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Prestige Gold
This plan is ideal if you or your family will be using medical services often, but do not wish to have dental or vision benefits. Prestige Gold offers broad coverage and you will pay 25% for most services once you meet your deductible. The below chart details the benefits of this plan.
Prestige Gold Plan Highlights |
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DEDUCTIBLE |
Individual |
$1,500 |
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Family |
$3,000 |
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COINSURANCE |
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25% |
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OUT-OF- |
Individual |
$8,700 |
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Family |
$17,400 |
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BENEFITS |
Preventive Care |
$0 |
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Routine Vision Exam |
Not covered |
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Annual Dental Exam |
Not covered |
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Personal Doctor Visit |
$30 per visit |
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Virtual Visit |
$0 per visit |
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Specialist Visit |
$60 per visit |
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Chiropractic |
25% after deductible |
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Hospital Stay |
25% after deductible |
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Emergency Room |
25% after deductible |
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X-ray and Diagnostic Imaging |
25% after deductible |
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Prescription Drug Coverage
All Network Health’s Prestige plans have built-in pharmacy benefits. See the chart below for prescription drug coverage information.
Prestige Gold Pharmacy Benefit Highlights |
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Retail |
Preventive Drugs |
$0 |
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Adherence Generics |
$0 |
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Tier 1 Generics |
$15 |
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Tier 2 Preferred Brand Drugs |
$30 |
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Tier 3 Non-Preferred Brand Drugs |
$60 |
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Tier 4 Preferred Specialty Drugs |
$250 |
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Tier 5 Non-Preferred Specialty Drugs |
$250 |
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