March 19, 2010

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Imerica - Healthy America – PPO Gold Series with 12 Month Rate Guarantee, Lifetime Max $5 Million – ILLINOIS

A comparison of the PPO Gold 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 PPO Gold Series with 12 Month Rate Guarantee, Lifetime Max $5 Million Application PPO Gold Series with 12 Month Rate Guarantee, Lifetime Max $5 Million Application
Brochure PPO Gold Series with 12 Month Rate Guarantee, Lifetime Max $5 Million Brochure PPO Gold Series with 12 Month Rate Guarantee, Lifetime Max $5 Million Brochure
Copay 4 Visits- $15 Primary Care Physician/$60 Specialist 4 Visits- $15 Primary Care Physician/$60 Specialist
Office Visit Subject to copay, after 4 visits- subject to deductible and coinsurance Subject to copay, after 4 visits- subject to deductible and coinsurance
Deductible $2,500(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 Family maximum combined out of pocket- 3x deductible plus 3x coinsurance. Family maximum combined out of pocket- 3x deductible plus 3x coinsurance.
Lifetime Maximum $2 Million Base, Optional Buyup $5 Million or $8 Million $2 Million Base, Optional Buyup $5 Million or $8 Million
Prescription Drugs
  • Generic: $0 deductible w/$15 copay
  • Brand: $500 deductible w/$40 copay and 50% Coinsurance
    		•
  • Generic: $0 deductible w/$15 copay
  • Brand: $500 deductible w/$40 copay and 50% 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.
    		•  (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 PPO Gold Series with 12 Month Rate Guarantee, Lifetime Max $5 Million PPO Gold Series with 12 Month Rate Guarantee, Lifetime Max $5 Million
    Maternity Optional Benefit Optional Benefit
    Physical Therapy PPO Gold Series with 12 Month Rate Guarantee, Lifetime Max $5 Million PPO Gold Series with 12 Month Rate Guarantee, Lifetime Max $5 Million
    Skilled Nursing PPO Gold Series with 12 Month Rate Guarantee, Lifetime Max $5 Million PPO Gold Series with 12 Month Rate Guarantee, Lifetime Max $5 Million
    Home Health Care PPO Gold Series with 12 Month Rate Guarantee, Lifetime Max $5 Million PPO Gold Series with 12 Month Rate Guarantee, Lifetime Max $5 Million
    Mental Health PPO Gold Series with 12 Month Rate Guarantee, Lifetime Max $5 Million PPO Gold 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
  • SAE (CIB Only)
    		•
  • Life
  • Maternity
  • SAE (CIB Only)
    		•