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Prestige Gold Essential
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. 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 |
$7,900 |
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Family |
$15,800 |
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BENEFITS |
Preventive Care |
$0 |
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Primary Care Doctor Visit |
$0 for first three visits, then $20 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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Laboratory Outpatient Services |
$25 per visit |
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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 Essential Pharmacy Benefit Highlights |
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Retail |
Preventive Drugs |
$0 |
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Adherence Generics (limited only to categories of select antidiabetics, statins and RAS antagonists) |
$2 (Tier 1) |
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Generics |
$15 (Tier 2) |
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Preferred Brand Drugs |
$60 (Tier 3) |
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Non-Preferred Brand Drugs |
35% after deductible (Tier 4) |
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Preferred Specialty Drugs |
35% after deductible (Tier 5) |
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Non-Preferred Specialty Drugs |
50% after deductible (Tier 6) |
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