Major Medical Copay 3500

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Major Medical Copay 3500

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Have questions? Book a meeting to discuss your options.

Plan Information

Major Medical insurance plan with copays for common services and opportunities for $0 care. Click the down arrow to learn more about this plan. 

Network Type
PPO/Open
Official Documents
Click to View

Deductible & Out-of-Pocket Limit

Tier 1 Preferred Network
Tier 2 Participating Providers
Tier 3 Non-Participating Providers
Individual Deductible
In Network Preferred $0
In Network $3,500
Out of Network $3,500
Family Deductible
In Network Preferred $0
In Network $7,000
Out of Network $7,000
Individual Out-of-Pocket Limit
In Network Preferred $7,000
In Network $7,000
Out of Network $14,000
Family Out-of-Pocket Limit
In Network Preferred $14,000
In Network $14,000
Out of Network $28,000

Doctor Visits

In Network Preferred
In Network
Out of Network
Preventive care visit
In Network Preferred N/A
In Network Free
Out of Network Not covered
Primary care visit
In Network Preferred N/A
In Network $25 copay
Out of Network 50% coinsurance
Specialist visit
In Network Preferred Free
In Network $45 copay (office visit) / 30% coinsurance (outpatient hospital)
Out of Network 50% coinsurance
Urgent Care
In Network Preferred Free
In Network $65 copay (office) / 30% coinsurance (hospital)
Out of Network 50% coinsurance (office) / N/A (outpatient hospital)
Telemedicine 24/365
In Network Preferred N/A
In Network Free
Out of Network N/A

Prescriptions

Prescription coverage is based on which category a drug falls into. To see how this plan categorizes prescriptions, browse its drug formulary.

Tier 1 Preferred Network
Tier 2 Participating Providers
Tier 3 Non-Participating Providers
Generic
In Network Preferred N/A
In Network $0 copay
Out of Network Not covered, except in emergencies
Preferred Brand
In Network Preferred N/A
In Network $35 copay
Out of Network Not covered, except in emergencies
Non-preferred Brand
In Network Preferred N/A
In Network $75 copay
Out of Network Not covered, except in emergencies

Labs & Imaging

These are tests your doctor may run when diagnosing a condition.

In Network Preferred
In Network
Out of Network
X-rays
In Network Preferred Free
In Network $50 copay (independent lab) / 30% coinsurance (outpatient hospital)
Out of Network 50% coinsurance (ind. lab) / N/A (outpatient hospital)
Imaging (CT/PET/MRI)
In Network Preferred Free
In Network 30% coinsurance
Out of Network 50% coinsurance
Labs/Bloodwork
In Network Preferred Free
In Network $50 copay (independent lab) / 30% coinsurance (outpatient hospital)
Out of Network 50% coinsurance (ind. lab) / N/A (outpatient hospital)

Hospital & Emergency

In Network Preferred
In Network
Out of Network
Emergency Room
In Network Preferred N/A
In Network 30% coinsurance
Out of Network N/A
Ambulance
In Network Preferred N/A
In Network 30% coinsurance
Out of Network N/A
Hospital stay (facility)
In Network Preferred Free
In Network 30% coinsurance
Out of Network N/A
Hospital stay (physician)
In Network Preferred Free
In Network 30% coinsurance
Out of Network N/A
Outpatient procedure (facility)
In Network Preferred Free
In Network 30% coinsurance
Out of Network N/A
Physical rehabilitation
In Network Preferred Free
In Network $45 copay
Out of Network 50% coinsurance

Mental Health

In Network Preferred
In Network
Out of Network
Outpatient Services
In Network Preferred Free
In Network $45 copay (provider’s office) / 30% coinsurance (hospital)
Out of Network 50% coinsurance
Inpatient Services
In Network Preferred Free
In Network 30% coinsurance
Out of Network 50% coinsurance

Virtual Mental Health

This plan includes membership with Amaze, providing unlimited access to providers 24/7 with no cost for a wide range of virtual services. Other members of your household, such as a spouse and children under 26, are still eligible for Amaze if even they are not on the plan with you.

Amaze mental health professionals provide immediate and responsive interventions such as bridge therapy and medication management. They also assist in finding the right care for you and your financial situation, should you need additional support.

Therapist
$0/visit
Psychiatrists
$0/visit

Pregnancy & Birth

This plan covers services provided before and after your child is born. 

In Network Preferred
In Network
Out of Network
Well baby care
In Network Preferred N/A
In Network Free
Out of Network Not covered
Labor, delivery, hospital stay
In Network Preferred Free
In Network 30% coinsurance
Out of Network N/A

Telemedicine

All plans include membership with telemedicine, providing unlimited access to a physician 24/7 with no cost for general medical visits.
Everyday Care
$0/visit
Specialist Guidance
$0/visit
Mental Health
$0/visit
Nutrition and Wellness
$0/visit

Free Clinical Preventive Care

Every plan includes over 74 preventive care services that are completely free on day one. These services keep you healthy before you become sick, including routine check-ups, counseling, screenings, and immunizations. For information on services covered click here.

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