Land of Lincoln Land of Lincoln National Complete PPO Plan Gold (Illinois)

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Company Land of Lincoln Mutual Health Insurance Co.
Plan Year 2014
State Illinois
Metal Tier Gold
Plan Type PPO
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Cost Sharing Benefits (In Network)

Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.

Deductible (Individual) $750
Deductible (Family) $1,500
Coinsurance 25%
Out of Pocket Maximum (Individual) $4,500
Out of Pocket Maximum (Family) $9,000

Doctors Visits

Primary Care Visit $25
Specialist Visit $35
In Patient Hospital Services 25% Coinsurance after deductible
Emergency Room Services $500

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 25% coinsurance
Laboratory Outpatient and Professional Services 25% coinsurance
X-ray and Diagnostic Imaging 25% coinsurance

Other

Mental / Behavioral Health 25% coinsurance
Rehabilitative Speech Therapy 25% coinsurance
Rehabilitative Occupational & Physical Therapy 25% coinsurance
Outpatient Facility 25% coinsurance
Outpatient Surgery 25% coinsurance

Prescription Drugs

Generic Rx $10
Preferred Brand Rx $25
Non Preferred Brand Rx 25% Coinsurance after deductible
Specialty Drugs 25% Coinsurance after deductible

Other Plans

Other plans that are available in the state.

Plan Name
Swedish Covenant Land of Lincoln Gold
Swedish Covenant Land of Lincoln Silver
Swedish Covenant Land of Lincoln Platinum
Land of Lincoln Champion PPO Gold
Land of Lincoln Champion PPO Platinum
Illinois Health Partners Land of Lincoln Gold
Illinois Health Partners Land of Lincoln Silver
Illinois Health Partners Land of Lincoln Platinum
Presence Health Land of Lincoln Gold PPO
Presence Health Land of Lincoln Silver PPO
Presence Health Land of Lincoln Platinum PPO
Centegra Land of Lincoln Health Plan - Gold
Centegra Land of Lincoln Health Plan - Silver Copay
Centegra Land of Lincoln Health Plan - Platinum
Adventist Land of Lincoln Gold PPO 500
Adventist Land of Lincoln Silver PPO 3000
Adventist Land of Lincoln Bronze PPO 5000
Adventist Land of Lincoln Platinum PPO 250
LLH Family Health Network Silver 3100
Chicago Health System | Land of Lincoln PPO Gold
Chicago Health System | Land of Lincoln PPO Silver
Land of Lincoln Preferred PPO Gold
Land of Lincoln Preferred PPO Silver
Land of Lincoln Preferred PPO Bronze
CO-OPtions Land of Lincoln National Elite Gold, a Multi-State Plan
CO-OPtions Land of Lincoln National Elite Silver, a Multi-State Plan
Land of Lincoln Freedom PPO Gold
Land of Lincoln Freedom PPO Silver
Land of Lincoln Freedom PPO Bronze

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