March 17, 2010

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Consumers Life Company – Georgia HSA 1200-80 – GEORGIA

A comparison of the Georgia HSA 1200-80 offered by Consumers Life 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 Georgia HSA 1200-80 Application Georgia HSA 1200-80 Application
Brochure Georgia HSA 1200-80 Brochure Georgia HSA 1200-80 Brochure
Copay N/A N/A
Office Visit 80% after deductible 60% after deductible
Deductible Individual: $1,200, Family: $2,400 Individual: $2,400, Family: $4,800
Coinsurance 80% 60%
Coinsurance Limit Georgia HSA 1200-80 Georgia HSA 1200-80
Out-of-Pocket Maximum Individual: $2,000, Family: $4,000(Excluding deductible) Individual: $4,000, Family: $8,000 (Excluding deductible)
Lifetime Maximum $2,500,000 $2,500,000
Prescription Drugs
  • Retail- 90 Day Supply-80% after deductible
  • Home Delivery-90 Day Supply-80% after deductible.
    		•
  • Retail- 90 Day Supply-80% after deductible
  • Home Delivery-90 Day Supply-80% after deductible.
    		•
    Emergency Room 80% after deductible
  • Emergency use: 80% after deductible
  • Non-emergency use: 60% after deductible
    		•
    Adult Preventative Care
  • Routine Physical Exam ($250 maximum per benefit period)- 80%
  • Routine mammogram (One per benefit period)- 80% after deductible
  • Routing Pap Tests- 80% after deductible
    		•
  • Well Child Services (to age six)- 60%
  • Well Child Care Services (limited to a $500 max per benefit period) (ages six to nine): 60% after deductible
    		•
    Child Preventative Care
  • Well Child Services (to age six)- 80%
  • Well Child Care Services (limited to a $500 max per benefit period) (ages six to nine): 80% after deductible
    		•
  • Well Child Services (to age six)- 60%
  • Well Child Care Services (limited to a $500 max per benefit period) (ages six to nine): 60% after deductible
    		•
    Lab / X-Ray
  • Diagnostic Services in a Physicians Office- 80% after deductible
  • Diagnostic Services other than a Physicians Office- 80% after deductible
    		•
  • Diagnostic Services in a Physicians Office- 60% after deductible
  • Diagnostic Services other than a Physicians Office- 60% after deductible
    		•
    Maternity Not Covered Not Covered
    Physical Therapy Physical Therapy, Occupational Therapy, and Chiropractic Services (30 visits combined per benefit period)- 80% after deductible Physical Therapy, Occupational Therapy, and Chiropractic Services (30 visits combined per benefit period)- 60% after deductible
    Skilled Nursing 30 days per benefit period; 80% after deductible 30 days per benefit period; 60% after deductible
    Home Health Care 100 days per benefit period; 80% after deductible 100 days per benefit period; 60% after deductible
    Mental Health
  • Inpatient Mental Health/Substance Abuse Services (30 days per benefit period; limited to one admission per benefit period and three admissions per lifetime): 100% after deductible.
  • Outpatient Mental Health/Substance Abuse Services (48 visits per benefit period): 80% after deductible.
    		•
  • Inpatient Mental Health/Substance Abuse Services (30 days per benefit period; limited to one admission per benefit period and three admissions per lifetime): 100% after deductible.
  • Outpatient Mental Health/Substance Abuse Services (48 visits per benefit period): 60% after deductible.
    		•
    Hospital Care Georgia HSA 1200-80 Georgia HSA 1200-80
    Optional Benefits Georgia HSA 1200-80 Georgia HSA 1200-80