March 18, 2010

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Consumers Life Company – Michigan PHP 4080-5000 – MICHIGAN

A comparison of the Michigan PHP 4080-5000 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 Michigan PHP 4080-5000 Application Michigan PHP 4080-5000 Application
Brochure Michigan PHP 4080-5000 Brochure Michigan PHP 4080-5000 Brochure
Copay $40 $40
Office Visit $40 Copay per visit then 100% 50% after deductible
Deductible Individual: $5,000, Family: $10,000 Individual: $10,000, Family: $20,000
Coinsurance 80% 50%
Coinsurance Limit Michigan PHP 4080-5000 Michigan PHP 4080-5000
Out-of-Pocket Maximum Individual: $3,000, Family: $9,000(Excluding deductible) Individual: $25,000, Family: $50,000 (Excluding deductible)
Lifetime Maximum $7,500,000 $7,500,000
Prescription Drugs Prescription Drug (Oral Contraceptives Included) -
  • Prescription Drug Benefit Period Deductible: Individual $250, family $500 (Excludes generics)
  • Prescription Drug Benefit Period Maximum: $2,000 per person
  • Prescription Drug Lifetime Maximum: $2,500,000
  • Retail (30-day supply): $15 Generic, $30 Formulary, and 50% with a minimum of $45 and maximum of $90 Non-formulary
  • Home Delivery (90-day supply): $37.50 Generic, $75 Formulary, and $112.50 Non-formulary
 Prescription Drug (Oral Contraceptives Included) -
  • Prescription Drug Benefit Period Deductible: Individual $250, family $500 (Excludes generics)
  • Prescription Drug Benefit Period Maximum: $2,000 per person
  • Prescription Drug Lifetime Maximum: $2,500,000
  • Retail (30-day supply): $15 Generic, $30 Formulary, and 50% with a minimum of $45 and maximum of $90 Non-formulary
  • Home Delivery (90-day supply): $37.50 Generic, $75 Formulary, and $112.50 Non-formulary
Emergency Room
  • Emergency use of an Emergency Room: $150 copay, then 80% after deductible
  • Non-Emergency use of an Emergency Room: $300 copay, then 80% after deductible
  • Ambulance ($2,500 maximum per benefit period): 80% after deductible
    		•
  • Emergency use of an Emergency Room: $150 copay, then 80% after deductible
  • Non-Emergency use of an Emergency Room: $300 copay, then 50% after deductible
  • Ambulance ($2,500 maximum per benefit period): 80% after deductible
    		•
    Adult Preventative Care Preventive Services -
    • Routine Physical Exam: $40 copay, then 100%
    • Routine Mammogram (One per benefit period): 80% after deductible
    • Routine Pap Tests (One per benefit period): 80% after deductible
    • Routine PSA Tests: 80% after deductible
    		 Preventive Care (Well Child Care Services to age nine. Exams and immunizations are limited to $1,000 maximum per benefit period) -
    • Well Child Care Exams: 50% after deductible
    • Well Child Immunizations and Labs: 50% after deductible
    Child Preventative Care Preventive Care (Well Child Care Services to age nine. Exams and immunizations are limited to $1,000 maximum per benefit period) -
    • Well Child Care Exams: $40 copay, then 100%
    • Well Child Immunizations and Labs: 80% after deductible
    		 Preventive Care (Well Child Care Services to age nine. Exams and immunizations are limited to $1,000 maximum per benefit period) -
    • Well Child Care Exams: 50% after deductible
    • Well Child Immunizations and Labs: 50% after deductible
    Lab / X-Ray Diagnostic Services: 80% after deductible; Routine EKG, chest X-ray, comprehensive metabolic panel, urinalysis and complete blood count: 80% after deductible Diagnostic Services: 50% after deductible; Routine EKG, chest X-ray, comprehensive metabolic panel, urinalysis and complete blood count: 50% after deductible
    Maternity Michigan PHP 4080-5000 Michigan PHP 4080-5000
    Physical Therapy
  • Physical Therapy (20 visits per benefit period): $40 copay, then 80%
  • Occupational Therapy (20 visits per benefit period): $40 copay, then 80%
  • Speech Therapy (20 visits per benefit period): $40 copay, then 80%
  • Chiropractic Services (12 visits per benefit period): $40 copay, then 80%
  • Cardiac Rehab (20 visits per benefit period): 80% after deductible
    		•
  • Physical Therapy (20 visits per benefit period): $40 copay, then 50% after deductible
  • Occupational Therapy (20 visits per benefit period): 50% after deductible
  • Speech Therapy (20 visits per benefit period): $40 copay, then 50% after deductible
  • Chiropractic Services (12 visits per benefit period): 50% after deductible
  • Cardiac Rehab (20 visits per benefit period): 50% after deductible
    		•
    Skilled Nursing Skilled Nursing Facility ($10,000 maximum per benefit period): 80% after deductible Skilled Nursing Facility ($10,000 maximum per benefit period): 50% after deductible
    Home Health Care Home Health Care (60 visits per benefit period): 80% after deductible Home Health Care (60 visits per benefit period): 50% after deductible (Coinsurance does not apply to coinsurance out-of-pocket maximums. These services will not be covered at 100% once coinsurance out-of-pocket maximums are met)
    Mental Health Mental Health & Substance Abuse -
    • Inpatient Mental Health Services (30 days per benefit period): 80% after deductible
    • Outpatient Mental Health Services (20 visits per benefit period): 80% after deductible
    • Inpatient and Outpatient Substance Abuse Services ($4,500 limit per benefit period): 80% after deductible
    		 Mental Health & Substance Abuse -
    • Inpatient Mental Health Services (30 days per benefit period): 50% after deductible (Coinsurance does not apply to coinsurance out-of-pocket maximums. These services will not be covered at 100% once coinsurance out-of-pocket maximums are met)
    • Outpatient Mental Health Services (20 visits per benefit period): 50% after deductible (Coinsurance does not apply to coinsurance out-of-pocket maximums. These services will not be covered at 100% once coinsurance out-of-pocket maximums are met)
    • Inpatient and Outpatient Substance Abuse Services ($4,500 limit per benefit period): 50% after deductible (Coinsurance does not apply to coinsurance out-of-pocket maximums. These services will not be covered at 100% once coinsurance out-of-pocket maximums are met)
    Hospital Care
  • Semi-Private Room and Board: 80% after deductible
  • Surgical Services: 80% after deductible
  • Diagnostic Services: 80% after deductible
    		•
  • Semi-Private Room and Board: 50% after deductible
  • Surgical Services: 50% after deductible
  • Diagnostic Services: 50% after deductible
    		•
    Optional Benefits Michigan PHP 4080-5000 Michigan PHP 4080-5000