Emergency Visit: You are responsible for the first $1,000 or $2,500, which counts toward your annual IUA-Initial Unshareable Amount.
Hospitalization: Your Initial Unshareable Amount, or IUA, is the maximum amount you would be responsible for paying out-of-pocket in the event of a major incident. 3 IUA per 12-month rolling period, and anything after would be shared as long as it exceeds $500
Direct Virtual Primary Care: Yes, unlimited visits with the same provider
Urgent Care Visit: Free through telehealth.
Preventative Care: Connected
includes:
- Preventive mammogram (6 mo. waiting period)
- Immunizations for ages 0-16 (6 mo. waiting period)
- Preventive colonoscopy- (6 mo. waiting period)
Prescription Coverage: Prescriptions for the medication(s) that are billed by a provider and are related to a qualified Need are shareable. Searches six U.S Platforms, the Word Drug Market, and Pharmacy Assistance programs to find the lowest costs for you.
Maternity: One Initial Unshareable Amounts (IUA’s) are applied to a single maternity need.
Mental Health: Lifeworks
includes:
- no session fees
- phone online and in-person
Pre-Existing Conditions: 24-month look back; no coverage for first 24 months; $25K 2nd year; $50K 3rd year; $125K 4th year and beyond. Exceptions for: Controlled diabetes, hypertension, high cholesterol, seasonal allergies, and intermittent asthma will not be considered pre-existing when reported prior to membership effective date.
Meets ACA Requirements: No
