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December 31, 2024
18th of month Prior to Effective date
18+
Available in All States
100% Coverage for Mandated Preventative Services
Adults | Woman | Children
$15 Copay (Unlimited)
Network Discount
$50 Copay (unlimited)
Network Discount
Covered Under Accident Indemnity
(Included with Bronze & Platinum Plans)
Not Covered
December 31, 2024
18th of month Prior to Effective date
18+
Available in All States
100% Coverage for Mandated Preventative Services
Adults | Woman | Children
$15 Copay (Unlimited)
$15 Copay (Unlimited)
$50 Copay (Unlimited)
$50 Copay (Unlimited)
Not Covered
Not Covered
Not Covered
December 31, 2024
18th of month Prior to Effective date
18+
Available in All States
100% Coverage for Mandated Preventative Services
Adults | Woman | Children
$15 Copay (Unlimited)
$15 Copay (Unlimited)
$50 Copay (Unlimited)
$50 Copay (Unlimited)
$200 Copay
(Max 1 CT Scan or MRI Visits Per Cal/Yr.) *
Not Covered
Not Covered
December 31, 2024
18th of month Prior to Effective date
18+
Available in All States
100% Coverage for Mandated Preventative Services
Adults | Woman | Children
$15 Copay (Unlimited)
$15 Copay (Unlimited)
$50 Copay (Unlimited)
$50 Copay (Unlimited)
$200 Copay
(Max 1 CT Scan or MRI Visits Per Cal/Yr.)
(Included with Bronze & Platinum Plans)
No Deductibles, No Annual Maximums, No Exclusions, No Pre-Existing Conditions.
Ability to purchase a 90-day supply of maintenance medications at retail locations
31-Day Supplies on most prescriptions
Mail order pharmacy services on both Generic and Brand Name drugs.
Up to 30%-80% Savings
Up to 30%-80% Savings.
Tier 1: $15
Tier 2: $30
Tier 3: $50
Tier 1: $15
Tier 2: $30
Tier 3: $50
* 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.
(Included with Bronze & Platinum Plans)
Daily Hospital Confinement Maximum | $150 / Day 365 Days |
Hospital Admission Per Hospital Confinement | $1,000 |
Daily Intensive Care Maximum | $450 / Day 30 Days |
Surgery: Abdominal, Thoracic, Tendon, Ligament, Rotator Cuff | $750 / Day |
Anesthesia | $187.50 /Day |
Continuous Care(1) Maximum | $90 / Day 30 Days |
Physician's Office | $25 / Day 6 Per Calendar Year |
Wellness Benefit | $25 / Day 1 Per Calendar Year |
Emergency Room | $75 / Day 3 Per Calendar Year |
Lab, EKG and other Diagnostic Tests | $20 Per Test Day 1 Per Calendar Year |
X-Ray, Echocardiography and Cardiovascular Ultrasound | $20 Per Test Day 2 Per Calendar Year |
Advanced Studies(2) | $100 / Day 1 Per Calendar Year |
Ambulatory Surgical Center | $25 / Day |
Surgery: Abdominal, Thoracic, Tendon, Ligament, Rotator Cuff | $750 / Day |
Anesthesia | $187.50 /Day |
Ambulance Services Ground | $120 / Day 1 Per Calendar Year |
Ambulance Services Air | $1,000 / Day 1 Per calendar Year |
Lodging Maximum | $100 I Day 15 Per calendar Year |
Prosthesis | $500 |
Transportation | $300 / Day 3 Per Calendar Year |
Accidental Death | $20,000 |
Accidental Death on Common earner | $40,000 |
Dislocation Benefit | $1,000 |
Fracture Benefit | $1,000 |
Burn Benefit | $7,500 |
Coma | $10,000 |
Dismemberment | $10,000 |
Paralysis | $10,000 |
1) Continuous Care means care received in a Skilled Nursing Facility, Rehabilitation Facility, Rehabilitation Un􀀃 or Home Health Care or Hospice. The Continuous Care must begin within 7 days following discharge from a hospital and be necessary to treat the same condition that caused the hosp􀀃alization. Benefits are payable for a period equal to the length of the preceding hospital stay not to exceed 30 days.
(2) Advanced studies tests consist of the following: Magnetic Resonance Imaging (MRI); Magnetic Resonance Angiography (MRA); Computed Axial Tomography (CAT Scans); Pos􀀃ron Emission Tomography (PET Scans); and Computed Tomography (CT scans).
Underwritten by |
(Included with Platinum Plan Only)
| |
Hospital Admission | $2,500 |
Hospital Confinement | $100 / Day 10 days Max |
Wellness | $50 / Year |
Rehab (Continuous Care) | $100 / Day 15 day max |
Underwritten by |