March 19, 2010

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Consumers Life Company – Georgia PHP 4070-5000 – GEORGIA

A comparison of the Georgia PHP 4070-5000 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 PHP 4070-5000 Application Georgia PHP 4070-5000 Application
Brochure Georgia PHP 4070-5000 Brochure Georgia PHP 4070-5000 Brochure
Copay $40 N/A
Office Visit Office Visit (Illness/Injury)- $40 copay, then 100% 60% after deductible
Deductible $5,000 Individual/$15,000 Family $10,000 Individual/$30,000 Family
Coinsurance 70% 60%
Coinsurance Limit Georgia PHP 4070-5000 Georgia PHP 4070-5000
Out-of-Pocket Maximum Coinsurance Out-of-Pocket Maximum (Excluding Deductible)- $2,000 Individual/$6,000 Family UNLIMITED
Lifetime Maximum $7,500,000 $7,500,000
Prescription Drugs
  • Prescription Drug Benefit Period Deductible- $200 Single/$600 Family
  • Retail (30 Day Supply)- $15 Generic/$30 Formulary/50% of cost for Non-Formulary ($45 minimum, $90 maximum)
  • Home Delivery (90 Day Supply)- $37.50 Generic/$75 Formulary/$112.50 Non-Formulary
    		•
  • Prescription Drug Benefit Period Deductible- $200 Single/$600 Family
  • Retail (30 Day Supply)- $15 Generic/$30 Formulary/50% of cost for Non-Formulary ($45 minimum, $90 maximum)
  • Home Delivery (90 Day Supply)- $37.50 Generic/$75 Formulary/$112.50 Non-Formulary
    		•
    Emergency Room $150 copay (waived if admitted), then 70% after deductible
  • Emergency use of an Emergency Room- $150 copay (waived if admitted), then 70% after deductible
  • Non-Emergency use of an Emergency Room- $150 copay (waived if admitted), then 60% after deductible
    		•
    Adult Preventative Care
  • Routine Physical Exam ($250 maximum per benefit period)- 70% after deductible
  • Routine Mammogram (One per benefit period)- 100%
  • Routine Pap Tests- 100%
    		•
  • Well Child Care Services (to age six):
    • Office Visit- 60%
    • Immunizations & Labs- 60%
  • Well Child Care Services (ages six to nine). Exams & Well Child Immunizations are limited to $500 maximum per benefit.
    • Office Visit- 60% after deductible
    • Immunizations & Labs- 60% after deductible
    		•
    Child Preventative Care
  • Well Child Care Services (to age six):
    • Office Visit- 70%
    • Immunizations & Labs- 70%
  • Well Child Care Services (ages six to nine). Exams & Well Child Immunizations are limited to $500 maximum per benefit.
    • Office Visit- 70% after deductible
    • Immunizations & Labs- 70% after deductible
    		•
  • Well Child Care Services (to age six):
    • Office Visit- 60%
    • Immunizations & Labs- 60%
  • Well Child Care Services (ages six to nine). Exams & Well Child Immunizations are limited to $500 maximum per benefit.
    • Office Visit- 60% after deductible
    • Immunizations & Labs- 60% after deductible
    		•
    Lab / X-Ray
  • Diagnostic Services in a Physicians Office- 100%
  • Diagnostic Services (other than a physician's office)- 70% after deductible
    		•
  • Diagnostic Services in a Physicians Office- 70% after deductible
  • Diagnostic Services (other than a physician's office)- 60% after deductible
    		•
    Maternity Not Covered Not Covered
    Physical Therapy Physical Therapy, Occupational Therapy, and Chiropractic Services (30 visits combined per benefit period)- 70% 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; 70% after deductible 30 days per benefit period; 70% after deductible
    Home Health Care 100 visits per benefit period; 70% after deductible 100 visits per benefit period; 70% after deductible
    Mental Health Optional Rider Optional Rider
    Hospital Care Georgia PHP 4070-5000 Georgia PHP 4070-5000
    Optional Benefits Mental Health Rider Mental Health Rider