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Starting at $87 per month.
$3,000 deductible (no maternity)
Plan Details (in-network)
Office Visits
Pay $30 per visit. 4 visit maximum.
Other Professional Services
Pay $0 after you meet your deductible.
Preventive Care
Pay $0 after you meet your deductible.
Overnight Hospital Stays
Pay $0 after you meet your deductible.
If You Don't Stay Overnight Pay $0 after
you meet your deductible.
Physical/Occupational Therapy,
Chiropractic Care.
Pay $0 after you meet your deductible.
12 visit maximum—in & out of
network.
Emergencies (in-network)
Emergency Room - Pay
$100 for each visit.
Ambulance Pay $0 after you meet your deductible.
Eyes : Vision Benefit
(in-network) You’ll pay only $25
for basic eyeglass lenses and receive
up to $100 toward frames or $80 toward
contact lenses every 24 months. In addition,
we’ll pay $50 for an eye exam or
to help out on the cost of glasses or
contact lenses every 12 months.
Teeth: Dental Benefits
(in-network) You'll pay $0 for
cleanings, exams and X-rays. After you
pay your $25 deductible, you'll pay 20%
for minor restorative procedures like
fillings. We'll pay up to $500/year for
your dental benefits.
Rx (in-network)
Only generic prescription drugs are covered.
Pharmacy: $10 for 30-day supply from the
pharmacy.
Mail Order: $20 for up to 60-day supply
in-network
Most You'll Pay Per Year in-network
$3,000 Annual Out of Pocket (OOP) Maximum
Stay in the network and the most you'll
pay for your medical bills this year is
your deductible amount. So if you bite
it big, you won't wipe out your savings.
Out of Network
$10,000 Annual Out of Pocket (OOP)
Go out of the network and the most you'll
pay for your medical bills this year is
$10,000 or more if they charge more than
we allow. Yeah, so staying in the network's
probably a good idea.
Plan Summary
Dental
Plan Details
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