| Type of Service |
|
Premier Silver
80/20 Plan
2500
Max Per
Occurance |
|
Premier Platinum
90/10 Plan
7500
Max Per
Occurance |
|
Physicians Office Visits
Primary/Specialists/Chiropractor |
|
$25 co-pay
to plan max |
|
$25 co-pay
to plan max
|
| Physician services - in-patient |
|
80% to plan max
|
|
90% to plan max |
| Hospitalization In-patient benefit |
|
80% to plan max |
|
90% to plan max
|
|
E/R Ambulence Service
|
|
$250 Deductible
Waived if due to accident or admittance. |
|
$200 Deductible
Waived if due to accident or admittance. |
|
|
|
|
|
| Out-of-Pocket Maximum |
|
None |
|
None
|
| Accidental Death Benefit |
|
$10,000 to designated Beneficiary |
|
$10,000 to designated Beneficiary |
| Tela-Doc Service
Unlimited immediate access to a board-certified physician 24/7 to answer health questions, diagnose, and prescribe medications. |
|
Yes
(no charge) |
|
Yes
(no charge) |
| Dental Benefits |
|
Savings up to 60% |
|
Savings up to 60% |
| Vision and Hearing Benefits |
|
Savings up to 60% |
|
Savings up to 60% |
| Mail Order Pharmacy |
|
Yes
(Express Scripts) |
|
Yes
(Express Scripts)
|
| Surgical Procedures |
|
Yes
(80% of Surgical procedures) |
|
Yes
(90% of Surgical procedures)
|
|
Per Occurrence Deductible
(No annual limit on occurrences
12 month pre-existing unless
proof of coverage-no
pre-existing on office visits or
prescription benefts)
|
|
$300.00 |
|
$200.00 |
| Additional Benefits |
- No annual contracts
- No waiting periods - very few claim forms
- Large PPO network for medical and dental - preferred pricing
- Accident Medical Plan - additional accident benefit over health plan benefits - all plans include this benefit (Except the Pinnacle Bronze Plan). $1,000 deductible and up to $25,000 benefit per accident
- Critical Illness (Available for a small increase in premium). This upgrade provides an additional $25,000 of coverage per person for Critical Illness related conditions (life threatening cancer, heart attack, stroke, major organ transplant, coronary artery bypass surgery, kidney failure, coma, paralysis, blindness, etc.)
|
| Premier Health Care RX Plan |
- $50 or less for a 30-day supply for medications included in the formulary
- Available through mail-order only
- 90-day supply typically ordered
- Preferred Pricing for medications not included in the formulary
- Pharmacy advisory service to save you even more
- Pharmacy advisory services to save you even more
- No reimbursement procedures - pay only your maximum or preferred pricing
- Retail / Mail Order Generic: $10 Maximum Member Payment ("Maximum") for 30 day supply
|
