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Benefits Summary

AmeriHealth® Point-of-Service (POS)


Benefits Option 1 Option 2 Option 3 Option 4 Option 5 Option 6
  Network Non-Network Network Non-Network Network Non-Network Network Non-Network Network Non-Network Network Non-Network
Deductible NONE $1,000 Individual/$2,000 Family NONE $1,500 Individual/$3,000 Family NONE $1,000 Individual/$2,000 Family NONE $1,500 Individual/$3,000 Family NONE $2,000 Individual/$4,000 Family NONE $2,500 Individual/$5,000 Family
Out-of-Pocket Maximum $5,000 Individual/$10,000 Family $15,000 Individual/$30,000 Family $5,000 Individual/$10,000 Family $15,000 Individual/$30,000 Family $5,000 Individual/$10,000 Family $15,000 Individual/$30,000 Family $5,000 Individual/$10,000 Family $15,000 Individual/$30,000 Family $5,000 Individual/$10,000 Family $15,000 Individual/$30,000 Family $5,000 Individual/$10,000 Family $15,000 Individual/$30,000 Family
Overall Lifetime Maximum Unlimited $5,000,000 Unlimited $5,000,000 Unlimited $5,000,000 Unlimited $5,000,000 Unlimited $5,000,000 Unlimited $5,000,000
Office Visit (PCP) $15/visit 70% $15/visit 70% $20/visit 70% $20/visit 70% $30/visit 60% $30/visit 70%
Specialist Visit $30/visit 70% $30/visit 70% $40/visit 70% $40/visit 70% $50/visit 60% $50/visit 60%
Inpatient Hospital Care* 100% 70% $200/day up to 5 days 70% 100% 70% $300/day up to 5 days 70% 100% 60% $400/day up to 5 days 60%
Outpatient Rehabilitation Therapy $30/visit 70% $40/visit 70% $40/visit 70% $40/visit 70% $50/visit 60% $50/visit 60%
Outpatient X-Ray (no copay applicable when service performed in ER or office setting) $30 Routine
$60 Complex*		 70% Routine
70% Complex*		 $30 Routine
$60 Complex*		 70% Routine
70% Complex*		 $40 Routine
$80 Complex*		 70% Routine
70% Complex*		 $40 Routine
$80 Complex*		 70% Routine
70% Complex*		 $50 Routine
$100 Complex*		 60% Routine
60% Complex*		 $50 Routine
$100 Complex*		 60% Routine
60% Complex*
Lab 100% 70% 100% 70% 100% 70% 100% 70% 100% 60% 100% 60%
Preventive Care $15/visit 70% (no deductible)* $15/visit 70% (no deductible)* $20/visit 70% (no deductible)* $20/visit 70% (no deductible)* $30/visit 60% (no deductible)* $30/visit 60% (no deductible)*
Maternity Care -1st OB Visit $15 70% $15 70% $20 70% $20 70% $30 60% $30 60%
Maternity Care – Hospital 100% 70% $200/day (up to 5 days) 70% 100% 70% $300/day (up to 5 days) 70% 100% 60% $400/day (up to 5 days) 60%
Emergency Care (copay not waived if admitted) $100 $100 $100 $100 $100 $100 $100 $100 $100 $100 $100 $100

* $750 per year allowance up to 1 year old; $500 per year allowance for all other members. Not subject to deductible.

The above table illustrates some of the benefit programs available. This managed care plan may not cover all your healthcare expenses. This information has been extracted from and is subject to the terms and conditions of all applicable group contracts and member handbooks.

For more information on the terms, limitations, and exclusions of the benefit programs, please contact your independent broker or our Marketing Department at 1-866-681-7368.