Family Member – Age 23 – $10,000 Initial Unshareable Amount
$210.00/ month with a $100.00 sign-up fee. on the 1st of each month with a 14-day free trial and a $100.00 sign-up fee
- All your medical needs are met by this plan.
- The out-of-pocket limit is the IUA you chose: $3,000, $5,000 or $10,000.
- There’s no lifetime maximum.
- For an emergency room visit, you’ll pay a $200 Copay. 100% coverage after IUA met.
Doctor visits will cost you:-
Primary Doctor: Network: $50 Copay, 100% coverage after IUA met.
Specialist: Network: $50 Copay, 100% coverage after IUA met.
Other practitioner: Network:$50 Copay, 100% coverage after IUA met.
Hospital services will cost you:-
Inpatient Hospital Services:
Network: $100 Copay per Day, 100% coverage after IUA met.
Inpatient Physician and Surgical Services:
Network: $100 Copay, 100% coverage after IUA met.
Explanation: All member cost sharing varies based upon Place of Service. Please refer to plan documents for additional information.
First payment: April 1, 2021