered at 100% (with no maximum)
    		•
    Lab / X-Ray Deductible, then 60% Deductible, then 60%
    Maternity Community Flex 60 Community Flex 60
    Physical Therapy
  • Physical, Occupational, and Speech Therapy- Subject to deductible and coinsurance (20 visits per family member per calendar year, per type of therapy)
  • Spinal Manipulation- Subject to deductible and coinsurance (Calendar year maximum of $500 per member)
    		•
  • Physical, Occupational, and Speech Therapy- Subject to deductible and coinsurance (20 visits per family member per calendar year, per type of therapy)
  • Spinal Manipulation- Subject to deductible and coinsurance (Calendar year maximum of $500 per member)
    		•
    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-Hospital- Deductible, then 60%
  • Outpatient Surgery- Deductible, then 60%
    		•  In-Network:
  • In-Hospital- Deductible, then 60%
  • Outpatient Surgery- Deductible, then 60%
    		•
    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