World Insurance - Brokerage – WorldCare Flex Advantage PPO – OKLAHOMA

A comparison of the WorldCare Flex Advantage PPO offered by World Insurance - Brokerage is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Application	WorldCare Flex Advantage PPO Application	WorldCare Flex Advantage PPO Application
Brochure	WorldCare Flex Advantage PPO Brochure	WorldCare Flex Advantage PPO Brochure
Copay	Optional Physician Office Visit Copay Benefit: $30 copay, limited to two visits per calendar year. After the two visit maximum, the charges will be subject to deductible and coinsurance.	N/A, subject to out-of-network deductible and coinsurance levels.
Office Visit	Subject to deductible and coinsurance See Copay section for Optional Physician Office Visit Copay Benefit	Subject to deductible and coinsurance See Copay section for Optional Physician Office Visit Copay Benefit
Deductible	$10,000 Maximum of 3 per family, per calendar year	Two times the In-Network deductible. Maximum of 3 per family, per calendar year
Coinsurance	WorldCare Flex Advantage PPO	WorldCare Flex Advantage PPO
Coinsurance Limit	WorldCare Flex Advantage PPO	WorldCare Flex Advantage PPO
Out-of-Pocket Maximum	Copayments for physician office visits, drugs and emergency room are not included in maximum	charges above usual and customary. Copayments for physician office visits, drugs and emergency room are not included in maximum
Lifetime Maximum	$2 million $5 million optional	$2 million $5 million optional
Prescription Drugs	Subject to deductible and coinsurance Optional Benefit to provide prescription drug copays: Subject to separate $100 RX deductible per calendar year. Generic - $20 or 20%^* Brand Name (formulary) - $35 or 50%^* Brand Name (non-formulary) - $50 or 50%^* ( ^* of the drug's cost, whichever is greater.)	Subject to deductible and coinsurance Optional Benefit to provide prescription drug copays: Subject to separate $100 RX deductible per calendar year. Generic - $20 or 20%^* Brand Name (formulary) - $35 or 50%^* Brand Name (non-formulary) - $50 or 50%^* ( ^* of the drug's cost, whichever is greater.)
Emergency Room	Emergency Room: If you visit an Emergency Room for an illness, you pay a $100 copayment in addition to your plan deductible and coinsurance. The $100 copayment does not apply to accidents.If you are admitted directly from the Emergency Room into the hospital as an inpatient, the copayment is waived. Foreign Travel Emergency: Coverage for the first 60 days with a $100,000 limit subject to the same deductible and coinsurance limits as the base plan.	Emergency Room: If you visit an Emergency Room for an illness, you pay a $100 copayment in addition to your plan deductible and coinsurance. The $100 copayment does not apply to accidents.If you are admitted directly from the Emergency Room into the hospital as an inpatient, the copayment is waived. Foreign Travel Emergency: Coverage for the first 60 days with a $100,000 limit subject to the same deductible and coinsurance limits as the base plan.
Adult Preventative Care	Not covered	WorldCare Flex Advantage PPO
Child Preventative Care	WorldCare Flex Advantage PPO	WorldCare Flex Advantage PPO
Lab / X-Ray	Covered	Covered
Maternity	Pregnancy or childbirth is not covered, except for complications of pregnancy.	Pregnancy or childbirth is not covered, except for complications of pregnancy.
Physical Therapy	Occupational, physical and speech therapy: $50 per visit to $2,000 maximum per calendar year	Occupational, physical and speech therapy: $50 per visit to $2,000 maximum per calendar year
Skilled Nursing	Up to 60 days in a calendar year.	Up to 60 days in a calendar year.
Home Health Care	40 visits per calendar year	40 visits per calendar year
Mental Health	Not covered	Not covered
Hospital Care	Subject to deductible and coinsurance Hospital semi-private room and board	Subject to deductible and coinsurance Hospital semi-private room and board
Optional Benefits	Maximum Benefit Option: increase lifetime maximum to $5 millionTerm Life Benefit RiderOutpatient Accident Benefit Rider: $500 benefit=$8	Maximum Benefit Option: increase lifetime maximum to $5 millionTerm Life Benefit RiderOutpatient Accident Benefit Rider: $500 benefit=$8

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