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Benefits at a Glance-Essential StaffCARE MVP 5500
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ANNUAL MAXIMUM
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Unlimited
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MEMBER BENEFITS
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In Network
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Out of Network
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Individual Deductible
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$5,500
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$11,000
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Family Deductible
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$11,000
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$22,000
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Coinsurance (payable by employee)
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20%
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40%
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OUT-OF-POCKET MAXIMUM
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Individual
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$6,350
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$12,700
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Family
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$12,700
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$25,400
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ESSENTIAL HEALTH BENEFITS (Coinsurance payable by employee after deductible)
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Preventive Care/Screening/Immunization (if in network deductible is waived
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0%
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40%`
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Physician Office Visits
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20%
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40%
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Ambulatory Patient Services
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20%
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40%
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Hospitalization (in-Patient and Out-Patient0
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20%
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40%
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Hospice
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20%
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40%
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Mental Health and Substance Abuse/Behavorial Health
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20%
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40%
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Maternity and Newborn Care
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20%
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40%
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Laboratory Service
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20%
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40%
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Rehabilitative and Habilitative Services/Devices
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20%
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40%
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Emergency Services
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20%
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40%
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PRESCRIPTIONS DRUGS (coinsurance payable by employee after the deductible
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Generic
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20%
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40%
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Preferred Brand
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30%
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50%
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Non-Preferred Brand
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40%
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50%
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Specialty
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50%
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N/A
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