This plan offers a low deductible and low copayments for common medical services. This plan is designed for an individual who wants a low deductible but is comfortable with a higher out-of-pocket limit. Your first three primary care doctor visits are $0 and just $20 per visit after that. In addition, you get a $0 annual vision exam and two dental exams for each covered member. The below chart details the benefits of this plan.
Prestige Gold Essential Plan Highlights |
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DEDUCTIBLE |
Individual |
$1,750 |
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Family |
$3,500 |
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COINSURANCE |
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20% |
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OUT-OF- |
Individual |
$8,950 |
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Family |
$17,900 |
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BENEFITS |
Preventive Care |
$0 |
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Routine Vision Exam |
$0 |
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Annual Dental Exam |
$0 |
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Personal Doctor Visit |
$0 for first three visits per family member, then $20 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 |
20% after deductible |
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Hospital Stay |
20% after deductible |
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Emergency Room |
$350 per visit |
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X-ray and Diagnostic Imaging |
$50 per visit |
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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 Essential 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 |
$60 |
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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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