March 12, 2010

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Imerica - Healthy America – 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 - Healthy America 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 None None
Office Visit Deductible and Coinsurance Deductible and Coinsurance
Deductible $2,000 HSA Gold Single Series with 12 Month Rate Guarantee, Lifetime Max $5 Million
Coinsurance 80% after deductible 60% after deductible
Coinsurance Limit 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
Out-of-Pocket Maximum (includes deductible) $5,500 (includes deductible) $11,000
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 (Subject to coinsurance only)
  • Routine Physical Exam- Maximum of $500 per insured per calendar year.
  • Mammograms, Pap test screening, Prostrate cancer screening, colorectal cancer screening- No Maximum, no waiting period.
  • Benefit available after the individual has been covered for at least 12 months.
    		•  (Subject to coinsurance only)
  • Routine Physical Exams- Maximum of $500 per insured per calendar year.
  • Childhood Immunizations- No maximum, no waiting period
    		•
    Child Preventative Care (Subject to coinsurance only)
  • Routine Physical Exams- Maximum of $500 per insured per calendar year.
  • Childhood Immunizations- No maximum, no waiting period
    		•  (Subject to coinsurance only)
  • Routine Physical Exams- Maximum of $500 per insured per calendar year.
  • 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 Optional Benefit Optional Benefit
    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
  • Life
  • Maternity
    		•
  • Life
  • Maternity
    		•