World Insurance - Brokerage – WorldCare HD Advantage PPO 100 w/ Comprehensive Rider – OKLAHOMA

A comparison of the WorldCare HD Advantage PPO 100 w/ Comprehensive Rider offered by World Insurance - Brokerage is detailed out below for both Network and Non-Network coverage.

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	Network	Non-Network

Network	See Provider	See Provider
Application	WorldCare HD Advantage PPO 100 w/ Comprehensive Rider Application	WorldCare HD Advantage PPO 100 w/ Comprehensive Rider Application
Brochure	WorldCare HD Advantage PPO 100 w/ Comprehensive Rider Brochure	WorldCare HD Advantage PPO 100 w/ Comprehensive Rider Brochure
Copay	N/A	N/A
Office Visit	Subject to deductible and coinsurance	Subject to deductible and coinsurance
Deductible	$5,600	$11,200
Coinsurance	100%	80%
Coinsurance Limit	WorldCare HD Advantage PPO 100 w/ Comprehensive Rider	WorldCare HD Advantage PPO 100 w/ Comprehensive Rider
Out-of-Pocket Maximum	WorldCare HD Advantage PPO 100 w/ Comprehensive Rider	WorldCare HD Advantage PPO 100 w/ Comprehensive Rider
Lifetime Maximum	WorldCare HD Advantage PPO 100 w/ Comprehensive Rider	WorldCare HD Advantage PPO 100 w/ Comprehensive Rider
Prescription Drugs	Subject to deductible and coinsurance You will automatically receive a discount drug card with your WorldCare HDHP policy/certificate. The cardentitles you to discounts on prescription drugs at any pharmacy in World's extensive nationwide pharmacy network,Express Scripts, including more than 90 percent of the nation's pharmacies.	Subject to deductible and coinsurance You will automatically receive a discount drug card with your WorldCare HDHP policy/certificate. The cardentitles you to discounts on prescription drugs at any pharmacy in World's extensive nationwide pharmacy network,Express Scripts, including more than 90 percent of the nation's pharmacies.
Emergency Room	Emergency Room: after deductible Foreign Travel Emergency: after deductible	Emergency Room: after deductible Plus $100 copayment if visit is for an illness and patient is not admitted directly into hospital asinpatient. Foreign Travel Emergency: after deductible; $100,000 lifetime maximum
Adult Preventative Care	Not covered	WorldCare HD Advantage PPO 100 w/ Comprehensive Rider
Child Preventative Care	WorldCare HD Advantage PPO 100 w/ Comprehensive Rider	WorldCare HD Advantage PPO 100 w/ Comprehensive Rider
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 RiderPrescription Drug Benefit with free discount drug card.	Maximum Benefit Option: increase lifetime maximum to $5 millionTerm Life Benefit RiderPrescription Drug Benefit with free discount drug card.