March 20, 2010

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Consumers Life Company – West Virginia PHP 5000/10000-40 – WEST VIRGINIA

A comparison of the West Virginia PHP 5000/10000-40 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 PHP 5000/10000-40 Application West Virginia PHP 5000/10000-40 Application
Brochure West Virginia PHP 5000/10000-40 Brochure West Virginia PHP 5000/10000-40 Brochure
Copay $40 N/A
Office Visit $40 copay, then 100% 50% after deductible
Deductible $5,000 Single/$10,000 Family $10,000 Single/$20,000 Family
Coinsurance 80% 50%
Coinsurance Limit (Excluding deductible) $2,000 Single/$6,000 Family Unlimited
Out-of-Pocket Maximum (Excluding deductible) $2,000 Single/$6,000 Family Unlimited
Lifetime Maximum $2,500,000 $2,500,000
Prescription Drugs
  • Prescription Drug Benefit Period Deductible- $250 Single/$500 Family
  • Prescription Drug Benefit Period Maximum- $2,000
  • 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- $250 Single/$500 Family
  • Prescription Drug Benefit Period Maximum- $2,000
  • 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
  • Emergency Use of an Emergency Room- $150 copay, then 80% after deductible
  • Non-Emergency Use of an Emergency Room- $150 copay, then 80% after deductible
    		•
  • Emergency Use of an Emergency Room- $150 copay, then 80% after deductible
  • Non-Emergency Use of an Emergency Room- $150 copay, then 50% after deductible
    		•
    Adult Preventative Care
  • Routine Physical Exam ($500 maximum per benefit period)- $40 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 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- $40 copay, then 100%
  • Well Child Immunizations- 100%
  • Well Child Labs- 80% 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 80% after deductible 50% after deductible
    Maternity Optional Rider Optional Rider
    Physical Therapy $40 copay, then 100% 50% after deductible (20 visits per benefit period)
    Skilled Nursing 80% after deductible ($5,000 maximum per benefit period) 50% after deductible ($5,000 maximum per benefit period)
    Home Health Care 80% after deductible (100 visits per benefit period) 50% after deductible (100 visits per benefit period)
    Mental Health
  • Inpatient- 80% after deductible
  • Outpatient- $25 copay, then 100%
    		•  50% after deductible
    Hospital Care 80% after deductible 50% after deductible
    Optional Benefits Maternity Rider
  • Preventive Services Rider
    		•  Maternity Rider
  • Preventive Services Rider
    		•