Care Within Reach. Access care in or out-of-network with AmeriHealth Point of Service.

Benefits Summary

AmeriHealth ® POS Plus Coinsurance

Benefits AmeriHealth POS Plus Coinsurance
$20/$40/90%		 AmeriHealth POS Plus Coinsurance
$30/$50/80%		 AmeriHealth POS Plus Coinsurance
$30/$50/70%
  In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network
Deductible $1,000 Individual
$2,000 Family		 $2,000 Individual
$4,000 Family		 $1,500 Individual
$3,000 Family		 $3,000 Individual
$6000 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/visit 70% $30/visit 60% $30/visit 50%

Specialist Visit

 $40/visit 70% $50/visit 60% $50/visit 50%
Inpatient Hospital Care** 90% 70% 80% 60% 70% 50%
PT/OT† $40/visit 70% $50/visit 60% $50/visit 50%
Outpatient X-ray
(no copay applicable when service is performed in ER or office setting)		 $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) $20/1st OB visit then 100% 70% $30/1st OB visit then 100% 60% $30/1st OB visit then 100% 50%
Emergency Care (copay not waived if admitted) $100 $100 $100 $100 $100 $100

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

** Precertification required

†Up to 30 visits per calendar year

The above table illustrates some of the benefit programs available. The AmeriHealth POS Plus 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.