LIMITED HEALTH PLANS
Minimum Essential Coverage plans - ACA compliant
NETWORK
-
Wellness & Preventative
100% Coverage for mandated ACA -
Telemedicine
$0 Copay (Unlimited) -
Primary Care Visits
$15 Copay (Unlimited) -
Specialist Visits
Network Discount -
Urgent Care Visits
$50 Copay (Unlimited) -
Lab Services
Network Discount -
X-Rays
Network Discount -
Generic RX
Discount -
Brand RX
Not covered
HOSPITAL INDEMNITY
-
Admission Benefit
Not covered -
Confinement Benefit
Not covered -
Inpatient Rehabilitation
Not covered -
Inpatient Surgery
Not covered -
Outpatient Surgery
Not covered -
Ambulance Benefit
Not covered -
Diagnostic Procedure
Not covered -
Emergency Room
Not covered -
Health Screening
Not covered -
Dependent Age Limit
Dependents to age 26 -
Portability
Not covered -
Life Insurance
Not covered
RATES
-
Member Only
$154.00 -
Member + Spouse
$274.00 -
Member + Child(ren)
$274.00 -
Member + Family
$353.00
NETWORK
-
Wellness & Preventative
100% Coverage for mandated ACA -
Telemedicine
$0 Copay (Unlimited) -
Primary Care Visits
$15 Copay (Unlimited) -
Specialist Visits
$15 Copay (Unlimited) -
Urgent Care Visits
$50 Copay (Unlimited) -
Lab Services
Network Discount -
X-Rays
$50 Copay (Unlimited) -
Generic RX
Tier 1: $10 Copay Tier 2: $25 Copay -
Brand RX
Tier 1: $50 Copay Tier 2: $75 Copay
HOSPITAL INDEMNITY
-
Admission Benefit
Not covered -
Confinement Benefit
Not covered -
Inpatient Rehabilitation
Not covered -
Inpatient Surgery
Not covered -
Outpatient Surgery
Not covered -
Ambulance Benefit
Not covered -
Diagnostic Procedure
Not covered -
Emergency Room
Not covered -
Health Screening
Not covered -
Dependent Age Limit
Dependents to age 26 -
Portability
Not covered -
Life Insurance
Not covered
RATES
-
Member Only
$216.00 -
Member + Spouse
$383.00 -
Member + Child(ren)
$379.00 -
Member + Family
$507.00
NETWORK
-
Wellness & Preventative
100% Coverage for mandated ACA -
Telemedicine
$0 Copay (Unlimited) -
Primary Care Visits
$15 Copay (Unlimited) -
Specialist Visits
$15 Copay (Unlimited) -
Urgent Care Visits
$50 Copay (Unlimited) -
Lab Services
$50 Copay (Unlimited) -
X-Rays
$50 Copay (Unlimited) -
Generic RX
Tier 1: $10 Copay Tier 2: $25 Copay -
Brand RX
Tier 1: $50 Copay Tier 2: $75 Copay
HOSPITAL INDEMNITY
-
Admission Benefit
$2,000 (1x/Yr.) -
Confinement Benefit
$50 /Day (30x/Yr.) -
Inpatient Rehabilitation
Not covered -
Inpatient Surgery
Not covered -
Outpatient Surgery
$250/$500 (1x/Yr.) -
Ambulance Benefit
Not covered -
Diagnostic Procedure
$250(1x/Yr.) -
Emergency Room
Not covered -
Health Screening
Not covered -
Dependent Age Limit
Dependents to age 26 -
Portability
Included -
Life Insurance
$10,000
RATES
-
Member Only
$252.00 -
Member + Spouse
$454.00 -
Member + Child(ren)
$437.00 -
Member + Family
$615.00
NETWORK
-
Wellness & Preventative
100% Coverage for mandated ACA -
Telemedicine
$0 Copay (Unlimited) -
Primary Care Visits
$15 Copay (Unlimited) -
Specialist Visits
$15 Copay (Unlimited) -
Urgent Care Visits
$50 Copay (Unlimited) -
Lab Services
$50 Copay (Unlimited) -
X-Rays
$50 Copay (Unlimited) -
Generic RX
Tier 1: $10 Copay Tier 2: $25 Copay -
Brand RX
Tier 1: $50 Copay Tier 2: $75 Copay
HOSPITAL INDEMNITY
-
Admission Benefit
$2,500 (1x/Yr.) -
Confinement Benefit
$200 /Day (30x/Yr.) -
Inpatient Rehabilitation
$100 /Day (15x/Yr.) -
Inpatient Surgery
$1,000 (1x/Yr.) -
Outpatient Surgery
$750/$1,500 (1x/Yr.) -
Ambulance Benefit
$500Air Trans. (2x/Yr.) $200 ground trans (2x/Yr.) -
Diagnostic Procedure
$250(1x/Yr.) -
Emergency Room
$100/Day (1x/Yr.) -
Health Screening
$50 (1x/Yr.) -
Dependent Age Limit
Dependents to age 26 -
Portability
Included -
Life Insurance
$10,000
RATES
-
Member Only
$293.00 -
Member + Spouse
$524.00 -
Member + Child(ren)
$501.00 -
Member + Family
$691.00