March 21, 2010

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Imerica – PPO Silver Series with 12 Month Rate Guarantee, Lifetime Max $5 Million – ARIZONA

A comparison of the PPO Silver Series with 12 Month Rate Guarantee, Lifetime Max $5 Million offered by Imerica is detailed out below for both Network and Non-Network coverage.

  Network Non-Network
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Network See Provider See Provider
Application PPO Silver Series with 12 Month Rate Guarantee, Lifetime Max $5 Million Application PPO Silver Series with 12 Month Rate Guarantee, Lifetime Max $5 Million Application
Brochure PPO Silver Series with 12 Month Rate Guarantee, Lifetime Max $5 Million Brochure PPO Silver Series with 12 Month Rate Guarantee, Lifetime Max $5 Million Brochure
Copay ubject to deductible and coinsurance ubject to deductible and coinsurance
Office Visit Subject to deductible and coinsurance Subject to deductible and coinsurance
Deductible $5,000(Maximum of 3 per family) $2,000 per person in addition to in-network deductible
Coinsurance 50% after deductible 50% after deductible
Coinsurance Limit PPO Silver Series with 12 Month Rate Guarantee, Lifetime Max $5 Million PPO Silver Series with 12 Month Rate Guarantee, Lifetime Max $5 Million
Out-of-Pocket Maximum Individual: $5,000, Family: 3 times deductible plus 3 times coinsurance Individual: $14,000, Family: 3 times deductible plus 3 times coinsurance
Lifetime Maximum $2 Million Base, Optional Buyup $5 Million or $8 Million $2 Million Base, Optional Buyup $5 Million or $8 Million
Prescription Drugs Discount drug card only Discount drug card only
Emergency Room Subject to deductible and coinsurance Subject to deductible and coinsurance
Adult Preventative Care Wellness Benefits (subject to co-insurance only):
  • Routine Physical Exams: Up to $500, no waiting period
  • Preventive (No maximum, no waiting period): Mammograms, PAP test screening, childhood immunizations, prostate cancer screening, colorectal cancer screening
 Wellness Benefits (subject to co-insurance only):
  • Routine Physical Exams: Up to $500, no waiting period
  • Childhood immunizations: No maximum, no waiting period
Child Preventative Care Wellness Benefits (subject to co-insurance only):
  • Routine Physical Exams: Up to $500, no waiting period
  • Childhood immunizations: No maximum, no waiting period
 Wellness Benefits (subject to co-insurance only):
  • Routine Physical Exams: Up to $500, no waiting period
  • Childhood immunizations: No maximum, no waiting period
Lab / X-Ray PPO Silver Series with 12 Month Rate Guarantee, Lifetime Max $5 Million PPO Silver Series with 12 Month Rate Guarantee, Lifetime Max $5 Million
Maternity PPO Silver Series with 12 Month Rate Guarantee, Lifetime Max $5 Million PPO Silver Series with 12 Month Rate Guarantee, Lifetime Max $5 Million
Physical Therapy PPO Silver Series with 12 Month Rate Guarantee, Lifetime Max $5 Million PPO Silver Series with 12 Month Rate Guarantee, Lifetime Max $5 Million
Skilled Nursing PPO Silver Series with 12 Month Rate Guarantee, Lifetime Max $5 Million PPO Silver Series with 12 Month Rate Guarantee, Lifetime Max $5 Million
Home Health Care PPO Silver Series with 12 Month Rate Guarantee, Lifetime Max $5 Million PPO Silver Series with 12 Month Rate Guarantee, Lifetime Max $5 Million
Mental Health PPO Silver Series with 12 Month Rate Guarantee, Lifetime Max $5 Million PPO Silver Series with 12 Month Rate Guarantee, Lifetime Max $5 Million
Hospital Care Subject to deductible and coinsurance Subject to deductible and coinsurance
Optional Benefits PPO Silver Series with 12 Month Rate Guarantee, Lifetime Max $5 Million PPO Silver Series with 12 Month Rate Guarantee, Lifetime Max $5 Million