• • 

  • Plan Anniversary

    September 1, 2021

  • Enrollment

    18th of month Prior to Effective date

  • Issue Ages

    18+

  • States Available

    Available in All States

  • Dependent Age Limit

    Dependents to age 26

  • Network

    

  • Wellness & Preventative (View Services)

    100% Coverage for Mandated Preventative Services

    Adults| Woman| Children

  • Telemedicine

    $0 Copay (Unlimited)

    

  • Primary Care Visit

    $15 Copay (Unlimited)

  • Specialist Office Visit

    Network Discount

  • Urgent Care Visits

    $50 Copay (Unlimited)

  • Lab Services

    Network Discount

  • X-Rays

    Network Discount

  • * Exclusions

    Office Visits do not include: Chiropractic Care, Physical Therapy, Occupational Therapy, Podiatry, Speech Therapy, Eyecare and Mental Health.

• • 

  • Plan Anniversary

    September 1, 2021

  • Enrollment

    18th of month Prior to Effective date

  • Issue Ages

    18+

  • States Available

    Available in All States

  • Dependent Age Limit

    Dependents to age 26

  • Network

    

  • Wellness & Preventative (View Services)

    100% Coverage for Mandated Preventative Services

    Adults| Woman| Children

  • Telemedicine

    $0 Copay (Unlimited)

    

  • Primary Care Visit

    $15 Copay (Unlimited)

  • Specialist Office Visit

    $15 Copay (Unlimited)

  • Urgent Care Visits

    $50 Copay (Unlimited)

  • Lab Services

    $50 Copay (Unlimited)

  • X-Rays

    $50 Copay (Unlimited)

  • * Exclusions

    Office Visits do not include: Chiropractic Care, Physical Therapy, Occupational Therapy, Podiatry, Speech Therapy, Eyecare and Mental Health.

• • 

  • Plan Anniversary

    September 1, 2021

  • Enrollment

    18th of month Prior to Effective date

  • Issue Ages

    18+

  • States Available

    Available in All States

  • Dependent Age Limit

    Dependent to age 26

  • Network

    

  • Wellness & Preventative (View Services)

    100% Coverage for Mandated Preventative Services

    Adults| Woman| Children

  • Telemedicine

    $0 Copay (Unlimited)

    

  • Primary Care Visit

    $15 Copay (Unlimited)

  • Specialist Office Visit

    $15 Copay (Unlimited)

  • Urgent Care Visits

    $50 Copay (Unlimited)

  • Lab Services

    $50 Copay (Unlimited)

  • X-Rays

    $50 Copay (Unlimited)

  • * Exclusions

    Office Visits do not include: Chiropractic Care, Physical Therapy, Occupational Therapy, Podiatry, Speech Therapy, Eyecare and Mental Health.

• • 

  • Plan Anniversary

    September 1, 2021

  • Enrollment

    18th of month Prior to Effective date

  • Issue Ages

    18+

  • States Available

    Available in All States

  • Dependent Age Limit

    Dependent to age 26

  • Network

    

  • Wellness & Preventative (View Services)

    100% Coverage for Mandated Preventative Services

    Adults| Woman| Children

  • Telemedicine

    $0 Copay (Unlimited)

    

  • Primary Care Visit

    $15 Copay (Unlimited)

  • Specialist Office Visit

    $15 Copay (Unlimited)

  • Urgent Care Visits

    $50 Copay (Unlimited)

  • Lab Services

    $50 Copay (Unlimited)

  • X-Rays

    $50 Copay (Unlimited)

  • * Exclusions

    Office Visits do not include: Chiropractic Care, Physical Therapy, Occupational Therapy, Podiatry, Speech Therapy, Eyecare and Mental Health.

Prescription Drugs

• • Rx Formulary

    

  • Rx Benefits

    Discount Pharmacy Card

    Generic:

    Up to 30%-80% Savings.

    Brand Name:

    Up to 30%-80% Savings.

• • Rx Formulary

    

  • Rx Benefits

    Generic RX

    (30 Day Supply)
    Tier 1: $10 Copay
    Tier 2: $25 Copay

    Brand RX

    (30 Day Supply)
    Tier 1: $50 Copay
    Tier 2: $75 Copay

• • Rx Formulary

    

  • Rx Benefits

    Generic RX

    (30 Day Supply)
    Tier 1: $10 Copay
    Tier 2: $25 Copay

    Brand RX

    (30 Day Supply)
    Tier 1: $50 Copay
    Tier 2: $75 Copay

• • Rx Formulary

    

  • Rx Benefits

    Generic RX

    (30 Day Supply)
    Tier 1: $10 Copay
    Tier 2: $25 Copay

    Brand RX

    (30 Day Supply)
    Tier 1: $50 Copay
    Tier 2: $75 Copay

Hospital - Surgical Indemnity Reimbursement - Underwritten By MetLife

If a plan benefit is listed as an indemnity reimbursement:
An Indemnity plan reimburses an insured after they submit a claim for a covered medical expense. This reimbursement pays the insured in addition to and regardless of any other insurance the insured may have.

• • Admission Benefit

    Not Covered

    
    

  • Confinement Benefit

    Not Covered

    
    

  • Inpatient Rehabilitation

    Not Covered

    
    

  • Inpatient Surgery

    Not Covered

    
    

  • Outpatient Surgery

    Not Covered

    
    

  • Diagnostic Procedure

    Not Covered

    
    

  • Emergency Room

    Not Covered

    
    

  • Pre-existing Condition Limitation

    Does Not Apply

    
    

  • Treatment of Normal Pregnancy

    Not Covered

    
    

• • Admission Benefit

    Not Covered

    
    

  • Confinement Benefit

    Not Covered

    
    

  • Inpatient Rehabilitation

    Not Covered

    
    

  • Inpatient Surgery

    Not Covered

    
    

  • Outpatient Surgery

    Not Covered

    
    

  • Diagnostic Procedure

    Not Covered

    
    

  • Emergency Room

    Not Covered

    
    

  • Pre-existing Condition Limitation

    Does Not Apply

    
    

  • Treatment of Normal Pregnancy

    Not Covered

• • Admission Benefit

    $2,000 (1x/Yr.)
    Indemnity Reimbursement
    
    

  • Confinement Benefit

    $50 /Day (30x/Yr.)
    Indemnity Reimbursement

  • Inpatient Rehabilitation

    Not Covered
    
    

  • Inpatient Surgery

    Not Covered

    
    

  • Outpatient Surgery

    $250/$500 (1x/Yr.)
    Indemnity Reimbursement
    
    

  • Diagnostic Procedure

    $250(1x/Yr.)
    Indemnity Reimbursement
    
    

  • Emergency Room

    Not Covered

    
    

  • Pre-existing Condition Limitation
    

    3 month look back period, 6 months treatment free / 12 month exclusion period.

  • Treatment of Normal Pregnancy

    Hospital Admission and Confinement Benefits are not payable for Birth within first 9 months of coverage.

• • Admission Benefit

    $2,500 (1x/Yr.)
    Indemnity Reimbursement
    
    

  • Confinement Benefit

    $200 /Day (30x/Yr.)
    Indemnity Reimbursement
    

  • Inpatient Rehabilitation

    $100 /Day (15x/Yr.)
    Indemnity Reimbursement

  • Inpatient Surgery

    $1,000 (1x/Yr.)
    Indemnity Reimbursement
    
    

  • Outpatient Surgery

    $750/$1,500 (1x/Yr.)
    Indemnity Reimbursement

  • Diagnostic Procedure

    $250(1x/Yr.)
    Indemnity Reimbursement
    
    

  • Emergency Room

    $100/Day (1x/Yr.)
    Indemnity Reimbursement
    
    

  • Pre-existing Condition Limitation

    3 month look back period, 6 months treatment free / 12 month exclusion period.

  • Treatment of Normal Pregnancy

    Hospital Admission and Confinement Benefits are not payable for Birth within first 9 months of coverage.

Hospital - Surgical Indemnity Reimbursement - Underwritten By MetLife

If a plan benefit is listed as an indemnity reimbursement:
An Indemnity plan reimburses an insured after they submit a claim for a covered medical expense. This reimbursement pays the insured in addition to and regardless of any other insurance the insured may have.

• • Ambulance Benefit

    Not Covered

  • Health Screening
    (Outpatient Benefit)

    Not Covered

  • Life Insurance

    Not Covered

  • Portability

    Not Covered

• • Ambulance Benefit

    Not Covered

  • Health Screening
    (Outpatient Benefit)

    Not Covered

  • Life Insurance

    Not Covered

  • Portability

    Not Covered

• • Ambulance Benefit

    Not Covered

  • Health Screening
    (Outpatient Benefit)

    Not Covered

  • Life Insurance

    $7,000

  • Portability

    Included

• • Ambulance Benefit

    $500Air Trans. (2x/Yr.) $200 ground trans (2x/Yr.)
    Indemnity Reimbursement

  • Health Screening
    (Outpatient Benefit)

    $50 (1x/Yr.)
    Indemnity Reimbursement

  • Life Insurance

    $7,000

  • Portability

    Included