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Access to the insurance plans and large group pricing on this website is predicated upon joining Elevate Wellness, a national association with over 80,000 members. Learn more


Plan Description




The Affordable Healthcare Solution

  • Eligibility: 18-64
  • Available in all 50 States
  • No Pre-Existing Conditions
  • ACA Compliant – Exceeds this requirement
  • Includes TELADOC - $0 Copay
  • Guaranteed Issue
  • Satisfies Employer Penalty A
  • PHCS Network


What it is: Everyday Health Care Needs

  • Preventative Care
  • Primary Care & Specialists Office Visits
  • Urgent Care Visits
  • Imaging, X-ray Services and Laboratory Services

  • Prescription Drugs
  • Hospital Coverage (Super MEC Plus only)
  • No Pre-Existing Conditions

 LIFELINE MEDICAL PLUSLIFELINE
MEDICAL PLUS 2
Network


Plan AnniversaryDecember 31, 2019December 31, 2019
Enrollment Deadline18th of month Prior
to Effective date
18th of month Prior
to Effective date
Issue Ages18-6418-64
States AvailableAvailable in all 50 StatesAvailable in all 50 States
Medical Benefits - Must utilize PHCS participating provider or facility
Preventative Services
100% Coverage for Mandated Preventative Services
All 21 Preventative Services for Adults
All 28 Preventative Services for Woman
All 31 Preventative Services for Children
100% Coverage for Mandated Preventative Services
All 21 Preventative Services for Adults
All 28 Preventative Services for Woman
All 31 Preventative Services for Children
Primary Care Office Visit$20 Copay
(Max 3 Visits Per Cal/Yr.)
$20 Copay
(Max 3 Visits Per Cal/Yr.)
Specialist Office Visit$50 Copay
(Max 3 Visits Per Cal/Yr.)
$50 Copay
(Max 3 Visits Per Cal/Yr.)
Urgent Care$50 Copay
(Max 3 Visits Per Cal/Yr.)
$50 Copay
(Max 3 Visits Per Cal/Yr.)
Diagnostic X-Ray, Lab$50 Copay
(Max 5 Visits Per Cal/Yr.)
$50 Copay
(Max 5 Visits Per Cal/Yr.)
*CT Scan or MRI$200 Copay
(Max 1 CT Scan or MRI Visits Per Cal/Yr.)
$200 Copay
(Max 1 CT Scan or MRI Visits Per Cal/Yr.)
**Hospital, Surgical, Ambulance, Emergency RoomNot Covered*** $0 Deductible 50% Coinsurance to $5,000
Max Benefit $2,500
See Below for Exclusions
* 3D MRIs or Contrast Services for MRIs and CT Scans are not covered, pre-authorization required prior to scans.
** Hospitalization services must be obtained at an authorized PHCS Facility. Pre-Authorization required prior to admission for all in-patient, out-patient and surgical procedures.
*** Exclusions for Hospital Benefit, Radiation Oncology and Chemotherapy.
Prescription Drugs
Rx FormularyView Citizens RX FormularyView Citizens RX Formulary
Tier 1 - Low Cost Generics$1 Copay$1 Copay
Tier 2 - Generics

10% Coinsurance

10% Coinsurance
Tier 3 - Preferred Brand20% Coinsurance20% Coinsurance
Tier 4 - Non-Preferred Brand40% Coinsurance40% Coinsurance
Tier 5 - Generic and Preferred Specialty

10% Coinsurance
(Pays 90% up to a max of $150 per RX)

10% Coinsurance
(Pays 90% up to a max of $150 per RX)
Tier 6 - Non-Preferred Specialty20% Coinsurance
(Pays 80% up to a max of $250 per RX)
20% Coinsurance
(Pays 80% up to a max of $250 per RX)




Teladoc
Teladoc provides members with on-demand 24/7 phone, email, and video access to U.S.-based licensed physicians for information, advice, and treatment including prescription medication when appropriate. Teladoc’s services are available anytime, anywhere. Members can use it from home, work or on the road.

www.teladoc.com/






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