Out-of-Network Benefits1
All AmeriHealth PPO High Deductible Health Plan options utilize the same cost-sharing schedule for out-of-network benefits.
| Deductible Single/Family | $5,000/$10,000 |
| Coinsurance | 50% |
| Out-of-Pocket Maximum Single/Family | $10,000/$20,000 |
| Overall Lifetime Maximum | $500,000 |
| Office Visits | |
|---|---|
| Doctor's Office Visits - Primary & OB/GYN Care - Specialist |
50% 50% |
| Physical/Occupational Therapy (30 visits per calendar year*) | 50% |
| Spinal Manipulations & Speech Therapy (20 visits each per calendar year*) | 50% |
| Cardiac & Pulmonary Rehabilitation (36 sessions each per calendar year*) | 50% |
| X-Ray/Radiology/Diagnostics** | 50% |
| Injectable Medications** | 50% |
| Lab/Pathology | 50% |
| Facility/Ancillary | |
| Hospital Inpatient** (70 days per calendar year) | 50% |
| Outpatient Surgery** | 50% |
| Skilled Nursing Facility** (120 days per calendar year) | 50% |
| Emergency Room (Not waived if admitted) | Covered at the in-network level |
| Outpatient Private Duty Nursing** (360 hours per calendar year*) | 50% |
| Prosthetics & Durable Medical Equipment (DME)** (DME: $2,500 maximum per calendar year) |
50% |
1 Out-of-network providers may bill you for differences between the Plan allowance, which is the amount paid by AmeriHealth, and the provider's actual charge. This amount may be significant. It is important to note that all percentages for out-of-network services are percentages of the Plan allowance, not the provider's actual charge.
* Combined in/out-of-network maximum
** Pre-authorization required.