March 16, 2010

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Consumers Life Company – Indiana PHP 2500/5000-25 – INDIANA

A comparison of the Indiana PHP 2500/5000-25 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 Indiana PHP 2500/5000-25 Application Indiana PHP 2500/5000-25 Application
Brochure Indiana PHP 2500/5000-25 Brochure Indiana PHP 2500/5000-25 Brochure
Copay $25 N/A
Office Visit $25 Copay, then 100% 50% after deductible
Deductible Individual: $2,500, Family: $5,000 Individual: $5,000, Family: $10,000
Coinsurance 80% 50%
Coinsurance Limit Indiana PHP 2500/5000-25 Indiana PHP 2500/5000-25
Out-of-Pocket Maximum Individual: $2,000, Family: $6,000 (Excluding Deductible) Unlimited (Excluding Deductible)
Lifetime Maximum $7,500,000 $7,500,000
Prescription Drugs
  • Prescription Drug Benefit Period Deductible- Individual: $250, Family: $500
  • Benefit Period Maximum- $2,000 per person
  • Retail- 30 Day Supply, $15 Generic/$30 Formulary/50% with a minimum of $45 and maximum of $90 Non-Formulary
  • Home Delivery- 90 Day Supply, $37.50 Generic/$75 Formulary/$112.50 Non-Formulary
    		•
  • Prescription Drug Benefit Period Deductible- Individual: $250, Family: $500
  • Benefit Period Maximum- $2,000 per person
  • Retail- 30 Day Supply, $15 Generic/$30 Formulary/50% with a minimum of $45 and maximum of $90 Non-Formulary
  • Home Delivery- 90 Day Supply, $37.50 Generic/$75 Formulary/$112.50 Non-Formulary
    		•
    Emergency Room $150 copay, then 80% after deductible
  • Emergency use: $150 copay, then 100% after deductible
  • Non-emergency use: $150 copay, then 50% after deductible
    		•
    Adult Preventative Care
  • Routine Physical Exam: $25 Copay, then 100%
  • Routine Mammogram (one per benefit period)- 80% after deductible
  • Routine Pap Tests (one per benefit period)- 80% after deductible
    		•
  • Well Child Care services to age nine. Exams & Immunizations are limited to $1,000 maximum per benefit period.
    • Exams- 50% after deductible
    • Immunizations & Labs- 50% after deductible
    		•
    Child Preventative Care
  • Well Child Care services to age nine. Exams & Immunizations are limited to $1,000 maximum per benefit period.
    • Exams- $25 Copay, then 100%
    • Immunizations & Labs- 80% after deductible
  • Well Child Care services to age nine. Exams & Immunizations are limited to $1,000 maximum per benefit period.
    • Exams- 50% after deductible
    • Immunizations & Labs- 50% after deductible
    		•
    Lab / X-Ray Diagnostic Services- 80% after deductible Diagnostic Services- 50% after deductible
    Maternity Not Covered Not Covered
    Physical Therapy 20 visits per benefit period, $25 Copay, then 80% 20 visits per benefit period, 50% after deductible
    Skilled Nursing $10,000 max per benefit period, 80% after deductible $10,000 max per benefit period, 50% after deductible
    Home Health Care 60 days per benefit period, 80% after deductible 60 days per benefit period, 50% after deductible
    Mental Health 80% after deductible 50% after deductible
    Hospital Care 80% after deductible 50% after deductible
    Optional Benefits
  • Prescription Drug Rider
    		•
  • Prescription Drug Rider
    		•