March 20, 2010

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Consumers Life Company – Indiana Wellness HSA 4000 – INDIANA

A comparison of the Indiana Wellness HSA 4000 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 Wellness HSA 4000 Application Indiana Wellness HSA 4000 Application
Brochure Indiana Wellness HSA 4000 Brochure Indiana Wellness HSA 4000 Brochure
Copay N/A N/A
Office Visit 100% after deductible 50% after deductible
Deductible Individual: $4,000, Family: $8,000 Individual: $8,000, Family: $16,000
Coinsurance 100% 50%
Coinsurance Limit Indiana Wellness HSA 4000 Indiana Wellness HSA 4000
Out-of-Pocket Maximum N/A (Excluding Deductible) Individual: $4,000, Family: $8,000 (Excluding Deductible)
Lifetime Maximum $7,500,000 $7,500,000
Prescription Drugs
  • Retail- 90 Day Supply, 100% after deductible.
  • Home Delivery- 90 Day Supply, 100% after deductible.
    		•
  • Retail- 90 Day Supply, 100% after deductible.
  • Home Delivery- 90 Day Supply, 100% after deductible.
    		•
    Emergency Room 100% after deductible
  • Emergency use: 100% after deductible
  • Non-emergency use: 50% after deductible
    		•
    Adult Preventative Care
  • Routine Physical Exam- 100% no deductible
  • Routine Mammogram (one per benefit period)- 100% no deductible
  • Routine Pap Tests (one per benefit period)- 100% no deductible
    		•
  • Well Child Care Services (to age nine)- Exams and Immunizations are limited to a $500 maximum per benefit period:
    • Well Child Care Exams, Immunizations & Labs- 50% after deductible
    		•
    Child Preventative Care
  • Well Child Care Services (to age nine)- Exams and Immunizations are limited to a $500 maximum per benefit period:
    • Well Child Care Exams, Immunizations & Labs- 100% no deductible
    		•
  • Well Child Care Services (to age nine)- Exams and Immunizations are limited to a $500 maximum per benefit period:
    • Well Child Care Exams, Immunizations & Labs- 50% after deductible
    		•
    Lab / X-Ray Diagnostic Services- 100% after deductible Diagnostic Services- 50% after deductible
    Maternity Not Covered Not Covered
    Physical Therapy 20 visits per benefit period, 100% after deductible 20 visits per benefit period, 50% after deductible
    Skilled Nursing $10,000 max per benefit period, 100% after deductible $10,000 max per benefit period, 50% after deductible
    Home Health Care 60 days per benefit period, 100% after deductible 60 days per benefit period, 50% after deductible
    Mental Health 100% after deductible 50% after deductible
    Hospital Care 100% after deductible 50% after deductible
    Optional Benefits None None