Consumer-driven health plan <CLIENT NAME> offers one medical plan — a consumer-driven health plan (CDHP). You pay first-dollar costs for all physicians’ visits, medical services and prescriptions until you meet your annual deductible. Once the applicable network or nonnetwork deductible has been met, coverage is shared with the company in a coinsurance arrangement until an out-of-pocket maximum is met.
Medical plan at a glance <Carrier> consumer driven health plan (CDHP)
In-network
Out-of-network
Individual
$1,300
$2,600
Family
$2,600
$5,200
Individual
$2,600
$5,200
Family
$5,200
$10,400
80%
60%
Specialist office visit
80%
60%
Preventive care (routine physical, well-child, pap smear, mammogram, prostate exam, and preventive diagnostic)
100%
60%
Outpatient diagnostic services: lab and X-ray
80%
60%
Routine eye exams
80%
60%
Maternity care
80%
60%
Outpatient surgery
80%
60%
Inpatient hospital care
80%
60%
Emergency care (hospital emergency room)
80%
80%
Urgent care center use
80%
60%
Ambulance service
80%
60%
Outpatient rehab (physical, occupational and speech therapy [60 visits per year combined], spinal manipulation)
80%
60%
Annual deductible (applies to out-of-pocket maximum)
Annual out-of-pocket maximum (includes deductible)
Covered services — plan pays Physician office services
Prescription drugs and mail order
Preventive medications
100%
Not Covered
Other prescriptions
80%
Not Covered
80%
60%
Mental health and chemical dependency (in- and outpatient authorized services)
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