HealthPlan Express - Benefit Detail

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Plan Benefit Summary

Company/Plan Name	WorldCare Flex Advantage PPO 80
Deductible
In-Network	$10,000 Per Person, Per Calendar Year
Out-Network	2X the In-Network Deductible
Maximum Family Deductible	3 Deductibles Per Family, Per Calendar Year
Coinsurance
In-Network	80/20% to $5,000
Out-Network	50/50% to $10,000
Maximum Out-Of-Pocket Coinsurance
In-Network	$1,000 excluding Deductible
Out-Network	$5,000 excluding Deductible, plus charges above usual & customary
Maximum Benefit	$2,000,000 lifetime (optional increase to $5,000,000 lifetime (not quoted))
Physician Office Visit
In-Network	$30 CoPay No limit on physician office visits
Out-Network	Deductible & CoInsurance Apply
Outpatient Lab & X-Ray
In-Network	$30 CoPay per occurrence, maximum benefit $200, then subject to Deductible & CoInsurance
Out-Network	Deductible & CoInsurance Apply
Outpatient Preventive Care
In-Network	After 6 month wait, covers up to $250 in Wellness benefits after $30 CoPay
Out-Network	Deductible & CoInsurance Apply
Prescription Drugs
Generic	Subject to Deductible and CoInsurance
Brand Name(formulary)	Subject to Deductible and CoInsurance
Brand Name(Non-formulary)	Subject to Deductible and CoInsurance
Outpatient Surgery
In-Network	Deductible & CoInsurance Apply
Out-Network	Deductible & CoInsurance Apply
Emergency Room
In-Network	Subject to Deductible & CoInsurance, plus $100 CoPay if visit is for illness & patient is not directly admitted into hospital as InPatient
Out-Network	Subject to Deductible & CoInsurance, plus $100 CoPay if visit is for illness & patient is not directly admitted into hospital as InPatient
Maternity Prenatal/Post Natal
In-Network	Not Covered, unless maternity Benefit option is selected (not quoted) (See Brochure for complications of pregnancy)
Out-Network	Not Covered, unless maternity Benefit option is selected (not quoted) (See Brochure for complications of pregnancy)
Inpatient Benefits
Hospitalization
In-Network	Deductible & CoInsurance Apply
Out-Network	Deductible & CoInsurance Apply
Surgical
In-Network	Deductible & CoInsurance Apply
Out-Network	Deductible & CoInsurance Apply
Maternity
In-Network	Not Covered, unless maternity Benefit option is selected (not quoted) (See Brochure for complications of pregnancy)
Out-Network	Not Covered, unless maternity Benefit option is selected (not quoted) (See Brochure for complications of pregnancy)
Rate Guarantee	Initial 12 month rate guarantee
Optional Benefits
Supplemental Accident	Benefit of $500, $1,000, $1,500, $2,000, $2,500, $3,000, or $5,000; pays full benefit for treatment of injuries on an OutPatient basis not to exceed the amount you choose per person, per calendar year(not all levels available in all states)(not quoted)
24 Hour Coverage	Included (see brochure)
Other

Affordable Health Insurance Quotes through HealthPlan Express

IMPORTANT NOTICES AND DISCLAIMERS

To be considered for reimbursement, insurers require that expenses must qualify as covered expenses. Expenses are also subject to reasonable and customary limits, unless you use a PPO/Network, as well as determinations of medical necessity.

This Benefit Comparison is intended as preliminary information only. The company provided (product specific) brochure contains important details concerning the benefits, limitations, exclusions and renewability of each plan. Be sure to download the brochure before applying. Refer to the policy as the binding authority for all terms and provisions of coverage. The rates provided are intended to be accurate but may change based on a number of factors including your medical history. The rates and terms of a policy may be changed by the insurance company with proper notification (and subject to any necessary regulatory approval). The rates shown are based on preferred underwriting criteria, if applicable.

Company Brochure

More details and variations in benefits for your state are in the company specific brochure and/or Outline of Coverage, which you can access by clicking the download brochure link above. Please do so before you apply. Alternatively, you may request this information be mailed to you.

Association Plans

Certain products available through some insurance companies require membership in an association which may be separate and distinct form the health plan/insurer. Details on membership and any fees are described in the company specific brochures.

World / NCA & ACA Disclaimer (not applicable to World Choice Short Term Medical plans)

World Insurance Company estimated base monthly premiums include the mandatory $7.50 per month dues for membership in NCA (WorldCare plans) and ACA (ExpressMed plans), an independent consumer organization. The one-time non-refundable application fee of $25.00 ($50.00 for Kansas WorldCare Value Advantage plans), is not included in the premiums quoted.

World Choice Short Term Medical Disclaimer

Choice Short Term Medical premiums do not include the one-time administrative or one-time application fee. These fees must be submitted with full term's premium at the time of application. (The one-time administrative fee for policy terms of one month only is $20.00 and for policy terms 2 months or more is $40.00. The one-time application fee for policy terms of one month only is $5.00 and for policy terms 2 months or more is $10.00.)

Do not cancel any in-force health coverage until you have received written formal approval of acceptance from the company you select. Rates shown are based upon the information you provided, and are subject to change based on the health plan underwriting practices, network choice and your selection of available optional benefits, if any. Final rates and effective dates are subject to underwriting and are always determined by the health insurance company.

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