Healthcore Advantage Benefits Summary
Please note changes in rates and benefits for contracts effective 1/1/10 through 12/1/10. Please call 1-800-427-1551 for current rates.
| Financial | |
|---|---|
| Deductible | $1,200 (single) / $2,400 (family) |
| Coinsurance | N/A |
| Member Out-of-pocket | $5,250 (single) / $10,500 (family) |
| Preventative Care | |
| Physical exam (once every 3 years) |
No charge |
| Well child visit | No charge |
| Office Visits | |
| Primary care physician office visit | Deductible then $20 co-payment |
| Specialist office visit | Deductible then $20 co-payment |
| Hospital Care | |
| Inpatient hospitalization | Deductible then $500 per continuous confinement |
| Prescription Drugs (optional coverage) | |
| Annual deductible | $1,200 (single) / $2,400 (family) shared medical and pharmacy deductible |
| Generic drugs | $10 co-payment |
| Brand name drugs | $20 co-payment plus the difference in cost between the brand name drug and its generic equivalent |
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Additional Benefits
| Financial | |
|---|---|
| Deductible | $1,200 (single) / $2,400 (family) |
| Coinsurance | N/A |
| Member Out-of-pocket | $5,250 (single) / $10,500 (family) |
| Preventative Care | |
| Physical exam (once every 3 years) |
No charge |
| Well child visit | No charge |
| Child immunizations (0-19 years old) |
No charge |
| Adult immunizations | $20 co-payment |
| Outpatient Care | |
| Primary care physician office visit | Deductible then $20 co-payment |
| Specialist office visit | Deductible then $20 co-payment |
| Surgery in physician's office | Deductible then $20 co-payment |
| MRI, CT scan, and other radiology services | Deductible then $20 co-payment |
| Hospital Care | |
| Physician services (non-surgical) |
Deductible then $20 co-payment |
| Pre-admission testing | Deductible then $20 co-payment |
| Surgeon's services | Deductible then lesser of $200 or 20% |
| Physician's anesthetic services | Deductible then $20 co-payment |
| Blood and blood products | Deductible then $20 co-payment |
| Semi-private room and board | Deductible then $500 per continuous confinement |
| All drugs and medications | No charge |
| Emergency Care | |
| Ambulance service | Not covered |
| Emergency room | Deductible then $50 co-payment. Waived if admitted to hospital. |
| Urgent care center | Deductible then $20 co-payment. Waived if admitted to hospital. |
| Maternity Care | |
| Prenatal and postnatal care | $10 co-payment |
| Hospital services for mother and child | Deductible then lesser of 20% of the cost of services or $200 per item or visit |
| Other Coverage | |
| Diabetes supplies and education | Deductible then $20 co-payment per item or visit |
| Physical therapy | Deductible then $20 co-payment per item or visit |
| Home healthcare | Deductible then $20 co-payment per item or visit |
| Chiropractic | Not covered |
| Mental Health IP | Not covered |
| Mental Health OP | Not covered |
| Prescription Drugs (optional coverage) | |
| Annual deductible | $1,200 (single) / $2,400 (family) shared medical and pharmacy deductible |
| Generic drugs | $10 co-payment |
| Brand name drugs | $20 co-payment plus the difference in cost between the brand name drug and its generic equivalent |