An ACA compliant health plan providing coverage for:
An enhanced plan providing:
Providing health coverage for:
Primary Physician Care, Preventive & Wellness Physician Care, Diagnostic Services & Prescription Drugs Meets the ACA requirement for valid health insurance
| 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 | $35.00 | 100% |
| Specialist Office Visit | $75.00 | 100% |
| Urgent Care (non-hospital urgent care) | $75.00 | 100% |
| Assumes existing Doctor. If new Doctor, Copays are double | ||
| Diagnostic Services for Illness and Accident Treatment | ||
| Laboratory Services | $50.00 (Per Panel Tested) | 100% |
| Radiology Services | $50.00 (Per Image) | 100% |
| CT / MRI / MRA / PET Scan | $50.00 (Per Image) | 100% |
| Prescription Drug Benefits | ||
| Preventive Prescription Drugs (See formulary attached) | $0.00 | 100% |
| Non-preventive Preferred Drugs (over 200 drugs) | $0.00 | 100% |
| Non-Preventive Value Drugs | $0.00 | Over 1,000 drugs under $50 All others at discounts up to 80% |
| Hospital / Facility Services | ||
| Other Inpatient Surgery | NA | 80% coinsurance after deductible |
| Outpatient Surgery | NA | 80% coinsurance after deductible |
| Non-Surgical Outpatient Procedures | NA | 80% coinsurance after deductible |
| Emergency Room Treatment | NA | 80% coinsurance after deductible |
| Chemotherapy, Radiation & Other Related | NA | 80% coinsurance after deductible |
| Non-Experimental Cancer Treatments | NA | 80% coinsurance after deductible |
| Dialysis | NA | 80% coinsurance after deductible |
You pay 20% after deductible is met / you pay nothing after maximum out of pocket is met
NOTE: Please refer to the Schedule of Benefits for a more in-depth list of Benefits Coverage, Limitations, and Exclusions.
*Only relates to non-hospital treatments.
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