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World Insurance - Brokerage – WorldCare Flex Advantage PPO – Wisconsin

A comparison of the WorldCare Flex Advantage PPO offered by WorldIns 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 see brochure see brochure
    Coinsurance Limit see brochure see brochure
    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 see brochure
    Child Preventative Care see brochure see brochure
    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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