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Benefits Summary

AmeriHealth ® POS Plus

Benefits Option 1 Option 2 Option 3
  Network Non-Network‡ Network Non-Network‡ Network Non-Network‡
Deductible NONE $1,500 Individual/$3,000 Family NONE $1,500 Individual/$3,000 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
Overall Lifetime Maximum Unlimited $5,000,000 Unlimited $5,000,000 Unlimited $5,000,000
Office Visit (PCP) $15/visit 70% $20/visit 70% $30/visit 60%
Specialist Visit $30/visit 70% $40/visit 70% $50/visit 60%
Inpatient Hospital Care** $200/day (up to 5 days) 70% $300/day (up to 5 days) 70% $400/day (up to 5 days) 60%
Outpatient Rehabilitation Therapy $30/visit 70% $40/visit 70% $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*		 $40 Routine
$80 Complex*		 70% Routine
70% Complex*		 $50 Routine
$100 Complex*		 60% Routine
60% Complex*
Lab 100% 70% 100% 70% 100% 60%
Preventive Care $15/visit $750 per year up to 1 year old; $500 per year all other members. Not subject to Deductible $20/visit $750 per year up to 1 year old; $500 per year all other members. Not subject to Deductible $30/visit $750 per year up to 1 year old; $500 per year all other members. Not subject to Deductible
Maternity Care $15/1st OB Visit
$200/day Hospital (up to 5 days)		 70%/1st OB Visit
70% Hospital		 $20/1st OB Visit
$300/day Hospital (up to 5 days)		 70%/1st OB Visit
70% Hospital		 $30/1st OB Visit
$400/day Hospital (up to 5 days)		 60%/1st OB Visit
60% Hospital
Emergency Care (copay not waived if admitted) $100 $100 $100 $100 $100 $100

* For network services, copayments and network coinsurance apply to OOP max. For non-network services, deductible and coinsurance apply to OOP max.

** Precertification required

‡ Out of network providers may bill members for any difference between the plan allowance, which is the amount paid by the plan, and the providers actual charge

The above table illustrates some of the benefit programs available. This managed care plan may not cover all your health care 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.