Plan Details

Not all coverage is the right coverage.

Your healthcare coverage is important to us. Age, family status, medical conditions, hobbies, lifestyle and a myriad of other factors will help you determine if you need a lot or a very little amount of health coverage. This summary will help you understand your plan and its coverage.


Summary of Medical Benefits

Copay Plan

In-Network

Out-of-Network

Deductible

Individual

Family

 

$2,500

$5,000

 

$5,000

$10,000

Out-of-Pocket Maximum

Individual

Family

 

$5,000

$10,000

 

$10,000

$20,000

Preventive Care Services

No Charge

50%* After Deductible

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$25 Copay

$25 Copay

20%* After Deductible

 

50%* After Deductible

50%* After Deductible

50%* After Deductible

Urgent Care Services

$75 Copay

50%* After Deductible

Complex Imaging: MRI/CT/PET Scans

20%* After Deductible

50%* After Deductible

Inpatient Hospital Care

Facility Fee

Physician Fee

 

$200 Copay, then 20%* After Deductible

20%* After Deductible

 

$300 Copay, then 50%* After Deductible

50%* After Deductible

Outpatient Procedures

Facility Fee

Physician Fee

 

$150 Copay, then 20%* After Deductible

20%* After Deductible

 

$250 Copay, then 50%* After Deductible

50%* After Deductible

Emergency Room

Emergency Medical Transportation

$400 Copay, then 20%* After Deductible

20%* After Deductible

$400 Copay, then 20%* After Deductible

20%* After Deductible

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

$200 Copay, then 20%* After Deductible

$25 Copay

 

$300 Copay, then 50%* After Deductible

50%* After Deductible

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty Drugs

Retail 30 Day Supply

$5 Copay

$45 Copay

$85 Copay

$250 Copay

Mail Order 90 Day Supply

$15 Copay

$135 Copay

$225 Copay

Not Available

NOTE: * Coinsurance

Please refer to your Summary Plan Description for actual coverage, limitation, and exclusion provisions

 

 

 

 


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