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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