March 12, 2010

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Consumers Life Company – West Virginia Value 500/1500 – WEST VIRGINIA

A comparison of the West Virginia Value 500/1500 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 Value 500/1500 Application West Virginia Value 500/1500 Application
Brochure West Virginia Value 500/1500 Brochure West Virginia Value 500/1500 Brochure
Copay $35 N/A
Office Visit $35 copay, then 100% 50% after deductible
Deductible $500 Single/$1,500 Family $1,500 Single/$4,500 Family
Coinsurance 70% 50%
Coinsurance Limit (Excluding deductible) $3,000 Single/$9,000 Family (Excluding deductible) Unlimited
Out-of-Pocket Maximum (Excluding deductible) $3,000 Single/$9,000 Family (Excluding deductible) Unlimited
Lifetime Maximum $2,000,000 $2,000,000
Prescription Drugs
  • Prescription Drug Benefit Deductible- $100 per person
  • Retail (30 Day Supply)- $25 copay- Generic drugs only
  • Home Delivery- Not Covered
    		•
  • Prescription Drug Benefit Deductible- $100 per person
  • Retail (30 Day Supply)- $25 copay- Generic drugs only
  • Home Delivery- Not Covered
    		•
    Emergency Room
  • Emergency Use of an Emergency Room- $250 copay, then 70% after deductible
  • Non-Emergency Use of an Emergency Room- Not Covered
    		•
  • Emergency Use of an Emergency Room- $250 copay, then 70% after deductible
  • Non-Emergency Use of an Emergency Room- Not Covered
    		•
    Adult Preventative Care
  • Routine Physical Exam ($500 maximum per benefit period)- $35 copay, then 100%
  • Routine Mammogram (one per benefit period)- 70% after deductible
  • Routine Pap Tests (one per benefit period)- 70% 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 $500 per child to age 1; thereafter, $150 per child per birth year to age 9.
  • 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 $500 per child to age 1; thereafter, $150 per child per birth year to age 9.
  • Well Child Care exams- $35 copay, then 100%
  • Well Child Immunizations- 100%
  • Well Child Labs- 70% 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 $500 per child to age 1; thereafter, $150 per child per birth year to age 9.
  • Well Child Care exams- 50% after deductible
  • Well Child Immunizations- 100%
  • Well Child Labs- 50% after deductible
    		•
    Lab / X-Ray $250 copay per day, then 70% after deductible 50% after deductible
    Maternity West Virginia Value 500/1500 West Virginia Value 500/1500
    Physical Therapy 70% after deductible (10 visits per benefit period) 50% after deductible (10 visits per benefit period)
    Skilled Nursing $250 copay per admission, then 70% after deductible ($5,000 maximum per benefit period) 50% after deductible ($5,000 maximum per benefit period)
    Home Health Care 70% after deductible (100 visits per benefit period) 50% after deductible (100 visits per benefit period)
    Mental Health
  • Inpatient- $250 copay per admission, then 70% after deductible
  • Outpatient- $35 copay, then 100%
    		•
  • Inpatient- 50% after deductible
  • Outpatient- 50% after deductible
    		•
    Hospital Care 70% after deductible 50% after deductible
    Optional Benefits West Virginia Value 500/1500 West Virginia Value 500/1500