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Benefits Summary

AmeriHealth® Point-of-Service (POS)

Benefits AmeriHealth
POS 5/B		 AmeriHealth
POS 15/E		 AmeriHealth
POS Select 111/G
  Referred Self-
Referred		 Referred Self-
Referred		 Referred Self-
Referred
Deductible None $200 Individual
$600 Family		 None $500 Individual
$1500 Family		 None $1000 Individual
$3000 Family
Out-of-Pocket Maximum $650/member $1000 Individual
$3000 Family		 $1000 Individual
$2000 Family		 $3000 Individual
$6000 Family		 $2000 Individual
$4000 Family		 $10,000 Individual
$30,000 Family
Overall Lifetime Maximum Unlimited $1,000,000 Unlimited $1,000,000 Unlimited $1,000,000
Office Visit (PCP) $5 80% $15 70% $20 60%
Specialist Visit $5 80% $25 70% $25 60%
Hospital Care
(Inpatient/Outpatient)		 100% 80% 100% 70% $125/day
$625 maximum admission		 60%
Outpatient Rehabilitation Therapy 100% 80% 100% 70% $25* 60%
X-ray 100% 80% 100% 70% $25* 60%
Lab 100% 80% 100% 70% 100% 60%
Preventive Care $5 80% $15 70% $20 60%
Maternity Care
1st visit
post 1st visit
$5
100%
80%
80%
$25
100%
70%
70%
$25
100%
60%
60%
Emergency Care $35 (waived if admitted) $35 (waived if admitted) $35 (waived if admitted) $35 (waived if admitted) $50 (waived if admitted) $50 (waived if admitted)

* This benefit plan applies copays to physical, occupational, and speech therapy visits, and X-rays. Up to 60 consecutive days per condition.

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 1-866-681-7372.