March 21, 2010

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WorldIns - ExpressMed – ExpressMed Premier Plus Traditional ($15,000 SL) – MONTANA

A comparison of the ExpressMed Premier Plus Traditional ($15,000 SL) offered by WorldIns - ExpressMed is detailed out below for both Network and Non-Network coverage.

  Network Non-Network
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Network See Provider See Provider
Application ExpressMed Premier Plus Traditional ($15,000 SL) Application ExpressMed Premier Plus Traditional ($15,000 SL) Application
Brochure ExpressMed Premier Plus Traditional ($15,000 SL) Brochure ExpressMed Premier Plus Traditional ($15,000 SL) Brochure
Copay $50 Copay, First 2 copays waived $50 Copay, First 2 copays waived
Office Visit $50 Copay, first 2 copays waived $50 Copay, first 2 copays waived
Deductible $10,000 $10,000
Coinsurance 50% 50%
Coinsurance Limit $7,500 $7,500
Out-of-Pocket Maximum $17,500 $17,500
Lifetime Maximum $3,000,000 $3,000,000
Prescription Drugs
  • Generic drugs: $0 deductible with $10 copay
  • Brand Name drugs: formulary $30 copay, non-formulary $50 copay
  • $200 calendar year Brand name drug deductible
    		•
  • Generic drugs: $0 deductible with $10 copay
  • Brand Name drugs: formulary $30 copay, non-formulary $50 copay
  • $200 calendar year Brand name drug deductible
    		•
    Emergency Room $1,000 Calendar Year Maximum after $150 Access Fee $1,000 Calendar Year Maximum after $150 Access Fee
    Adult Preventative Care $300 Calendar Year Maximum after $50 Copay, 6 month waiting period $300 Calendar Year Maximum after $50 Copay, 6 month waiting period
    Child Preventative Care $300 Calendar Year Maximum after $50 Copay, 6 month waiting period $300 Calendar Year Maximum after $50 Copay, 6 month waiting period
    Lab / X-Ray $25 Copay per test, up to $200 per test $25 Copay per test, up to $200 per test
    Maternity Not covered unless optional rider selected Not covered unless optional rider selected
    Physical Therapy ExpressMed Premier Plus Traditional ($15,000 SL) ExpressMed Premier Plus Traditional ($15,000 SL)
    Skilled Nursing Up to 60 visits per calendar year Up to 60 visits per calendar year
    Home Health Care Up to 40 days Up to 40 days
    Mental Health Not covered Not covered
    Hospital Care Subject to Deductible and Coinsurance Subject to Deductible and Coinsurance
    Optional Benefits
  • Accident Expense Rider
  • Term Life Rider
  • Short Term Convalescent Care Rider
  • Critical Illness Rider
  • Maternity Rider
    		•
  • Accident Expense Rider
  • Term Life Rider
  • Short Term Convalescent Care Rider
  • Critical Illness Rider
  • Maternity Rider
    		•