This coverage is enhanced, flexible and convenient. Copayments are predictable for high-demand services, such as preventive care and in-network office visits. This new health-care solution balances affordability with extended coverage for our members.

• Choice of provider networks:
  • Participating, PPP or Access
• Choice of deductible amounts:
• $300, $500, $1,000, $2,000 or $3,000
• Copayments for office visits, not subject to deductible
• Office visits (E&M), preventive services (e.g., women’s, well baby, routine health exams), non-facility urgent care, mental health/chemical dependency office services
  • $20 copayment for visit with Personal Physician
  • $10 copayment for immunization administration (with or without office visit)
    • Serum is covered in full, not subject to deductible or coinsurance
  • $40 copayment for visit with Specialist
• Other services (DXL, procedures) during visit subject to deductible and coinsurance. Deductible waived on first $500 in-network diagnostic x-ray and lab (coinsurance applies)
• Most services paid at 80% in-network, 60% out-of-network after deductible
  • Ambulance services paid at 70% after deductible