Free Yourself. See any provider without a referral in- or out-of-network with AmeriHealth PPO.

Benefits Summary

AmeriHealth® PPO

Receive care from any provider without a referral in network or non-network. Some services may require preauthorization.

Benefits AmeriHealth PPO D201 AmeriHealth PPO C30 AmeriHealth PPO B30
  Network Non-Network Network Non-Network Network Non-Network
Individual Deductible NONE $250/$500/$1,000 NONE $1,000/$2,500 $500/$1,000/$2,500 (Network/Non-Network combined)
Family Deductible NONE 2x Individual NONE 2x Individual 2x Individual
After Deductible, Plan Pays 100% 80% 100% 70% 80% 60%
Out-of-Pocket Maximum $1,000/$2,000 $2,500/$5,000 $4,000/$8,000 $12,000/$24,000 $5,000/$10,000 $15,000/$30,000
Overall Lifetime Maximum Unlimited Unlimited Unlimited
Office Visits $20 80% $30 70% $30 60%
Inpatient Hospital Care 100% 80% 100% after inpatient copay of $300 per day; $1,500 per adm; $3,000 per calendar year, per person 70% 80% after ded and inpatient copay of $200 per day; $1,000 per adm; $2,000 per calendar year, per person 60%
Lab 100% 80% 100% 70% 80% 60%
Preventive Care 100% up to $750 per covered child each year from birth through end of calendar year in which child reaches age one. $500 calendar year maximum for all others. 100% up to $750 per covered child each year from birth through end of calendar year in which child reaches age one. $500 calendar year maximum for all others. 100% up to $750 per covered child each year from birth through end of calendar year in which child reaches age one. $500 calendar year maximum for all others.
Maternity Care $25 (first visit only) 80% $25 (first visit only) 70% $25 (first visit only) 60%
Emergency Care $50 (waived if admitted) $50 (waived if admitted) $50 (waived if admitted) $50 (waived if admitted) $50 (waived if admitted) $50 (waived if admitted)

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.