March 19, 2010

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Consumers Life Company – West Virginia HSA 4000 – WEST VIRGINIA

A comparison of the West Virginia 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 West Virginia HSA 4000 Application West Virginia HSA 4000 Application
Brochure West Virginia HSA 4000 Brochure West Virginia HSA 4000 Brochure
Copay N/A N/A
Office Visit 100% after deductible 50% after deductible
Deductible $4,000 Single/$8,000 Family $8,000 Single/$16,000 Family
Coinsurance 100% 50%
Coinsurance Limit (Excluding deductible) N/A (Excluding deductible) Unlimited
Out-of-Pocket Maximum (Excluding deductible) N/A (Excluding deductible) Unlimited
Lifetime Maximum $2,500,000 $2,500,000
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
  • 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 ($500 maximum per benefit period)- 100% after deductible
  • Routine Mammogram (one per benefit period)- 100% after deductible
  • Routine Pap Tests (one per benefit period)- 100% after deductible
    		•
  • Well Child Care exams and labs to age nine. Well Child Care immunizations to age 16. Well Child Care exams are limited to a $500 maximum per benefit period.
  • Well Child Care exams- 50% after deductible
  • Well Child Immunizations- 100%
  • Well Child Labs- 50% after deductible
    		•
    Child Preventative Care
  • Well Child Care exams and labs to age nine. Well Child Care immunizations to age 16. Well Child Care exams are limited to a $500 maximum per benefit period.
  • Well Child Care exams- 100% after deductible
  • Well Child Immunizations- 100%
  • Well Child Labs- 100% after deductible
    		•
  • Well Child Care exams and labs to age nine. Well Child Care immunizations to age 16. Well Child Care exams are limited to a $500 maximum per benefit period.
  • Well Child Care exams- 50% after deductible
  • Well Child Immunizations- 100%
  • Well Child Labs- 50% after deductible
    		•
    Lab / X-Ray 100% after deductible 50% after deductible
    Maternity West Virginia HSA 4000 West Virginia HSA 4000
    Physical Therapy 100% after deductible (20 visits per benefit period) 50% after deductible (20 visits per benefit period)
    Skilled Nursing 100% after deductible ($5,000 maximum per benefit period) 50% after deductible ($5,000 maximum per benefit period)
    Home Health Care 100% after deductible (100 visits per benefit period) 50% after deductible (100 visits per benefit period)
    Mental Health 100% after deductible 50% after deductible
    Hospital Care 100% after deductible 50% after deductible
    Optional Benefits West Virginia HSA 4000 West Virginia HSA 4000