March 21, 2010

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Imerica - Healthy America – HSA Platinum Single Series with 12 Month Rate Guarantee, Lifetime Max $5 Million – ILLINOIS

A comparison of the HSA Platinum 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 Platinum Single Series with 12 Month Rate Guarantee, Lifetime Max $5 Million Application HSA Platinum Single Series with 12 Month Rate Guarantee, Lifetime Max $5 Million Application
Brochure HSA Platinum Single Series with 12 Month Rate Guarantee, Lifetime Max $5 Million Brochure HSA Platinum Single Series with 12 Month Rate Guarantee, Lifetime Max $5 Million Brochure
Copay None None
Office Visit Subject to deductible and coinsurance. Subject to deductible and coinsurance.
Deductible $2,850 $5,700
Coinsurance 100% after deductible 80% after deductible
Coinsurance Limit N/A N/A
Out-of-Pocket Maximum (includes deductible)$2,850 (includes deductible)$6,850
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 periodBenefit not available
    		•
    Child Preventative Care (Subject to coinsurance only)
  • Routine Physical Exams- Maximum of $500 per insured per calendar year.
  • Childhood Immunizations- No maximum, no waiting periodBenefit not available
    		•  (Subject to coinsurance only)
  • Routine Physical Exams- Maximum of $500 per insured per calendar year.
  • Childhood Immunizations- No maximum, no waiting periodBenefit not available
    		•
    Lab / X-Ray HSA Platinum Single Series with 12 Month Rate Guarantee, Lifetime Max $5 Million HSA Platinum Single Series with 12 Month Rate Guarantee, Lifetime Max $5 Million
    Maternity Optional Benefit Optional Benefit
    Physical Therapy HSA Platinum Single Series with 12 Month Rate Guarantee, Lifetime Max $5 Million HSA Platinum Single Series with 12 Month Rate Guarantee, Lifetime Max $5 Million
    Skilled Nursing HSA Platinum Single Series with 12 Month Rate Guarantee, Lifetime Max $5 Million HSA Platinum Single Series with 12 Month Rate Guarantee, Lifetime Max $5 Million
    Home Health Care HSA Platinum Single Series with 12 Month Rate Guarantee, Lifetime Max $5 Million HSA Platinum Single Series with 12 Month Rate Guarantee, Lifetime Max $5 Million
    Mental Health HSA Platinum Single Series with 12 Month Rate Guarantee, Lifetime Max $5 Million HSA Platinum 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
    		•