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Assurant Health - PPO Plan Benefits

MaxPlan, CoreMed Plan, One Deductible - Plan Benefits

Plan Feature MaxPlanSM CoreMed Plan OneDeductible HSA Plan
Plan Design Unless otherwise noted, all deductibles, maximums and benefit amounts are applied per person and are reset each January 1.
Individual Deductible
Amount you pay toward covered expenses before the plan pays benefits
$500, $1,000, $1,500, $2,500, $5,000 or $10,000 $500, $1,000, $1,500, $2,000, $3,000, $5,000 or $10,000 Individual Plan: $1,100, $1,600, $2,100, $2,700, $3,750, or $5,000
Family Deductible
Family deductible maximum is two times the individual deductible and is met collectively by two or more persons. Family Plan: $2,200, $3,200, $4,200, $5,400, $7,500 or $10,000 per family.
Benefit Percentage
Percentage of covered expenses the plan pays after the deductible is met
100%, 80%, 70%, or 50% 80%, 70%, or 50% 100%, 80%, or 50%
Coinsurance
Percentage of covered expenses you pay after the deductible is met
0%, 20%, 30% or 50% 20%, 30% or 50% 0%, 20% or 50%
Coinsurance Out-of-Pocket Maximum*
After this maximum is met, the plan pays 100% of covered expenses
$0 to $7,500 depending on coinsurance $1,250 to $7,500 depending on coinsurance $0 to $2,500 depending on coinsurance
Outpatient Services Maximum
The annual maximum amount the plan pays toward outpatient services
No Maximum -- the medical insurance plan pays benefits up to the lifetime benefit maximum No Maximum -- the medical insurance plan pays benefits up to the lifetime benefit maximum No Maximum -- the medical insurance plan pays benefits up to the lifetime benefit maximum
Annual Maximum
The total annual maximum amount the plan pays
No Maximum -- the health insurance plan pays benefits up to the lifetime benefit maximum No Maximum -- the health insurance plan pays benefits up to the lifetime benefit maximum No Maximum -- the health insurance plan pays benefits up to the lifetime benefit maximum
Lifetime Benefit Maximum
The total maximum amount the plan pays
$3 million or $8 million $2 million or $6 million $3 million or $8 million
Outpatient Benefits Benefits are subject to deductible and coinsurance unless otherwise noted.
Prescription Drugs - Generic $15 copay (no deductible) $15 copay (no deductible) Covered (deductible and coinsurance apply).
Prescription Drugs - Brand name $500 deductible / $25 copay + 20% coinsurance (Family deductible maximum is $1,000 and is met collectively by two or more persons) $500 deductible / $25 copay + 50% coinsurance (Family deductible maximum is $1,000 and is met collectively by two or more persons) Covered (deductible and coinsurance apply).
Preventive Services
Mammograms, Pap smears and PSA screening
Covered from the first day Covered after you have been insured for 12 months. Covered from the first day
Other preventive services, office visits and immunizations Up to $750 in benefits -- available from the first day
- Copay, if selected, applies to office visits and immunizations
Up to $500 in benefits -- after you have been insured for 12 months
- Copay, if selected, applies to office visits and immunizations
Up to $500 in benefits -- available from the first day
- Optional First-Dollar Preventive Services Benefit.
Office Visits Covered Covered Covered
Office Visit Copay
Optional benefit
$35 copay per network office visit -- no limit on visits
- Visits for illness, injury and preventive services are eligible
$35 copay for each of four network office visits per person
- Visits for illness, injury and (after 12 months) preventive services are eligible
- Additional visits are covered subject to deductible and coinsurance
not available.
Diagnostic Imaging and Laboratory Services Covered Covered Covered
Outpatient Hospital, Surgical Center or Urgent Care Facility Covered Covered
- Outpatient facility fee: $0 or $200 per outpatient surgery.
Covered
Professional Ground and Air Ambulance Covered Covered Covered
Emergency Room Covered
- $75 emergency room fee -- waived if admitted to the hospital.
Covered
- $75 emergency room fee -- waived if admitted to the hospital.
Covered
- $75 emergency room fee -- waived if admitted to the hospital.
Health Care Practitioner Services Covered Covered Covered
Outpatient Physical Medicine Up to $3,000 in benefits Up to $3,000 in benefits Up to $3,000 in benefits
Home Health Care Up to 160 hours Up to 160 hours Up to 160 hours
Inpatient Benefits
Benefits are subject to deductible and coinsurance unless otherwise noted.
Inpatient Hospital
Covered Covered
- Inpatient facility fee: $0, $200 or $750 per day for first three days of each confinement. ($0 available with $0 outpatient, $200 and $750 available with $200 outpatient)
Covered
Inpatient Rehabilitation Facility
Up to 90 days Up to 90 days Up to 90 days
Subacute Rehabilitation and Skilled Nursing Facilities
Up to 90 days Up to 90 days Up to 90 days
Transplants
Covered Covered Covered
Behavioral Health and Substance Abuse
Inpatient and outpatient benefits are paid at 50% up to $2,500
- Coinsurance does not apply to the out-of-pocket maximum
Not covered Inpatient and outpatient benefits are paid at 50% up to $2,500
- Coinsurance applies to the out-of-pocket maximum
Optional Features Optional features are available at an additional cost.
Optional Benefits and Discount Programs
Discount programs are not insurance
SuiteSolutions, Office Visit Copay, Maternity Benefit, Accident Medical Expense, Supplemental Life and Dental/Vision Discount Card SuiteSolutions, Office Visit Copay, Maternity Benefit, Accident Medical Expense, Supplemental Life and Dental/Vision Discount Card SuiteSolutions, First-Dollar Preventive Services Benefit, Maternity Benefit, Accident Medical Expense, Supplemental Life and Dental/Vision Discount Card
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