Emergency Visit: You are responsible for first $1,000 or $2,500, which counts toward your annual IUA-Intial 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 iincident.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 same provider
Urgent Care Visit: Free through tele-health.
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 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
Caregiver Network: PHCS/Multiplan.
Primary Health Care Service with the largest network of healthcare professionals and facilities nationwide.
Dental: There are no waiting periods, low deductible for major services and see any provider in the network, through Connection Dental.
Vision: Visit any provider, $10 copay for eye health exam, plan will pay $150 annually for vision services per member.
