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Medical Plan

Preventive Services
You Pay:
Preventive care services for adults age 19 and older including the preventive services recommended by the U.S. Preventive Services Taskforce. Services include but are not limited to:
  • Visits or exams for preventive care, including a history and risk assessment, chest X-ray, EKG, urinalysis, CBC, fasting lipid profile, cholesterol tests and metabolic and general health panel tests
  • Preventive screenings: Pap smears, mammograms, colorectal cancer tests, prostate cancer tests, STD screenings, genetic counseling in certain situations, and related office visits
Nothing for covered services
Routine immunizations for adults age 19 and older [as licensed by the U.S. Food and Drug Administration (FDA)], not limited to:
  • Hepatitis (Types A and B)
  • Herpes Zoster (shingles)
  • Human Papillomavirus (HPV)
  • Influenza (flu)
  • Measles, Mumps, Rubella
  • Meningococcal
  • Pneumococcal
  • Tetanus-diphtheria, pertussis booster (one every 10 years)
  • Varicella (chickenpox)
*These vaccines are also covered by your Pharmacy benefits when provided by pharmacies.
Nothing for covered services
Preventive care services for children up to age 19, including preventive services recommended under the Affordable Care Act and the American Academy of Pediatrics. These services include but are not limited to visits or exams for preventive care, routine hearing and vision screenings, laboratory tests, immunizations, and nutritional counseling. Nothing for covered services
FIVESTAR Telehealth Mobile Clinic
Office visits, Medication, Laboratory testing, EKG, Radiology (Preferred Hospital only) Nothing
Telehealth Primary Care and Mental Health/Substance Abuse
Office visits $15 (telehealth) office visit Copayment
Professional Provider’s Care
Office visits $25 office visit Copayment for Primary Care Provider (PCP)
$50 office visit Copayment for Specialist
X-ray, lab and diagnostic testing $800 Deductible
20% Coinsurance
Routine exams and other preventive care services Nothing for covered services
Outpatient/Inpatient Consultations $800 Deductible
20% Coinsurance
Surgical care $800 Deductible
20% Coinsurance
Medical Emergency
Emergency care - Facility $200 Copayment for Emergency Department visit
Emergency care - Professional $800 Deductible
20% Coinsurance
Urgent care $50 Copayment for urgent care center
Hospital/Facility Care
Inpatient care $800 Deductible
20% Coinsurance
Outpatient care $800 Deductible
20% Coinsurance
Maternity Care
Prenatal and postpartum office visits $25 Copayment
Obstetrical care performed by a physician or nurse midwife, such as prenatal and postpartum testing (including ultrasound, lab and diagnostic tests), and delivery $800 Deductible
20% Coinsurance
Inpatient hospital
Precertification is not required. Note: you may stay in the hospital for up to 48 hours after a regular delivery and 96 hours after a c-section. We will cover a longer stay if medically necessary; precertification is required for any inpatient stay beyond these time frames.
$800 Deductible
20% Coinsurance
Mental Health and Substance Abuse
Inpatient Hospital/Facility $800 Deductible
20% Coinsurance
Outpatient Hospital/Facility Care $800 Deductible
20% Coinsurance
Office visits $25 office visit Copayment

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