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