March 14, 2010

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Avalon Healthcare – IFOCUS Plan D-9 E – FLORIDA

A comparison of the IFOCUS Plan D-9 E offered by Avalon Healthcare is detailed out below for both Network and Non-Network coverage.

  Network Non-Network
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Network See Provider See Provider
Application IFOCUS Plan D-9 E Application IFOCUS Plan D-9 E Application
Brochure IFOCUS Plan D-9 E Brochure IFOCUS Plan D-9 E Brochure
Copay
  • PCP: $35 copay, then covered at 100%
  • Specialist: Deductible & Coinsurance
    		•
  • PCP: $60 copay, then covered at 100%
  • Specialist: Deductible & Coinsurance
    		•
    Office Visit
  • PCP: $35 copay, then covered at 100%
  • Specialist: Deductible & Coinsurance
    		•
  • PCP: $60 copay, then covered at 100%
  • Specialist: Deductible & Coinsurance
    		•
    Deductible Individual: $5,000, Family: $10,000 Individual: $10,000, Family: $20,000
    Coinsurance 80% 60%
    Coinsurance Limit Individual: $5,000, Family: $10,000 Individual: $10,000, Family: $20,000
    Out-of-Pocket Maximum Individual: $10,000, Family: $20,000 Individual: $20,000, Family: $40,000
    Lifetime Maximum $5,000,000 (Maximum applies to combined in and out of network benefits) $5,000,000 (Maximum applies to combined in and out of network benefits)
    Prescription Drugs Provided by Rider - See Rider for a complete description of benefits and cost-sharing requirements. Provided by Rider - See Rider for a complete description of benefits and cost-sharing requirements.
    Emergency Room Deductible & Coinsurance Deductible & Coinsurance
    Adult Preventative Care
  • Annual Routine Ob/Gyn Exam (Annual Pap/Mammogram): $50 copay, deductible waived
  • Preventive Health (Physical, waiting period waived): $50 copay, deductible waived
    		•  Coinsurance only - deductible waived
    Child Preventative Care $50 copay, then covered at 100% Coinsurance only - deductible waived
    Lab / X-Ray Deductible & Coinsurance Deductible & Coinsurance
    Maternity See Optional Rider See Optional Rider
    Physical Therapy Deductible & Coinsurance (prior authorization required; limited to 60 visits/year) Deductible & Coinsurance (prior authorization required; limited to 60 visits/year)
    Skilled Nursing Deductible & Coinsurance (prior authorization required; limited to 30 days/year) Deductible & Coinsurance (prior authorization required; limited to 30 days/year)
    Home Health Care Deductible & Coinsurance (prior authorization required; limited to 30 days/year) Deductible & Coinsurance (prior authorization required; limited to 30 days/year)
    Mental Health Not Applicable Not Applicable
    Hospital Care Deductible & Coinsurance Deductible & Coinsurance
    Optional Benefits None None