World Insurance - Brokerage – WorldCare Comp Medical PPO – WISCONSIN

A comparison of the WorldCare Comp Medical 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 Comp Medical PPO Application	WorldCare Comp Medical PPO Application
Brochure	WorldCare Comp Medical PPO Brochure	WorldCare Comp Medical PPO Brochure
Copay	N/A	N/A
Office Visit	Subject to Deductible and Coinsurance	Subject to Deductible and Coinsurance
Deductible	$25,000	$50,000
Coinsurance	WorldCare Comp Medical PPO	WorldCare Comp Medical PPO
Coinsurance Limit	WorldCare Comp Medical PPO	WorldCare Comp Medical PPO
Out-of-Pocket Maximum	WorldCare Comp Medical PPO	WorldCare Comp Medical PPO
Lifetime Maximum	$2,000,000	$2,000,000
Prescription Drugs	Generic only, $0 Copay, Spc. Deductible and Coinsurance	Generic only, $0 Copay, Spc. Deductible and Coinsurance
Emergency Room	$0 Access Fee, then subject to Deductible and Coinsurance	$0 Access Fee, then subject to Deductible and Coinsurance
Adult Preventative Care	Subject to Deductible and Coinsurance, up to $500	Subject to Deductible and Coinsurance, up to $500
Child Preventative Care	Subject to Deductible and Coinsurance, up to $500	Subject to Deductible and Coinsurance, up to $500
Lab / X-Ray	$0 Access Fee, then Subject to Deductible and Coinsurance	$0 Access Fee, then Subject to Deductible and Coinsurance
Maternity	Not covered unless optional rider selected	Not covered unless optional rider selected
Physical Therapy	$50 per visit - up to $5,000 per calendar year	$50 per visit - up to $5,000 per calendar year
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	WorldCare Comp Medical PPO	WorldCare Comp Medical PPO
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

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