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Starting at $81 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 (in-network) We'll
pay $50 for routine eye exam, glasses,
or contact lenses
Teeth (in-network) $25
deductible $500 annual maximum Preventive
& Diagnostic Pay $0.
Minor Restorative Pay 20% after you meet
your deductible.
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
$5,000 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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