Routine-Care Layer
The 90% of care that causes 15% of claims.
This is the everyday utilization layer. It makes common care understandable: preventive care, office visits, urgent care, outpatient testing, behavioral health, DME, and common prescriptions.
Benefit Schedule
| Benefit | In Network | Out of Network |
|---|---|---|
| PPO Network | Refer to list of PPO Networks | |
| Deductible / Coinsurance / Out of Pocket | $0 / 100% / ACA Max | $0 / 100% / ACA Max |
| Preventive for Adults | 100% Coverage for Preventive Care Services | 100% Coverage for Preventive Care Services |
| Preventive for Women and Children | 100% | |
| Telephonic Primary Care Services | 100% | 100% |
| Office Visit Primary Care Physician | $15 Copay | RBP |
| Office Chiropractic Care Visit | $30 Copay | RBP |
| Office Visit Specialist | $25 Copay | RBP |
| CAT Scan / MRI or outpatient testing | $150 Copay | RBP |
| Emergency Room | $400 Copay | RBP |
| Urgent Care | $40 Copay | RBP |
| Durable Medical Equipment | $40 Copay | RBP |
| Psychiatric / Substance Abuse Office Visit | $15 Copay | RBP |
| Prescription Drugs | ||
| Prescription Generic / Preferred Brand / Non-Preferred | $15 / $25 / $75 Copay | NA |
| Mail Order Copays | 1 copay for 3 months | Not covered |