Georgia PHP 4070 5000 – Consumers Life Company –
A comparison of the Georgia PHP 4070 5000 offered by
Consumers Life Company
is detailed out below for both Network and Non-Network coverage.
|
|
Network
|
Non-Network
|
|
|
| Copay |
$40 |
N/A |
| OfficeVisit |
Office Visit (Illness/Injury)- $40 copay, then 100% |
60% after deductible |
| Deductible |
|
|
| Coinsurance |
70% |
60% |
| Coinsurance Limit |
|
|
| Out-of-Pocket Maximum |
$7,500,000 |
$7,500,000 |
| Lifetime Maximum |
Overall Annual Benefit Period Maximum: $7,500,000 |
Overall Annual Benefit Period Maximum: $7,500,000 |
| Prescription Drugs |
Prescription Drug Benefit Period Deductible- $200 Single/$600 Family
Retail (30 Day Supply)- $15 Generic/$30 Formulary/50% of cost for Non-Formulary ($45 minimum, $90 maximum)
Home Delivery (90 Day Supply)- $37.50 Generic/$75 Formulary/$112.50 Non-Formulary |
Prescription Drug Benefit Period Deductible- $200 Single/$600 Family
Retail (30 Day Supply)- $15 Generic/$30 Formulary/50% of cost for Non-Formulary ($45 minimum, $90 maximum)
Home Delivery (90 Day Supply)- $37.50 Generic/$75 Formulary/$112.50 Non-Formulary |
| Emergency Room |
$150 copay (waived if admitted), then 70% after deductible |
Emergency use of an Emergency Room- $150 copay (waived if admitted), then 70% after deductible
Non-Emergency use of an Emergency Room- $150 copay (waived if admitted), then 60% after deductible |
| Adult Preventative Care |
In accordance with state and federal law (1) |
In accordance with state and federal law (1) |
| Child Preventative Care |
In accordance with state and federal law (1) |
In accordance with state and federal law (1) |
| Lab / X-Ray |
Diagnostic Services in a Physicians Office- 100%
Diagnostic Services (other than a physician's office)- 70% after deductible |
Diagnostic Services in a Physicians Office- 70% after deductible
Diagnostic Services (other than a physician's office)- 60% after deductible |
| Maternity |
Not Covered |
Not Covered |
| Physical Therapy |
Physical Therapy, Occupational Therapy, and Chiropractic Services (30 visits combined per benefit period)- 70% after deductible |
Physical Therapy, Occupational Therapy, and Chiropractic Services (30 visits combined per benefit period)- 60% after deductible |
| Home Health Care |
100 visits per benefit period; 70% after deductible |
100 visits per benefit period; 70% after deductible |
| Mental Health |
Optional Rider |
Optional Rider |
| Hospital Care |
|
|
