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  • 1. Summary of Health Benefits
  • 2. Deductible Out of Pocket Preventative Care Hospital Services Prescription Services Emergency Services Mental Health Services Other Services Doctor’s Services Click
  • 3.
    • In Network
    • cost
    • $###
    Plan Year Deductible Out of Network cost $### What is a Network? Health Insurance companies maintain networks consisting of specific hospitals, doctors and other medical providers they have made prior arrangements and relationships with. You should always try to use a provider in network to ensure coverage and a lower deductible. The amount you must pay in a year before you become eligible for insurance benefits .
  • 4.
    • In Network
    • cost
    • $####
    Plan Year Out-of-Pocket Out of Network cost $#### The maximum amount you are obligated to pay out-of-pocket each year.
  • 5. Preventative Care 100% of deductible is waived for In-Network and Out-of –Network preventative care for
  • 6. Doctor’s Services Health Plans will look at what is Reasonable and Customary for doctors in your area and base your reimbursement on that amount. Office Visits Chiropractic $500 max per year Allergy In Network ##% covered after deductible ##% covered after deductible ##% covered after deductible Out of Network ##% R&C after deductible ##% R&C after deductible ##% R&C after deductible
  • 7. Emergency Services Health Plans will look at what is Reasonable and Customary for doctors in your area and base your reimbursement on that amount . Emergency Room and ER Physician In Network ##% after deductible Out of Network ##% R&C costs after deductible
  • 8. Hospital Services Health Plans will look at what is Reasonable and Customary for doctors in your area and base your reimbursement on that amount. In-Patient Surgical Facility Supplies Room and Board In-Patient Newborn Care Misc. Hospital Charges Out-Patient In Network ##% after deductible ##% after deductible ##% after deductible Out of Network ##% R&C costs after deductible ##% R&C costs after deductible ##% R&C costs after deductible
  • 9. Mental Disorders Substance Abuse Health Plans will look at what is Reasonable and Customary for doctors in your area and base your reimbursement on that amount. In-Patient Treatment Out-Patient Treatment In Network ##% after deductible ##% after deductible Out of Network ##% R&C costs after deductible ##% R&C costs after deductible
  • 10. Prescription Drug Benefit Retail, up to ## day supply ##% to $#### combined out of pocket maximum Mailorder, up to ## day supply ##% to $#### combined out of pocket maximum
  • 11. Other Services Private Nursing Duty ##% after deductible ##% R&C after deductible Home Health Care 80 Visits ##% after deductible ##% R&C after deductible Disagnostic X-ray, Lab (Outpatient and Inpatient) ##% after deductible ##% R&C after deductible Physical Therapy Occupational and speech ($500 max) (Therapy reviewed for medical necessity after 20 visits) ##% after deductible ##% R&C after deductible Ambulance ##% after deductible ##% R&C after deductible Durable Medical Equipment $### max per calendar year ##% after deductible ##% R&C after deductible