Monthly Premium Plan premium Health plan premium Drug plan premium Maximum Out-of-Pocket |
$0 $0 $0 $3400 |
Ambulance | $75 |
Doctor's office visits Primary Physician Specialist | $0 per visit $0 per visit |
Lab Services | $0 |
X-rays | $0 |
MRI, CT scans | $0 |
Emergency Care | $85 (world-wide $0, $7500 max) |
Urgent Care | $0-$10 per visit (waived if admitted) |
Home health care | $0 |
Outpatient Surgery | $100 per visit |
Renal dialysis | $30 per visit |
Monthly Premium Plan premium Health plan premium Drug plan premium Maximum Out-of-Pocket |
$0 $0 $0 $3400 |
Ambulance | $75 |
Doctor's office visits Primary Physician Specialist | $0 per visit $0 per visit |
Lab Services | $0 |
X-rays | $0 |
MRI, CT scans | $0 |
Emergency Care | $85 (world-wide $0, $7500 max) |
Urgent Care | $0-$10 per visit (waived if admitted) |
Home health care | $0 |
Outpatient Surgery | $100 per visit |
Renal dialysis | $30 per visit |