March 19, 2010

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American Medical Security Life Insurance Company – MedOne Security- PPO Facility Copay Plan – KANSAS

A comparison of the MedOne Security- PPO Facility Copay Plan offered by American Medical Security Life Insurance Company is detailed out below for both Network and Non-Network coverage.

  Network Non-Network
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Network See Provider See Provider
Application MedOne Security- PPO Facility Copay Plan Application MedOne Security- PPO Facility Copay Plan Application
Brochure MedOne Security- PPO Facility Copay Plan Brochure MedOne Security- PPO Facility Copay Plan Brochure
Copay $30 N/A
Office Visit $30 Copay then 100% Subject to deductible, then coinsurance.
Deductible $1,000(2 per family maximum) $2,000(2 per family maximum)
Coinsurance MedOne Security- PPO Facility Copay Plan MedOne Security- PPO Facility Copay Plan
Coinsurance Limit MedOne Security- PPO Facility Copay Plan MedOne Security- PPO Facility Copay Plan
Out-of-Pocket Maximum $3,000 per person $6,000 per person
Lifetime Maximum $5,000,000 $5,000,000
Prescription Drugs
  • Non-Insurance Drug Discount Program
    		•
  • Non-Insurance Drug Discount Program
    		•
    Emergency Room $100 copay then subject to deductible, then coinsurance. Copay is waived if immediately confined. $100 copay then subject to deductible, then coinsurance. Copay is waived if immediately confined.
    Adult Preventative Care $30 Copay then 100% Not covered
    Child Preventative Care $30 Copay then 100% Not covered
    Lab / X-Ray Subject to deductible, then coinsurance. Subject to deductible, then coinsurance.
    Maternity Not covered Not covered
    Physical Therapy Subject to deductible, then coinsurance. Subject to deductible, then coinsurance.
    Skilled Nursing $500 Inpatient Copay or $250 Outpatient Copay then Subject to deductible, then coinsurance limited to 30 days per calendar year. $500 Inpatient Copay or $250 Outpatient Copay then Subject to deductible, then coinsurance limited to 30 days per calendar year.
    Home Health Care Subject to deductible, then coinsurance. Limited to 20 visits per calendar year. Subject to deductible, then coinsurance. Limited to 20 visits per calendar year.
    Mental Health Not covered Not covered
    Hospital Care $500 Inpatient Copay or $250 Outpatient Copay then subject to deductible, then coinsurance. $500 Inpatient Copay or $250 Outpatient Copay then subject to deductible, then coinsurance.
    Optional Benefits MedOne Security- PPO Facility Copay Plan MedOne Security- PPO Facility Copay Plan