| Plan Design |
Unless otherwise noted, all deductibles, maximums and benefit amounts are applied per person and are reset each January 1. |
Individual Deductible Amount you pay toward covered expenses before the plan pays benefits |
$500, $1,000 or $2,500 |
$2,000, $3,000 or $5,100 |
Family Deductible
|
Family deductible maximum is three times the individual deductible and is met collectively by three or more persons. |
Family deductible maximum is two times the individual deductible and is met collectively by two or more persons. |
Benefit Percentage Percentage of covered expenses the plan pays after the deductible is met |
75% or 50% |
100%, 75%, or 50% |
Coinsurance Percentage of covered expenses you pay after the deductible is met |
25% or 50% |
0%, 25% or 50% |
Coinsurance Out-of-Pocket Maximum* After this maximum is met, the plan pays 100% of covered expenses |
$2,000 with the 50% coinsurance plan
$3,000 with the 25% coinsurance plan |
$0 to $3,000 depending on coinsurance |
Outpatient Services Maximum The annual maximum amount the plan pays toward outpatient services |
$2,500, $5,000 or $10,000 (All outpatient benefits are subject to this maximum.) |
$15,000 or $25,000 (All outpatient benefits are subject to this maximum.) |
Annual Maximum The total annual maximum amount the plan pays |
$50,000, $100,000 or $250,000 (All benefits are subject to this maximum.) |
No Maximum>/b> - the plan pays inpatient benefits up to the lifetime benefit maximum. |
Lifetime Benefit Maximum The total maximum amount the plan pays |
$2 million |
$2 million |
| Outpatient Benefits |
Benefits are subject to deductible and coinsurance unless otherwise noted. |
| Prescription Drugs - Generic |
$15 copay (no deductible)
- $2,000 maximum for brand and generic combined
- Buy-up option: annual maximum amount for brand and generic combined |
Covered (subject to deductible and coinsurance)
- $2,000 maximum for brand and generic combined
- Buy-up option: lifetime maximum amount for brand and generic combined |
| Prescription Drugs - Brand name |
$500 deductible / $25 copay + 50% coinsurance (Family deductible maximum is $1,000 and is met collectively by two or more persons)
- $2,000 maximum for brand and generic combined
- Buy-up option: annual maximum amount for brand and generic combined |
Covered (subject to deductible and coinsurance)
- $2,000 maximum for brand and generic combined
- Buy-up option: lifetime maximum amount for brand and generic combined |
Preventive Services Mammograms, Pap smears and PSA screening |
Covered after you have been insured for 12 months. |
Covered after you have been insured for 12 months. |
| Other preventive services, office visits and immunizations |
Up to $500 in benefits -- after you have been insured for 12 months. - Copay, if selected, applies to office visits and immunizations |
Covered after you have been insured for 12 months |
| Office Visits |
Covered |
Covered |
Office Visit Copay Optional benefit |
$25 copay for each of two network office visit per person
- Visits for illness, injury and (after 12 months) preventive services are eligible
- Additional visits are covered subject to deductible and coinsurance |
Not available |
| Diagnostic Imaging and Laboratory Services |
Covered |
Covered |
| Outpatient Hospital, Surgical Center or Urgent Care Facility |
Covered |
Covered - Outpatient facility fee: $0 or $200 per outpatient surgery. |
| Professional Ground and Air Ambulance |
Up to $1,000 for one trip |
Up to $1,000 for one trip |
| Emergency Room |
Covered - $75 emergency room fee -- waived if admitted to the hospital. |
Covered - $75 emergency room fee -- waived if admitted to the hospital. |
| Health Care Practitioner Services |
Covered |
Covered |
| Outpatient Physical Medicine |
$50 per visit for up to two visits
- Chiropractic not covered |
$50 per visit for up to two visits
- Chiropractic not covered |
| Home Health Care |
Not covered |
Not covered |
Inpatient Benefits
|
Benefits are subject to deductible and coinsurance unless otherwise noted. |
Inpatient Hospital
|
Covered |
Covered |
Inpatient Rehabilitation Facility
|
$100 per day for up to 50 days |
$100 per day for up to 50 days |
Subacute Rehabilitation and Skilled Nursing Facilities
|
Up to 30 days |
Up to 30 days |
Transplants
|
Covered |
Covered |
Behavioral Health and Substance Abuse
|
Not covered |
Not covered |
| Optional Features |
Optional features are available at an additional cost. |
Optional Benefits and Discount Programs Discount programs are not insurance |
SuiteSolutions, Office Visit Copay, Accident Medical Expense and Dental/Vision Discount Card |
SuiteSolutions, Accident Medical Expense and Dental/Vision Discount Card |
| Get A Quote |
See just how affordable Quality Health Coverage can be!
 |