Imerica - Healthy America – PPO Platinum Series with 12 Month Rate Guarantee, Lifetime Max $2 Million – SOUTH CAROLINA

A comparison of the PPO Platinum Series with 12 Month Rate Guarantee, Lifetime Max $2 Million offered by Imerica - Healthy America is detailed out below for both Network and Non-Network coverage.

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	Network	Non-Network

Network	See Provider	See Provider
Application	PPO Platinum Series with 12 Month Rate Guarantee, Lifetime Max $2 Million Application	PPO Platinum Series with 12 Month Rate Guarantee, Lifetime Max $2 Million Application
Brochure	PPO Platinum Series with 12 Month Rate Guarantee, Lifetime Max $2 Million Brochure	PPO Platinum Series with 12 Month Rate Guarantee, Lifetime Max $2 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	80% after deductible	60% after deductible
Coinsurance Limit	$10,000	$10,000
Out-of-Pocket Maximum	$2,000 plus deductible	$8,000 plus deductible
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	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- 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 Platinum Series with 12 Month Rate Guarantee, Lifetime Max $2 Million	PPO Platinum Series with 12 Month Rate Guarantee, Lifetime Max $2 Million
Maternity	PPO Platinum Series with 12 Month Rate Guarantee, Lifetime Max $2 Million	PPO Platinum Series with 12 Month Rate Guarantee, Lifetime Max $2 Million
Physical Therapy	PPO Platinum Series with 12 Month Rate Guarantee, Lifetime Max $2 Million	PPO Platinum Series with 12 Month Rate Guarantee, Lifetime Max $2 Million
Skilled Nursing	PPO Platinum Series with 12 Month Rate Guarantee, Lifetime Max $2 Million	PPO Platinum Series with 12 Month Rate Guarantee, Lifetime Max $2 Million
Home Health Care	PPO Platinum Series with 12 Month Rate Guarantee, Lifetime Max $2 Million	PPO Platinum Series with 12 Month Rate Guarantee, Lifetime Max $2 Million
Mental Health	PPO Platinum Series with 12 Month Rate Guarantee, Lifetime Max $2 Million	PPO Platinum Series with 12 Month Rate Guarantee, Lifetime Max $2 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)