If you are looking for information on Individual Health Insurance In Atlanta, GA, CoventryOne of GA Is Made For You. Coventry Health Insurance in Georgia or Coventry Medical Has Very Competitive Rates And Excellent Benefits With Unlimited $20 Dr.'s Office Co-Pays. This plan is designed for Individuals and Families Looking for Health Insurance in Metro Atlanta & Most of GA. Featuring Low Cost Health Insurance Quotes For Individuals and Families in GA.
Authorized Agent  Bill Howell     770-938-9000
  
 

 North Carolina
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CoventryOne GA POS In-Network Benefit Summary
 
 
Description of Benefits
  
$500
  
$1,000
  
$2,000
  
$3,000
  
 $5,000
  
$10,000
 
Lifetime Maximum Per Member
  
$6,000,000
  
$6,000,000
  
$6,000,000
  
$6,000,000
  
$6,000,000
  
$6,000,000
 
Annual Deductible Per Member
(3 person maximum)
  
$500
  
$1,000
  
$2,000
  
$3,000
  
$5,000
  
$10,000
 
Annual Out-of-Pocket Maximum
(3 person family maximum)
  
$2,500 plus deductible per member
  
$2,500 plus deductible per member
  
$2,500 plus deductible per member
  
$2,500 plus deductible per member
  
$2,500 plus deductible per member
  
$2,500 plus deductible per member
Office Visits - (PPO Physicians and Specialists-includes X-ray and lab work only when performed and billed by the physician's office)  
$20/$55
  
$20/$55
  
$20/$55
  
$20/$55
  
$20/$55
  
$20/$55
Preventive Care for Babies and Children (through age 5)  
$20
  
$20
  
$20
  
$20
  
$20
  
$20
Preventive Screenings for Adults
(unlimited yearly max)
Colonscopy will be paid at 70% after the yearly deductible is met.		  
$20
  
$20
  
$20
  
$20
  
$20
  
$20
Mammograms

 

Covered at 100% - no copay

 Covered at 100% - no copay

 

Covered at 100% - no copay

  Covered at 100% - no copay

 

Covered at 100% - no copay

 Covered at 100% - no copay
Professional Services
Including surgery, anesthesia, in-hospital physician care, diagnostic X-ray and lab.		  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
Inpatient Hospital Services
Surgery, x-ray, in-hospital physician visits, organ/tissue transplants		  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
Maternity  
NOT COVERED
  
NOT COVERED
  
NOT COVERED
  
NOT COVERED
  
NOT COVERED
  
NOT COVERED
Outpatient Medical Care  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
Short Term Therapies:
Physical/Occupational/Speech
Respiratory Therapy, Cardiac and Pulmonary Rehabilitation
(no limit on # of visits)
Developmental Delay is not covered		  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
 Chiropractic Services
(24 visits per year - Care must be received from ActivHealth Provider)		  $10 $10   $10 $10   $10 $10 
 Mental Health-
Available only by purchase of an additional rider for $20.73/month
(rider gives 48 O/P Vis & 30 I/P days per yr.)		 Available only by purchasing a Rider Available only by purchasing a Rider   Available only by purchasing a Rider Available only by purchasing a Rider   Available only by purchasing a Rider Available only by purchasing a Rider 
Infusion Therapy/Chemotherapy  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
Emergency Room Care -

For Medical Emergency or Serious Accidental Injury
(Non emergency use of the emergency
room is not a covered benefit)

 $150 copay then 100% coverage $150 copay then 100% coverage $150 copay then 100% coverage $150 copay then 100% coverage $150 copay then 100% coverage $150 copay then 100% coverage
 Urgent Care  
$55 Copay
  
$55 Copay
  
$55 Copay
  
$55 Copay
  
$55 Copay
  
$55 Copay
Ambulatory Surgical Center  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
Ambulance Service  
$150
  
$150
  
$150
  
$150
  
$150
  
$150
Hospice  
Plan pays 70% with deductible waived
  
Plan pays 70% with deductible waived
  
Plan pays 70% with deductible waived
  
Plan pays 70% with deductible waived
  
Plan pays 70% with deductible waived
  
Plan pays 70% with deductible waived
Home Health Care -
Limited to 30 days, in and out of network combined		  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
Durable Medical Equipment, Prosthetics and Orthoses
limited to $2,500 annual max, all combined		  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
Skilled Nursing Facility
Limited to 30 days, in and out of network combined		  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
Transplants
(NEW-Unlimited Benefit)		  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
  
Plan pays 70% after deductible
Prescription Drugs -
Retail Drugs - per prescription (up to a 30-day supply-mail order available)		  
After a $100 deductible per person, you pay:
  
After a $250 deductible per person, you pay:
  
After a $250 deductible per person, you pay:
  
After a $250 deductible per person, you pay:
  
After a $500 deductible per person, you pay:
  
After a $1,000 deductible per person, you pay:
 

Tier 1 (Generic Drugs)

No deductible necessary
  
$10 copayment
  
$10 copayment
  
$10 copayment
  
$10 copayment
  
$10 copayment
  
$10 copayment
  Tier 2 (Formulary Brand)  
$35 copayment
  
$35 copayment
  
$35 copayment
  
$35 copayment
  
$35 copayment
  
$35 copayment
  Tier 3 (Non-Formulary Brand)  
$50 copayment
  
$50 copayment
  
$50 copayment
  
$50 copayment
  
$50 copayment
  
$50 copayment
  Tier 4 (self edministered injectables)  
$100 copayment
  
$100 copayment
  
$100 copayment
  
$100 copayment
  
$100 copayment
  
$100 copayment
Dental ( all care must be received from a DeltaCare provider.  
Various Copays
  
Various Copays
  
Various Copays
  
Various Copays
  
Various Copays
  
Various Copays
Vision - one exam every 12 months (care must be received from an Avesis provider)  
$15 Copay
  
$15 Copay
  
$15 Copay
  
$15 Copay
  
$15 Copay
  
$15 Copay
Waiting period for all undisclosed pre-existing conditions is at least one year from contract effective date.
 *Refer to your individual certificate of coverage for complete benefit details
(As with all insurance providers, not disclosing known prexisting conditions could result in termination of your benefits)

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