March 12, 2010

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

A comparison of the PPO Silver 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 Silver Series with 12 Month Rate Guarantee, Lifetime Max $5 Million Application PPO Silver Series with 12 Month Rate Guarantee, Lifetime Max $5 Million Application
Brochure PPO Silver Series with 12 Month Rate Guarantee, Lifetime Max $5 Million Brochure PPO Silver 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 $2,500(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 Subject to deductible and coinsurance. Subject to deductible and coinsurance.
Prescription Drugs Discount Card Only Discount Card Only
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 Silver Series with 12 Month Rate Guarantee, Lifetime Max $5 Million PPO Silver Series with 12 Month Rate Guarantee, Lifetime Max $5 Million
    Maternity Optional Benefit Optional Benefit
    Physical Therapy PPO Silver Series with 12 Month Rate Guarantee, Lifetime Max $5 Million PPO Silver Series with 12 Month Rate Guarantee, Lifetime Max $5 Million
    Skilled Nursing PPO Silver Series with 12 Month Rate Guarantee, Lifetime Max $5 Million PPO Silver Series with 12 Month Rate Guarantee, Lifetime Max $5 Million
    Home Health Care PPO Silver Series with 12 Month Rate Guarantee, Lifetime Max $5 Million PPO Silver Series with 12 Month Rate Guarantee, Lifetime Max $5 Million
    Mental Health PPO Silver Series with 12 Month Rate Guarantee, Lifetime Max $5 Million PPO Silver 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)
    		•