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WorldIns - ExpressMed – ExpressMed Premier Traditional ($15,000 SL) – MONTANA
A comparison of the ExpressMed Premier Traditional ($15,000 SL) offered by WorldIns - ExpressMed is detailed out below for both Network and Non-Network coverage.
| Network | Non-Network | |
|---|---|---|
|
||
| Network | See Provider | See Provider |
| Application | ExpressMed Premier Traditional ($15,000 SL) Application | ExpressMed Premier Traditional ($15,000 SL) Application |
| Brochure | ExpressMed Premier Traditional ($15,000 SL) Brochure | ExpressMed Premier Traditional ($15,000 SL) Brochure |
| Copay | $50 | $50 |
| Office Visit | $50 Copay, no calendar year maximum | $50 Copay, no calendar year maximum |
| Deductible | $5,000 | $5,000 |
| Coinsurance | ExpressMed Premier Traditional ($15,000 SL) | ExpressMed Premier Traditional ($15,000 SL) |
| Coinsurance Limit | ExpressMed Premier Traditional ($15,000 SL) | ExpressMed Premier Traditional ($15,000 SL) |
| Out-of-Pocket Maximum | ExpressMed Premier Traditional ($15,000 SL) | ExpressMed Premier Traditional ($15,000 SL) |
| Lifetime Maximum | $3,000,000 | $3,000,000 |
| Prescription Drugs | ||
| Emergency Room | $150 Access Fee, then subject to Deductible and Coinsurance. (Access fee waived if admitted) | $150 Access Fee, then subject to Deductible and Coinsurance. (Access fee waived if admitted) |
| Adult Preventative Care | Up to $250 benefit, subject to Deductible and Coinsurance, 6 month waiting period | Up to $250 benefit, subject to Deductible and Coinsurance, 6 month waiting period |
| Child Preventative Care | Up to $250 benefit, subject to Deductible and Coinsurance, 6 month waiting period | Up to $250 benefit, subject to Deductible and Coinsurance, 6 month waiting period |
| Lab / X-Ray | $50 Copay per test, up to $200 per test | $50 Copay per test, up to $200 per test |
| Maternity | Not covered unless optional benefit selected | Not covered unless optional benefit selected |
| Physical Therapy | ExpressMed Premier Traditional ($15,000 SL) | ExpressMed Premier 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 | ||