Not all coverage is the right coverage.
Your healthcare coverage is important to us. Age, family status, medical conditions, hobbies, lifestyle and a myriad of other factors will help you determine if you need a lot or a very little amount of health coverage. This summary will help you understand your plan and its coverage. You can find more detailed plan information by reviewing your Summary Plan Description here.
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Summary of Medical Benefits
Copay Plan
Big Tree Medical
Health Cooperative of Missouri
Healthlink
Deductible
Individual
Family
N/A
$0
$3,000
$7,000
Out-of-Pocket Maximum
$4,500
$9,000
Preventive Care Services
No Charge
Office Visits
Primary Office Visit
Specialist Office Visit
Chiropractic Visit
$40 Copay
$60 Copay
$75 Copay
20%*
Urgent Care Services
Complex Imaging: MRI/CT/PET Scans
Inpatient Hospital Care
Facility Fee
Physician Fee
0%*
Outpatient Procedures
Emergency Room
Emergency Medical Transportation
$250 Copay (waived if admitted)
Mental Health/Chemical Dependency
Inpatient
Office Visit
Prescription Drug Coverage
Generic
Preferred Brand
Non-Preferred Brand
Specialty
Retail 30 Day Supply
$5 Copay
$15 Copay
$25 Copay
$100 Copay
Mail Order 90 Day Supply
$10 Copay
$30 Copay
$50 Copay
Not Covered
NOTE: * Coinsurance After Deductible
Please refer to your Summary Plan Description for actual coverage, limitation, and exclusion provisions, including out of network services.
If you prefer talking with a HealthEZ representative, call 855-290-1411