This plan offers quality coverage with the lowest deductible of all our gold-level plans. It also has the lowest out-of-pocket maximum and you'll be responsible for 50 percent coinsurance on covered-in network services once the deductible has been met. In addition, you get a $0 annual vision exam and two dental exams for each covered member. This plan is ideal for a person who is comfortable paying a higher monthly premium and receiving lower medical bills throughout the year. The below chart details the benefits of this plan.
This plan is also available without dental and vision benefits.
Prestige Gold 50 Plan Highlights |
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DEDUCTIBLE |
Individual |
$1,000 |
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Family |
$2,000 |
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COINSURANCE |
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50% |
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OUT-OF- |
Individual |
$4,300 |
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Family |
$8,600 |
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BENEFITS |
Preventive Care |
$0 |
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Routine Vision Exam |
$0 |
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Annual Dental Exam |
Reimbursement |
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Personal Doctor Visit |
$0 for first visit per family member, then 50% after deductible |
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Virtual Visit |
$0 per visit |
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Specialist Visit |
50% after deductible |
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Chiropractic |
50% after deductible |
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Hospital Stay |
50% after deductible |
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Emergency Room |
50% after deductible |
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X-ray and Diagnostic Imaging |
50% after deductible |
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All Network Health’s Prestige plans have built-in pharmacy benefits. See the chart below for prescription drug coverage information.
Prestige Gold 50 Pharmacy Benefit Highlights |
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Retail |
Preventive Drugs |
$0 |
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Tier 1 Generic and Adherence Generic Drugs Adherence Generics are limited to specific medications to treat certain conditions and are designated in the comprehensive drug list with the label “$0” and are available at no cost, subject to applicable deductible |
$15 |
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Tier 2 Preferred Brand Drugs |
$50 |
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Tier 3 Non-Preferred Brand Drugs |
50% after deductible |
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Tier 4 Preferred Specialty Drugs |
40% after deductible |
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Tier 5 Non-Preferred Specialty Drugs |
50% after deductible |
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