March 17, 2010

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Imerica – HSA Gold Single Series with 12 Month Rate Guarantee, Lifetime Max $5 Million – COLORADO

A comparison of the HSA Gold Single 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 HSA Gold Single Series with 12 Month Rate Guarantee, Lifetime Max $5 Million Application HSA Gold Single Series with 12 Month Rate Guarantee, Lifetime Max $5 Million Application
Brochure HSA Gold Single Series with 12 Month Rate Guarantee, Lifetime Max $5 Million Brochure HSA Gold Single Series with 12 Month Rate Guarantee, Lifetime Max $5 Million Brochure
Copay Subject to deductible and coinsurance Subject to deductible and coinsurance
Office Visit Subject to deductible and coinsurance Subject to deductible and coinsurance
Deductible $2,000 $4,000
Coinsurance 80% after deductible 60% after deductible
Coinsurance Limit $3,500 $7,000
Out-of-Pocket Maximum $3,500 $7,000
Lifetime Maximum $2 Million Base, Optional Buyup $5 Million or $8 Million $2 Million Base, Optional Buyup $5 Million or $8 Million
Prescription Drugs Subject to deductible and coinsurance Subject to deductible and coinsurance
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 screenings, 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 HSA Gold Single Series with 12 Month Rate Guarantee, Lifetime Max $5 Million HSA Gold Single Series with 12 Month Rate Guarantee, Lifetime Max $5 Million
Maternity HSA Gold Single Series with 12 Month Rate Guarantee, Lifetime Max $5 Million HSA Gold Single Series with 12 Month Rate Guarantee, Lifetime Max $5 Million
Physical Therapy HSA Gold Single Series with 12 Month Rate Guarantee, Lifetime Max $5 Million HSA Gold Single Series with 12 Month Rate Guarantee, Lifetime Max $5 Million
Skilled Nursing HSA Gold Single Series with 12 Month Rate Guarantee, Lifetime Max $5 Million HSA Gold Single Series with 12 Month Rate Guarantee, Lifetime Max $5 Million
Home Health Care HSA Gold Single Series with 12 Month Rate Guarantee, Lifetime Max $5 Million HSA Gold Single Series with 12 Month Rate Guarantee, Lifetime Max $5 Million
Mental Health HSA Gold Single Series with 12 Month Rate Guarantee, Lifetime Max $5 Million HSA Gold Single Series with 12 Month Rate Guarantee, Lifetime Max $5 Million
Hospital Care Subject to deductible and coinsurance Subject to deductible and coinsurance
Optional Benefits HSA Gold Single Series with 12 Month Rate Guarantee, Lifetime Max $5 Million HSA Gold Single Series with 12 Month Rate Guarantee, Lifetime Max $5 Million