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Benefits Summary

AmeriHealth® POS Coinsurance

Benefits AmeriHealth POS Coinsurance
$20/$40/90%		 AmeriHealth POS Coinsurance
$30/$50/80%		 AmeriHealth POS Coinsurance
$30/$50/70%
  Network care Non-Network care Network care Non-Network care Network care Non-Network care
Deductible $1,000 Individual
$2,000 Family		 $2,000 Individual
$4,000 Family		 $1,500 Individual
$3,000 Family		 $3,000 Individual
$6,000 Family		 $2,000 Individual
$4,000 Family		 $3,000 Individual
$6,000 Family
Out-of-Pocket maximum* $2,000 Individual
$4,000 Family		 $5,000 Individual
$10,000 Family		 $2,500 Individual
$5,000 Family		 $6,000 Individual
$12,000 Family		 $3,500 Individual
$7,000 Family		 $15,000 Individual
$30,000 Family
Overall lifetime maximum Unlimited $5 million Unlimited $5 million Unlimited $5 million
Office visit (PCP) $20 70% $30 60% $30 50%
Specialist visit $40 70% $50 60% $50 50%
Inpatient hospital care** 90% 70% 80% 60% 70% 50%
Outpatient therapy‡ $40 70% $50 60% $50 50%
X-ray $40
Routine
$80
Complex**		 70%

70%**		 $50
Routine
$100 Complex**		 60%

60%**		 $50
Routine
$100
Complex**		 50%

50%**
Lab 100% 70% 100% 60% 100% 50%
Maternity care (physician) $20 first visit
100% thereafter		 70% $30 first visit
100% thereafter		 60% $30 first visit
100% thereafter		 50%
Emergency care (waived if admitted) $100 $100 $100 $100 $100 $100

* Annual out-of-pocket (OOP) maximum per person/per family. For network services, copayments, network coinsurance and deductibles apply to the OOP maximum. For non-network services, coinsurance is included.

** Precertification required

‡ This benefit plan applies copays to physical, occupational, and speech therapy** visits. Physical and occupational therapy have a 30-visit calendar year limit. Speech therapy is subjected to a 20 calendar year visit limit for all three plan designs.

The table above illustrates the available benefit programs. The AmeriHealth POS Coinsurance 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.