Sound Health Insurance by UniCare Life & Health Insurance Company—UniCare is a WellPoint company. WellPoint Inc.
Select A State > California Nevada Colorado Texas Illinois
  Get a Tonik Health Quote Apply Now Contact us  
health insurance california Home If you have any questions, please call (818) 987-5000

Here’s a list of FAQs about Tonik Health by BC & Life Insurance Company

 

Q1: What is different about Tonik?

A1: Everything!

No paperwork – just a quick and easy online application that only takes about 15 minutes

Easy-to-understand health insurance designed for your lifestyle.

Premium payments that you can actually afford Includes medical, dental, vision and generic prescription drug benefits in one package

Instant approval if you qualify.

There’s a customer service team dedicated just for Tonik members

Q2: What Tonik plans are available?

A2: There are three plans to choose from:

Thrill Seeker PPO Plan ($20 office visit copay/$5,000 deductible)

Part-Time Daredevil PPO Plan ($30 office visit copay/$3,000 deductible)

Calculated Risk Taker PPO Plan ($40 office visit copay/$1,500 deductible)

Q3: What do Tonik plans cover?

A3: Covered benefits include preventive care, office visits, hospitalization, emergency services, dental, vision,

generic prescription drugs and more. For specific details regarding what is covered, go to tonikhealth.com

and check out the plan summaries posted for each plan.

Q4: What is covered when I visit my doctor?

A4: Your office visit copay will cover the cost of professional services, like routine physical exams, preventive

care, lab work and X-rays that you receive in your doctor’s office during the office visit.

Q5: Can I see a specialist?

A5: You can see any specialist as long as she or he is in the Blue Cross network. You’ll pay the same copay

as you would for regular doctor visits.

Q6: Are emergency services covered?

A6: Emergency services are covered. You’ll pay the $100 copay which will include all covered services

received in the Emergency Room. This copay will be waived if the Emergency Room visit results in an

inpatient admission.

Q7: Am I covered when I’m away from home?

A7: If you need to see a doctor when you are away from home and you are in the United States, you’re covered

under the BlueCard program. The toll-free BlueCard phone number will be on the back of your Member ID

card. If you’re travelling outside of the United States, you’ll be covered for medical emergencies only.

Q8: What’s the deal with generic drugs?

A8: Your plan has benefits for generic prescription drugs only (as opposed to brand-name). You can still get a

brand-name drug, but it’ll probably cost you more. Generic drugs are identical to their brand-name

equivalents in active ingredient, dosage form, strength and quality – and they’re cheaper.

Q9: Can you explain the dental benefits for me?

A9: When you go to any Blue Cross PPO dentist, the in-network Tonik dental benefits are:

The Tonik plans will cover 100% of the in-network costs for annual cleanings, exams and X-rays.

After you pay your $25 deductible, the Tonik plans will cover 80% for fillings and other minor

restorative procedures, up to the $500 annual maximum.

Q10: What are the vision benefits?

A10: Vision services are a covered benefit on all Tonik plans. The plan will pay $50 per year towards the cost

of your glasses, contacts or a routine eye exam.

Q11: How do I sign up?

A11: Just go to my Web site or tonikhealth.com and click Apply Now. When asked, type in my name and Agent

ID number. Be sure you have your Social Security number, previous health insurance information,

medical history and prescription drug information handy.

Q12: What if I want to cover my spouse or dependents?

A12: Separate Tonik applications will need to be completed online for your spouse and each dependent.

Find Provider

 

 

Glossary

Copay – The amount you pay for a doctor visit or other medical services such as an Emergency Room visit or generic prescription drug.

Deductible – Depending on the Tonik plan you choose, your deductible each year will be $1,500, $3,000, or $5,000 – that’s how much you have to pay before BCL&H starts paying for certain services outlined in your policy booklet. Your monthly premium payments do not count toward your deductible. You also have a separate $25 deductible for certain dental benefits. In some cases, like when you go to the doctor’s office, your deductible is waived.

Emergency – The sudden onset of a medical or psychiatric condition with symptoms so severe that not being treated immediately could result in one or more of the following:

Permanent jeopardy of your health Other serious medical or psychiatric consequences

Serious impairment to bodily functions Serious and permanent dysfunction of any organ or any other part of you 

In-Network/Out-of-Network – Blue Cross has negotiated with more than 50,000 PPO doctors and over 400 hospitals to provide you with quality care and services at a much lower, in-network cost to you. Services from providers who have not contracted with Blue Cross will cost you more because they charge out-of-network rates. In other words, staying in-network saves you money.

Mail Order Service – If you take a prescription medication regularly, you can save a lot of time by getting it through the mail. No more waiting in line at the pharmacy every month. Just check out PrecisionRx at www.precisionrx.com for more information or call them at (800) 892-8562.

Office Visit – Covered professional services, like routine physical exams, preventive care, lab work and X-rays that you receive in your doctor’s office during the office visit.

Other Professional Services – X-rays, blood tests, anesthesia, etc. received separately from professional services covered under your office visit.

Out-of-Pocket Maximum (OOP) – Your annual OOP in-network is the most you’ll have to pay for in-network covered services within a calendar year, then BCL&H pays the rest. This amount varies depending on the plan you choose ($1,500, $3,000, or $5,000). Basically, meet your deductible – and you’ve reached your in-network OOP. If you go out-of-network, your annual OOP is much higher – $10,000.

Participating Pharmacy – To pay the lowest possible costs for your prescriptions you should have them filled at a participating pharmacy. In addition to all those doctors and hospitals, Blue Cross has a network of 5,000 participating pharmacies in California and access to over 61,000 nationwide.

Policy Booklet – A booklet with detailed information about your plan benefits that will be mailed to you after you enroll in a Tonik plan.

Premium – The payments you pay each month for Tonik coverage.

PPO – PPO stands for "Preferred Provider Organization." The Blue Cross PPO network is made up of more than 50,000 doctors and 400 hospitals that they’ve negotiated with to provide you with services at a much lower cost to you.