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Plan | ![]() |
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Plan Anniversary | September 1, 2021 | September 1, 2021 | September 1, 2021 | September 1, 2021 |
Enrollment | 18th of month Prior to Effective date |
18th of month Prior to Effective date |
18th of month Prior |
18th of month Prior to Effective date |
Issue Ages | 18+ | 18+ | 18+ | 18+ |
States Available | Available in All States | Available in All States | Available in All States | Available in All States |
Dependent Age Limit | Dependents to age 26 | Dependents to age 26 | Dependent to age 26 | Dependent to age 26 |
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Network | ![]() |
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Wellness & Preventative | 100% Coverage for Mandated Preventative Services Adults | Woman | Children |
100% Coverage for Mandated Preventative Services Adults | Woman | Children |
100% Coverage for Mandated Preventative Services Adults | Woman | Children |
100% Coverage for Mandated Preventative Services Adults | Woman | Children |
Telemedicine | $0 Copay (Unlimited)![]() |
$0 Copay (Unlimited)![]() |
$0 Copay (Unlimited)![]() |
$0 Copay (Unlimited)![]() |
Primary Care Visits* | $15 Copay (Unlimited) | $15 Copay (Unlimited) | $15 Copay (Unlimited) | $15 Copay (Unlimited) |
Specialist Office Visits* | Network Discount | $15 Copay (Unlimited) | $15 Copay (Unlimited) | $15 Copay (Unlimited) |
Urgent Care Visits | $50 Copay (Unlimited) | $50 Copay (Unlimited) | $50 Copay (Unlimited) | $50 Copay (Unlimited) |
Lab Services | Network Discount |
$50 Copay (Unlimited) |
$50 Copay (Unlimited) | $50 Copay (Unlimited) |
X-Rays | Network Discount | $50 Copay (Unlimited) | $50 Copay (Unlimited) | $50 Copay (Unlimited) |
* Exclusions | Office Visits do not include: Chiropractic Care, Physical Therapy, Occupational Therapy, Speech Therapy and Mental Health. | |||
Discount Bundle | Dental - Vision - DME Diabetic - Hearing - Fitness |
Dental - Vision - DME Diabetic - Hearing - Fitness |
Dental - Vision - DME Diabetic - Hearing - Fitness |
Dental - Vision - DME Diabetic - Hearing - Fitness |
Prescription Drugs | ||||
Rx Formulary | ![]() |
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Rx Benefits | Discount Pharmacy Card Brand Name:
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Generic RX Brand RX |
Generic RX Brand RX |
Generic RX Brand RX |
Hospital - Surgical Indemnity Reimbursement - Underwritten By MetLife | ||||
If a plan benefit is listed as an indemnity reimbursement: An Indemnity plan reimburses an insured after they submit a claim for a covered medical expense. This reimbursement pays the insured in addition to and regardless of any other insurance the insured may have. |
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Admission Benefit | Not Covered | Not Covered | $2,000 (1x/Yr.) Indemnity Reimbursement |
$2,500 (1x/Yr.) Indemnity Reimbursement |
Confinement Benefit | Not Covered | Not Covered | $50 /Day (30x/Yr.) Indemnity Reimbursement |
$200 /Day (30x/Yr.) Indemnity Reimbursement |
Inpatient Rehabilitation | Not Covered | Not Covered | Not Covered | $100 /Day (15x/Yr.) Indemnity Reimbursement |
Inpatient Surgery | Not Covered | Not Covered | Not Covered | $1,000 (1x/Yr.) Indemnity Reimbursement |
Outpatient Surgery | Not Covered | Not Covered | $250/$500 (1x/Yr.) Indemnity Reimbursement |
$750/$1,500 (1x/Yr.) Indemnity Reimbursement |
Diagnostic Procedure | Not Covered | Not Covered | $250(1x/Yr.) Indemnity Reimbursement |
$250(1x/Yr.) Indemnity Reimbursement |
Emergency Room | Not Covered | Not Covered | Not Covered | $100/Day (1x/Yr.) Indemnity Reimbursement |
Pre-existing Condition Limitation | Does Not Apply | Does Not Apply | 3 month look back period, 6 months treatment free / 12 month exclusion period. | 3 month look back period, 6 months treatment free / 12 month exclusion period. |
Treatment of Normal Pregnancy | Not Covered | Not Covered | Hospital Admission and Confinement Benefits are not payable for Birth within first 9 months of coverage. | Hospital Admission and Confinement Benefits are not payable for Birth within first 9 months of coverage. |
Other Benefits | ||||
Ambulance Benefit | Not Covered | Not Covered | Not Covered | $500Air Trans. (2x/Yr.) $200 ground trans (2x/Yr.) Indemnity Reimbursement |
Health Screening (Outpatient Benefit) |
Not Covered | Not Covered | Not Covered | $50 (1x/Yr.) Indemnity Reimbursement |
Life Insurance | Not Covered | Not Covered | $7,000 | $7,000 |
Portability | Not Covered | Not Covered | Included | Included |