Healthcore Encompass Benefits Summary
| Financial | |
|---|---|
| Deductible | N/A |
| Coinsurance | N/A |
| Member Out-of-pocket | N/A |
| Preventative Care | |
| Physical exam (once every 3 years) |
No charge |
| Well child visit | No charge |
| Office Visits | |
| Primary care physician office visit | $20 co-payment |
| Specialist office visit | $20 co-payment |
| Hospital Care | |
| Inpatient hospitalization | $200 per continuous confinement with $600 annual max |
| Prescription Drugs (optional coverage) | |
| Annual deductible | $100 per member, per calendar year |
| 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 | N/A |
| Coinsurance | N/A |
| Member Out-of-pocket | N/A |
| 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 | $20 co-payment |
| Specialist office visit | $20 co-payment |
| Surgery in physician's office | $20 co-payment |
| MRI, CT scan, and other radiology services | $20 co-payment |
| Hospital Care | |
| Physician services (non-surgical) |
$20 co-payment |
| Pre-admission testing | $20 co-payment |
| Surgeon's services | Lesser of $100 or 10% |
| Physician's anesthetic services | $20 co-payment |
| Blood and blood products | $20 co-payment |
| Semi-private room and board | $200 per continuous confinement with $600 annual max |
| All drugs and medications | No charge |
| Emergency Care | |
| Ambulance service | Not covered |
| Emergency room | $50 co-payment; waived if admitted to hospital. |
| Urgent care center | $20 co-payment; waived if admitted to hospital. |
| Maternity Care | |
| Prenatal and postnatal care | $10 co-payment |
| Hospital services for mother and child | No charge |
| Other Coverage | |
| Diabetes supplies and education | $20 co-payment per item or visit |
| Physical therapy | $20 co-payment per item or visit |
| Home healthcare | $20 co-payment per item or visit |
| Chiropractic | $20 co-payment per item or visit |
| Mental Health IP | Not covered |
| Mental Health OP | Not covered |
| Prescription Drugs (optional coverage) | |
| Annual deductible | $100 per member, per calendar year |
| 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 |