Ease Bronze
Plan Type | |
---|---|
Member Only | $550.66 |
Member and Spouse | $781.34 |
Member and Child | $732.33 |
Family | $1,052.00 |
An ACA compliant health plan providing coverage for:
An enhanced plan providing:
Providing health coverage for:
Preventive & Wellness Physician Care, Diagnostic Services & Preventative Prescription Drugs Meets the ACA requirement for valid health coverage
Medical Services | Patient Copay | Coverage After Copay |
---|---|---|
Physician Services for Preventive & Wellness Treatment | ||
Annual Physical Exam | $0.00 | 100% |
Well Women’s Visits | $0.00 | 100% |
Well Child Visits | $0.00 | 100% |
Other Preventive Testing & Screening (see schedule attached) | $0.00 | 100% |
Physician Services for Illness and Accident Treatment | ||
Primary Care Physician’s Office Visit | $25.00 | 100% |
Specialist Office Visit | $50.00 | 100% |
Urgent Care (non-hospital urgent care) | $50.00 | 100% |
Assumes existing Doctor. If new Doctor, Copays are double | ||
Diagnostic Services for Illness and Accident Treatment | ||
Laboratory Services | $50.00 | 100% |
Radiology Services | $50.00 | 100% |
CT / MRI / MRA / PET Scan | $350.00 | 100% |
Prescription Drug Benefits | ||
Preventive Pharmacy Prescription - Retail, up to a 30 day supply | Generic: $0 Copay | 100% |
Non-Preventive Pharmacy - up to a 30 day supply* *This is a separate benefit bundled with the Ease Bronze Global Data LP Plan. This Non-Preventive Pharmacy Benefit is provided by an AM Best rated insurance company. Please refer to full plan disclosure provided below this table. |
Individual: $1,000 deductible Family: $2,000 deductible Formulary Generics: $10 Copay Formulary Brands: $30 Copay $1,000 max per person, per month |
$0.00 |
Hospital / Facility Services | ||
Other Inpatient Surgery | $350.00 | 100% |
Outpatient Surgery | $350.00 | 100% |
Non-Surgical Outpatient Procedures | $350.00 | 100% |
Emergency Room Treatment | $350.00 | 100% |
Chemotherapy, Radiation & Other Related | NA | NA |
Non-Experimental Cancer Treatments | NA | NA |
Dialysis | NA | NA |
NOTE: Please refer to the Schedule of Benefits for a more in-depth list of Benefits Coverage, Limitations, and Exclusions.
*All members are enrolled into Alliance for Consumers USA to be eligible to receive the prescription drug insurance benefits. The prescription drug insurance benefits are underwritten by an AM Best rated insurance company under policy issued to Alliance for Consumers USA. The Global Data LP Plan fees charged for their plan will include the following Alliance for Consumers USA Fees which include fees for the prescription drug benefit: Member Only: $20.82 / Member & Spouse: $38.18 / Member and Children: $34.91 / Family:$57.30. The AM Best insurance company provides only the prescription drug benefit insurance. The AM Best insurance company does not provide nor is affiliated with the other benefits or services provided as a part of membership. Refer to the Prescription Drug Description of Benefits for more details.
A complete prescription drug plan that works for the whole family.
Generic Preventive Medications | |||||||||||||
Generic Preventive Medications: | $0 Copay | ||||||||||||
Preferred Formulary Prescription Drugs | |||||||||||||
Preferred Generics: | $0 Copay |
Formulary Generic Drugs: | $10 Copay |
Formulary Brand Name Drugs: | $30 Copay |
Additional preferred Brand & Generic Drugs: | $50 or less | Copays listed apply only to drugs listed on the formulary Subject to an annual deductible of $1,000 per person / $2,000 per family Maximum monthly benefit of $1,000 per person / $2,000 per family |
Non-Formulary Prescription Drugs are provided at our negotiated network rates savings members up to 90% off the usual and customary charge | |
|
*All members are enrolled into Alliance for Consumers USA to be eligible to receive the prescription drug insurance benefits. The prescription drug insurance benefits are underwritten by an AM Best rated insurance company under policy issued to Alliance for Consumers USA. The Global Data LP Plan fees charged for their plan will include the following Alliance for Consumers USA Fees which include fees for the prescription drug benefit: Member Only: $20.82 / Member & Spouse: $38.18 / Member and Children: $34.91 / Family:$57.30. The AM Best insurance company provides only the prescription drug benefit insurance. The AM Best insurance company does not provide nor is affiliated with the other benefits or services provided as a part of membership. Refer to the Prescription Drug Description of Benefits for more details.
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