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

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