March 20, 2010

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Consumers Life Company – Michigan Wellness HSA 4000 – MICHIGAN

A comparison of the Michigan 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 Michigan Wellness HSA 4000 Application Michigan Wellness HSA 4000 Application
Brochure Michigan Wellness HSA 4000 Brochure Michigan Wellness HSA 4000 Brochure
Copay N/A N/A
Office Visit 100% after deductible 50% after deductible
Deductible Single: $4,000, Family: $8,000 Single: $8,000, Family: $16,000
Coinsurance 100% 50%
Coinsurance Limit Michigan Wellness HSA 4000 Michigan Wellness HSA 4000
Out-of-Pocket Maximum N/A Single: $4,000, Family: $8,000 (Excluding deductible)
Lifetime Maximum $3,000,000 $3,000,000
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
  • Emergency Use of an Emergency Room: 100% after deductible
  • Non-Emergency Use of an Emergency Room: 100% after deductible
    		•
  • Emergency Use of an Emergency Room: 100% after deductible
  • Non-Emergency Use of an Emergency Room: 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
  • Routine PSA Tests: 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; Routine EKG, chest X-ray, comprehensive metabolic panel, urinalysis and complete blood count: 100% no deductible Diagnostic Services: 50% after deductible; Routine EKG, chest X-ray, comprehensive metabolic panel, urinalysis and complete blood count: 50% after deductible
    Maternity Michigan Wellness HSA 4000 Michigan Wellness HSA 4000
    Physical Therapy
  • Physical Therapy (20 visits per benefit period): 100% after deductible
  • Occupational Therapy (20 visits per benefit period): 100% after deductible
  • Speech Therapy (20 visits per benefit period): 100% after deductible
    		•
  • Physical Therapy (20 visits per benefit period): 50% after deductible
  • Occupational Therapy (20 visits per benefit period): 50% after deductible
  • Speech Therapy (20 visits per benefit period): 50% after deductible
    		•
    Skilled Nursing Skilled Nursing Facility ($10,000 maximum per benefit period): 100% 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): 100% after deductible Home Health Care (60 visits per benefit period): 50% after deductible
    Mental Health
  • Inpatient Mental Health Services (30 days per benefit period): 100% after deductible
  • Outpatient Mental Health Services (20 visits per benefit period): 50% after deductible
  • Inpatient and Outpatient Substance Abuse Services ($4,500 limit per benefit period): 100% after deductible
    		•
  • Inpatient Mental Health Services (30 days per benefit period): 50% after deductible (Coinsurance does not apply to coinsurance out-of-pocket maximum. 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 maximum. 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 maximum. These services will not be covered at 100% once Coinsurance out-of-pocket maximums are met.)
    		•
    Hospital Care Semi-Private Room and Board: 100% after deductible Semi-Private Room and Board: 50% after deductible
    Optional Benefits Michigan Wellness HSA 4000 Michigan Wellness HSA 4000