March 20, 2010

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Imerica - AHU – The Edge PPO Gold Series with 24 Month Rate Guarantee, Unlimited Visits, Lifetime Max $2 Million – ARIZONA

A comparison of the The Edge PPO Gold Series with 24 Month Rate Guarantee, Unlimited Visits, Lifetime Max $2 Million offered by Imerica - AHU is detailed out below for both Network and Non-Network coverage.

  Network Non-Network
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Network See Provider See Provider
Application The Edge PPO Gold Series with 24 Month Rate Guarantee, Unlimited Visits, Lifetime Max $2 Million Application The Edge PPO Gold Series with 24 Month Rate Guarantee, Unlimited Visits, Lifetime Max $2 Million Application
Brochure The Edge PPO Gold Series with 24 Month Rate Guarantee, Unlimited Visits, Lifetime Max $2 Million Brochure The Edge PPO Gold Series with 24 Month Rate Guarantee, Unlimited Visits, Lifetime Max $2 Million Brochure
Copay Unlimited Visits- $15 Primary Care Physician/$60 Specialist Unlimited Visits- $15 Primary Care Physician/$60 Specialist
Office Visit Choice of four or unlimited office copays; $15 Primary Care Physician/$60 Specialist Choice of four or unlimited office copays; $15 Primary Care Physician/$60 Specialist
Deductible $1,500(Maximum of 3 per family) $2,000 per person in addition to in-network deductible
Coinsurance 50% after deductible 70% after deductible
Coinsurance Limit $10,000 $10,000
Out-of-Pocket Maximum $5,000 plus deductible $14,000 plus deductible
Lifetime Maximum $2 Million Base $2 Million Base
Prescription Drugs
  • Generic: $0 deductible w/$15 copay
  • Brand: $500 deductible w/$40 copay
    		•
  • Generic: $0 deductible w/$15 copay
  • Brand: $500 deductible w/$40 copay
    		•
    Emergency Room Subject to deductible and coinsurance Subject to deductible and coinsurance
    Adult Preventative Care (Subject to coinsurance only)
  • Routine Physical Exam- Up to $500, no waiting period
  • Preventive Services- No maximum, no waiting period (Mammograms, Pap test screening, Prostate cancer screening, Colorectal cancer screening)
  • Benefit available after the individual has been covered for at least 12 months.
    		•  (Subject to coinsurance only)
  • Routine Physical Exams- Up to $500, no waiting period
  • Childhood Immunizations- No maximum, no waiting period
    		•
    Child Preventative Care (Subject to coinsurance only)
  • Routine Physical Exams- Up to $500, no waiting period
  • Childhood Immunizations- No maximum, no waiting period
    		•  (Subject to coinsurance only)
  • Routine Physical Exams- Up to $500, no waiting period
  • Childhood Immunizations- No maximum, no waiting period
    		•
    Lab / X-Ray The Edge PPO Gold Series with 24 Month Rate Guarantee, Unlimited Visits, Lifetime Max $2 Million The Edge PPO Gold Series with 24 Month Rate Guarantee, Unlimited Visits, Lifetime Max $2 Million
    Maternity The Edge PPO Gold Series with 24 Month Rate Guarantee, Unlimited Visits, Lifetime Max $2 Million The Edge PPO Gold Series with 24 Month Rate Guarantee, Unlimited Visits, Lifetime Max $2 Million
    Physical Therapy The Edge PPO Gold Series with 24 Month Rate Guarantee, Unlimited Visits, Lifetime Max $2 Million The Edge PPO Gold Series with 24 Month Rate Guarantee, Unlimited Visits, Lifetime Max $2 Million
    Skilled Nursing The Edge PPO Gold Series with 24 Month Rate Guarantee, Unlimited Visits, Lifetime Max $2 Million The Edge PPO Gold Series with 24 Month Rate Guarantee, Unlimited Visits, Lifetime Max $2 Million
    Home Health Care The Edge PPO Gold Series with 24 Month Rate Guarantee, Unlimited Visits, Lifetime Max $2 Million The Edge PPO Gold Series with 24 Month Rate Guarantee, Unlimited Visits, Lifetime Max $2 Million
    Mental Health The Edge PPO Gold Series with 24 Month Rate Guarantee, Unlimited Visits, Lifetime Max $2 Million The Edge PPO Gold Series with 24 Month Rate Guarantee, Unlimited Visits, Lifetime Max $2 Million
    Hospital Care Subject to deductible and coinsurance Subject to deductible and coinsurance
    Optional Benefits
  • Life
  • Maternity
    		•
  • Life
  • Maternity
    		•