Details at a Glance

• Plan Type
• PPO
• Office Visit for Primary Doctor
• 0% Coinsurance after deductible
• Office Visit for Specialist
• 0% Coinsurance after deductible
• Coinsurance
• 0% after deductible
• Separate Prescription Drugs Deductible
• None
• Prescription Drugs
• Discount Card Included
  This added value feature is not insurance
• Health Savings Account (HSA) Eligible
• Yes ( See HSA Administrators)
• Out-of-Network Coverage
• Yes  (Details in plan brochure below)
• Out of Country Coverage
• Emergency Care Only. Paid as out-of-network, and member must submit an itemized bill with services rendered and a diagnosis in order to be reimbursed. 

Physicians

• Primary Care Physician (PCP) Required
• No
• Specialist Referrals Required
• No

Preventive Care Coverage

• Periodic Health Exam
• 0% Coinsurance/ No Deductible
  to $300/Calendar Year Preventive Care Maximum
  90 Day Waiting Period
• Periodic OB-GYN Exam
• Exam: 0% Coinsurance/No Deductible to $300/Calendar Year Preventive Care Maximum; 90 Day Waiting Period
  Pap Smear/Mammogram: 0% Coinsurance/No Deductible; No Preventive Care Maximum. No Waiting Period
• Well Baby Care
• 0% Coinsurance/ No Deductible
  to $300/Calendar Year Preventive Care Maximum
  90 Day Waiting Period

Prescription Drug Coverage

• Prescription Drugs Other Coverage
• Discount Card Included
  This added value feature is not insurance
• Mail Order for Prescription Drugs
• Not Available
• Separate Prescription Drugs Deductible
• None

Hospital Services Coverage

• Emergency Room
• 0% Coinsurance after deductible
• Outpatient Lab/X-Ray
• 0% Coinsurance after deductible
• Outpatient Surgery
• 0% Coinsurance after deductible
• Hospitalization
• 0% Coinsurance after deductible

Maternity Coverage

• Pre & Postnatal Office Visit
• Not Covered
• Labor & Delivery Hospital Stay
• Not Covered

Additional Coverage

• Chiropractic Coverage
• Not Covered
• Mental Health Coverage
• Not Covered

Additional Information

• A.M. Best Rating
• A- as of 06/05/2009
• Electronic Signature for Application Available
• Yes
• Will insurance company obtain and pay for medical records?
• Yes
• Additional information about this health insurance plan is available in the documents below.
  Plan Brochure
  Exclusions and Limitations

Action

• Get live professional advice about this insurance plan
• Get Live Advice