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(These plans are all compatible with Health Savings Accounts) |
![]() Authorized Agent* |
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(click here for out-of-network benefit summary) |
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(Individual/family deductible then % Covered by insurance) |
100% Plan |
100% Plan |
100% Plan |
80% Plan |
80% Plan |
80% Plan |
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| Lifetime Maximum Per Member |
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Annual
Deductible: Family |
$1,000 |
$1,800 |
$2,600 |
$1,000 |
$1,800 |
$2,600 |
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Annual
Out-of-Pocket Maximum: Family |
$1,000 |
$1,800 |
$2,600 |
$3,000 |
$4,000 |
$5,000 |
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Office
Visits - (PPO
Physicians and Specialists- includes X-ray and lab work when performed and billed by the physician's office) |
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Preventive
Care for Babies and Children (through age 5) |
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Preventive
Care for Adults ($250 benefit max. per year) |
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Professional
Services Including surgery, anesthesia in-hospital physician care, diagnostic X-ray and lab. |
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Inpatient
Hospital Services Surgery, x-ray, in-hospital physician visits, organ/tissue transplants |
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Maternity
(Available
on Family Contracts Only) Note: No maternity benefits are payable for the first 12 months of coverage. |
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| Outpatient Medical Care |
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Physical/Occupational
Therapy, Chiropractic (Limited to 30 visits per year combined) |
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Mental,
Emotional or Functional Nervous Disorders - Hospital Inpatient Only - Outpatient is not a covered benefit |
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| Infusion Therapy/Chemotherapy |
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| Emergency Room Care |
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| Ambulatory Surgical Center |
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| Ambulance Service |
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Home Health
Care Maximum of 100 visits per year for preferred and non-preferred providers combined |
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Speech/Respiratory
Therapy/Skilled Nursing Maximum of 30 visits per year per specialty |
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Hospice Maximum lifetime covered expense of $10,000 |
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Home Health
Care - Maximum of 100 visits per year |
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| Durable Medical Equipment and Prosthetics |
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Private
Duty Nursing $2,500 per year maximum |
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| Prescription Drugs - Includes Generic, Brand Formulary and Non-Brand Formulary |
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Waiting period for all pre-existing
conditions is at least one year from contract effective date. *Refer to your individual certificate of coverage for complete benefit details |
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Click here to have an enrollment kit mailed or e-mailed to you (Adobe Acrobat reader is necessary to download this file.) Click here to download the free Adobe Acrobat reader |
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9 Dunwoody Pk. South Suite 136 Atlanta, GA 30338 |
(770) 396-9517 Outside of the Atlanta area, call toll-free: 1-877-711-8376. Email: holly@insurance-now.com |
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