Plan Details

Plan Details

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

Reference Based Pricing Plan 1

Reference Based Pricing

Calendar Year Deductible

Individual Only

Individual Under Family

Family

 

$1,000

$1,000

$2,000

Coinsurance

20%

Out-of-Pocket Maximum

Individual Only

Individual Under Family

Family

 

$2,000

$2,000

$4,000

Preventative Care

100% Covered

Office Visits

Primary Services

Specialist Office Visit

Chiropractic Services

 

$20 Copay

$40 Copay

$20 Copay

Hospital Services

20%*

Emergency Services**

Emergency Room

Emergency Medical Transportation

 

$375 Copay

20%*

Urgent Care Services

$75 Copay

Teledoc Services

General Consultations

Dermatology

Mental Health- Therapist

Mental Health- Psychiatrist, initial evaluation

Mental Health- Psychiatrist, ongoing session

 

No Charge

No Charge

No Charge

No Charge

No Charge

Mental Health/ Chemical Dependency

Inpatient

Outpatient

 

20%*

$20 Copay

*After Deductible

** Referenced Based Pricing applies unless a network is utilized

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

 

 

 

Summary of Pharmacy Benefits

Retail 30 Day Supply

Mail Order 90 Day Supply

Prescription Drug Coverage

Generic

Preferred Brand

Non-preferred Brand

Specialty

 

$10 Copay

$35 Copay

$70 Copay

Not Covered

 

$10 Copay

$88 Copay

$175 Copay

Not available


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