March 21, 2010

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Imerica – HSA Platinum Single Series with 24 Month Rate Guarantee, Lifetime Max $2 Million – GEORGIA

A comparison of the HSA Platinum Single Series with 24 Month Rate Guarantee, Lifetime Max $2 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 Platinum Single Series with 24 Month Rate Guarantee, Lifetime Max $2 Million Application HSA Platinum Single Series with 24 Month Rate Guarantee, Lifetime Max $2 Million Application
Brochure HSA Platinum Single Series with 24 Month Rate Guarantee, Lifetime Max $2 Million Brochure HSA Platinum Single Series with 24 Month Rate Guarantee, Lifetime Max $2 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 $5,500 $11,000
Coinsurance 100% after deductible 80% after deductible
Coinsurance Limit $0 $4,000
Out-of-Pocket Maximum $0 $4,000
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 Platinum Single Series with 24 Month Rate Guarantee, Lifetime Max $2 Million HSA Platinum Single Series with 24 Month Rate Guarantee, Lifetime Max $2 Million
Maternity HSA Platinum Single Series with 24 Month Rate Guarantee, Lifetime Max $2 Million HSA Platinum Single Series with 24 Month Rate Guarantee, Lifetime Max $2 Million
Physical Therapy HSA Platinum Single Series with 24 Month Rate Guarantee, Lifetime Max $2 Million HSA Platinum Single Series with 24 Month Rate Guarantee, Lifetime Max $2 Million
Skilled Nursing HSA Platinum Single Series with 24 Month Rate Guarantee, Lifetime Max $2 Million HSA Platinum Single Series with 24 Month Rate Guarantee, Lifetime Max $2 Million
Home Health Care HSA Platinum Single Series with 24 Month Rate Guarantee, Lifetime Max $2 Million HSA Platinum Single Series with 24 Month Rate Guarantee, Lifetime Max $2 Million
Mental Health HSA Platinum Single Series with 24 Month Rate Guarantee, Lifetime Max $2 Million HSA Platinum Single Series with 24 Month Rate Guarantee, Lifetime Max $2 Million
Hospital Care Subject to deductible and coinsurance Subject to deductible and coinsurance
Optional Benefits HSA Platinum Single Series with 24 Month Rate Guarantee, Lifetime Max $2 Million HSA Platinum Single Series with 24 Month Rate Guarantee, Lifetime Max $2 Million