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Georgia 4070 3500 Value Plan – Consumers Life Company –

A comparison of the Georgia 4070 3500 Value Plan offered by Consumers Life Company is detailed out below for both Network and Non-Network coverage.

  Network Non-Network
Copay Physician/Office Services:
  • Office and Urgent Care Visit (Illness/Injury): $40 copay, then 100%
  • Specialists Visits: $60 copay, then 100%
  • Urgent Care Office Visits: $60 copay, then 100%
 Physician/Office Services:
  • Office and Urgent Care Visit (Illness/Injury): 60% after deductible
  • Specialists Visits: 60% after deductible
  • Urgent Care Office Visits: 60% after deductible
OfficeVisit Physician/Office Services:
  • Office and Urgent Care Visit (Illness/Injury): $40 copay, then 100%
  • Specialists Visits: $60 copay, then 100%
  • Urgent Care Office Visits: $60 copay, then 100%
 Physician/Office Services:
  • Office and Urgent Care Visit (Illness/Injury): 60% after deductible
  • Specialists Visits: 60% after deductible
  • Urgent Care Office Visits: 60% after deductible
Deductible
Coinsurance 70% 60%
Coinsurance Limit Individual: $5,000, Family: $10,000
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 - Oral Contraceptives Included:
  • Prescription Drug Benefit Period Deductible: $1,000 per person, excluding generics
  • Prescription Drug Lifetime Maximum: $2,500,000
  • Retail - 30 Day Supply: Generic: $10, Formulary: $35, Non-Formulary: $50, For drugs $600 or more, 30% up to $250 max.
  • Home Delivery - 90 Day Supply: Generic: $25, Formulary: $87.50, Non-Formulary: $125, For drugs $1,800 or more, 30% up to $625 max.
 Prescription Drug - Oral Contraceptives Included:
  • Prescription Drug Benefit Period Deductible: $1,000 per person, excluding generics
  • Prescription Drug Lifetime Maximum: $2,500,000
  • Retail - 30 Day Supply: Generic: $10, Formulary: $35, Non-Formulary: $50, For drugs $600 or more, 30% up to $250 max.
  • Home Delivery - 90 Day Supply: Generic: $25, Formulary: $87.50, Non-Formulary: $125, For drugs $1,800 or more, 30% up to $625 max.
Emergency Room
  • Emergency Use of an Emergency Room: $250 copay, then 70%
  • Non-Emergency Use of an Emergency Room: $350 copay, then 70%
    		•
  • Emergency Use of an Emergency Room: $250 copay, then 70%
  • Non-Emergency Use of an Emergency Room: $350 copay, then 60%
    		•
    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 70% after deductible 60% after deductible
    Maternity N/A N/A
    Physical Therapy Physical Therapy, Occupational Therapy, Speech Therapy and Chiropractic Services (24 visits maximum combined per benefit period): 70% after deductible Physical Therapy, Occupational Therapy, Speech Therapy and Chiropractic Services (24 visits maximum combined per benefit period): 60% after deductible
    Home Health Care 70% after deductible (30 visits per benefit period) 70% after deductible (30 visits per benefit period)
    Mental Health
    Hospital Care 70% after deductible 60% after deductible
    Verisign Truste