Amerus Ultimate 5K PPO: read the 2026 benefits

Understand the Ultimate 5K PPO’s office copays, deductible, hospital costs and limits before using its published household price.

Office visits are one part of the design

The 2026 plan guide lists a $40 in-network primary care copay and an $80 specialist copay, with the deductible not applying to those visits. Eligible preventive care is shown with no charge in network. These are not blanket prices for every service performed at a visit; imaging, procedures and facility charges have their own rows.

Larger care uses different cost sharing

The guide lists a $5,000 individual and $10,000 family in-network deductible, followed by 30% coinsurance for many hospital, imaging and surgery services. It also lists an $8,700 individual and $17,400 family in-network out-of-pocket maximum. Read the SBC exceptions and limits before using those numbers as a budget.

Check what the monthly amount includes

The guide describes a separate hospital and accident gap plan in its monthly brochure rates. Its benefits have different terms and limits from the medical plan. Ask for a complete first-month charge, the exact benefit schedules and a written underwriting result before applying. Do not treat the published household price as final approval.

Make the comparison useful

For a shopper who mostly expects office visits, the listed copays are easy to notice. For someone expecting imaging or hospitalization, the deductible and coinsurance are more important. Compare both kinds of year. Ask specifically whether an accompanying gap benefit is optional, what it pays, and whether its price is already included in the presented monthly amount.

Sources

Frequently asked questions

Does the $40 office copay cover every test at the visit?

No. The plan guide treats office visits, lab work, imaging and other services separately. Check the exact service and provider.

Educational information reviewed October 28, 2026. Product terms, rates, network access, state availability and underwriting can change. The current official plan documents and written eligibility decision control. Prestige is an independent insurance agency, not the insurer.

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