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WorldIns - ExpressMed – ExpressMed Premier HSA PPO – WISCONSIN
A comparison of the ExpressMed Premier HSA PPO 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 HSA PPO Application | ExpressMed Premier HSA PPO Application |
| Brochure | ExpressMed Premier HSA PPO Brochure | ExpressMed Premier HSA PPO Brochure |
| Copay | N/A | N/A |
| Office Visit | Subject to Deductible and Coinsurance | Subject to Deductible and Coinsurance |
| Deductible | Individual: $2,900, Family: $5,800 | Individual: $5,800,Family: $11,600 |
| Coinsurance | 50% | 50% |
| Coinsurance Limit | ExpressMed Premier HSA PPO | ExpressMed Premier HSA PPO |
| Out-of-Pocket Maximum | ExpressMed Premier HSA PPO | ExpressMed Premier HSA PPO |
| Lifetime Maximum | $3,000,000 | $3,000,000 |
| Prescription Drugs | Subject to Deductible and Coinsurance | Subject to Deductible and Coinsurance |
| Emergency Room | $100 Access Fee, then subject to Deductible and Coinsurance | $100 Access Fee, then subject to Deductible and Coinsurance |
| Adult Preventative Care | Subject to Deductible and Coinsurance up to $250 per calendar year after 12 month waiting period | Subject to Deductible and Coinsurance up to $250 per calendar year after 12 month waiting period |
| Child Preventative Care | Subject to Deductible and Coinsurance up to $250 per calendar year after 12 month waiting period | Subject to Deductible and Coinsurance up to $250 per calendar year after 12 month waiting period |
| Lab / X-Ray | Subject to Deductible and Coinsurance | Subject to Deductible and Coinsurance |
| Maternity | Not covered unless optional rider selected | Not covered unless optional rider selected |
| Physical Therapy | ExpressMed Premier HSA PPO | ExpressMed Premier HSA PPO |
| 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 | ||