March 10, 2010

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Imerica - Healthy America – HSA Bronze Single Series with 24 Month Rate Guarantee, Lifetime Max $5 Million – TEXAS

A comparison of the HSA Bronze Single Series with 24 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 Bronze Single Series with 24 Month Rate Guarantee, Lifetime Max $5 Million Application HSA Bronze Single Series with 24 Month Rate Guarantee, Lifetime Max $5 Million Application
Brochure HSA Bronze Single Series with 24 Month Rate Guarantee, Lifetime Max $5 Million Brochure HSA Bronze Single Series with 24 Month Rate Guarantee, Lifetime Max $5 Million Brochure
Copay None None
Office Visit Subject to deductible and coinsurance. Subject to deductible and coinsurance.
Deductible $5,000 $5,000
Coinsurance 100% after deductible 80% after deductible
Coinsurance Limit N/A N/A
Out-of-Pocket Maximum
  • (includes deductible) $5,000
  • $20,000 maximum per insured per calendar year on outpatient expenses
    		•
  • Plan pays 80%
  • $20,000 maximum per insured per calendar year on outpatient expenses
    		•
    Lifetime Maximum $2 Million Base, Optional Buyup $5 Million or $8 Million $2 Million Base, Optional Buyup $5 Million or $8 Million
    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 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 Bronze Single Series with 24 Month Rate Guarantee, Lifetime Max $5 Million HSA Bronze Single Series with 24 Month Rate Guarantee, Lifetime Max $5 Million
    Maternity Optional Benefit Optional Benefit
    Physical Therapy HSA Bronze Single Series with 24 Month Rate Guarantee, Lifetime Max $5 Million HSA Bronze Single Series with 24 Month Rate Guarantee, Lifetime Max $5 Million
    Skilled Nursing HSA Bronze Single Series with 24 Month Rate Guarantee, Lifetime Max $5 Million HSA Bronze Single Series with 24 Month Rate Guarantee, Lifetime Max $5 Million
    Home Health Care HSA Bronze Single Series with 24 Month Rate Guarantee, Lifetime Max $5 Million HSA Bronze Single Series with 24 Month Rate Guarantee, Lifetime Max $5 Million
    Mental Health HSA Bronze Single Series with 24 Month Rate Guarantee, Lifetime Max $5 Million HSA Bronze Single Series with 24 Month Rate Guarantee, Lifetime Max $5 Million
    Hospital Care
  • Subject to deductible and coinsurance.
  • $20,000 maximum per insured per calendar year on outpatient expenses.
    		•
  • Subject to deductible and coinsurance.
  • $20,000 maximum per insured per calendar year on outpatient expenses.
    		•
    Optional Benefits
  • Life
  • Maternity
    		•
  • Life
  • Maternity
    		•