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Company

Plan Type

Plan ID

Plan Name

Deductibles

PCP Office Visit

Specialist Office Visit

ObGyn Wellness

Lifetime Max

Application
Aetna PPO - details 3726 PPO 1500 1500.0000 / 3000 $25 copay $35 copay No charge, deductible waived (no waiting period, no calendar max, annual pap/mammogram) $5 million application
PPO - details 8278 PPO 1500 1500.0000 / 3000 $25 copay, deductible waived $35 copay, deductible waived No charge, deductible waived, no waiting period or calendar year max, Annual Pap/Mammogram N/A application
PPO - details 8279 PPO 2500 2500.0000 / 5000 $30 copay, deductible waived $40 copay, deductible waived No charge, deductible waived, no waiting period or calendar year max, Annual Pap/Mammogram N/A application
PPO - details 3727 PPO 2500 2500.0000 / 5000 $30 copay $40 copay No charge, deductible waived (no waiting period, no calendar max, annual pap/mammogram) $5 million application
PPO - details 3728 PPO 5000 5000.0000 / 10000 $40 copay $50 copay No charge, deductible waived (no waiting period, no calendar max, annual pap/mammogram) $5 million application
PPO - details 8280 PPO 5000 5000.0000 / 10000 $40 copay, deductible waived $50 copay, deductible waived No charge, deductible waived, no waiting period or calendar year max, Annual Pap/Mammogram N/A application
PPO - details 6182 PPO 7500 plus Dental Coverage 7500.0000 / 15000 $30 copay, unlimited visits, deductible waived 20% after deductible, unlimited visits No charge, deductible waived (No waiting period, no calendar year maximum. Annual Pap / Mammogram) $5 Million application
PPO - details 8286 PPO 7500 plus Dental Coverage 7500.0000 / 15000 $30 copay, unlimited visits, deductible waived 20% after deductible, unlimited visits No charge, deductible waived, no waiting period or calendar year max, Annual Pap/Mammogram N/A application
HSA - details 8281 PPO High Deductible 5000 (HSA Compatible) 5000.0000 / 10000 No charge after deductible No charge after deductible No charge, deductible waived, no waiting period or calendar year max, Annual Pap/Mammogram N/A application
HSA - details 3730 PPO High Deductible 5000 (HSA Compatible) 5000.0000 / 10000 No charge after deductible No charge after deductible No charge, deductible waived (no waiting period, no calendar max, annual pap/mammogram) $5 million application
PPO - details 8285 PPO Value 10000 10000.0000 / 20000 $30 copay, deductible waived, for 1st 2 visits, 30% after deductible for subsequent visits (non-specialist and specialist visits combined) $30 copay, deductible waived, for 1st 2 visits, 30% after deductible for subsequent visits (non-specialist and specialist visits combined) No charge, deductible waived, no waiting period or calendar year max, Annual Pap/Mammogram N/A application
PPO - details 6179 PPO Value 10000 10000.0000 / 20000 $30 copay, deductible waived, for 1st 2 visits, 30% after deductible for subsequent visits (non-specialist and specialist visits combined) $30 copay, deductible waived, for 1st 2 visits, 30% after deductible for subsequent visits (non-specialist and specialist visits combined) No charge, deductible waived (No waiting period, no calendar year max, Annual Pap/Mammogram) $1 million application
PPO - details 6178 PPO Value 2500 2500.0000 / 5000 $30 copay, deductible waived, for 1st 2 visits, 30% after deductible for subsequent visits (non-specialist and specialist visits combined) $30 copay, deductible waived, for 1st 2 visits, 30% after deductible for subsequent visits (non-specialist and specialist visits combined) No charge, deductible waived (No waiting period, no calendar year max, Annual Pap/Mammogram) $1 million application
PPO - details 8284 PPO Value 2500 2500.0000 / 5000 $30 copay, deductible waived, for 1st 2 visits, 30% after deductible for subsequent visits (non-specialist and specialist visits combined) $30 copay, deductible waived, for 1st 2 visits, 30% after deductible for subsequent visits (non-specialist and specialist visits combined) No charge, deductible waived, no waiting period or calendar year max, Annual Pap/Mammogram N/A application
PPO - details 8283 PPO Value 5000 5000.0000 / 10000 $30 copay, deductible waived, for 1st 2 visits, 30% after deductible for subsequent visits (non-specialist and specialist visits combined) $30 copay, deductible waived, for 1st 2 visits, 30% after deductible for subsequent visits (non-specialist and specialist visits combined) No charge, deductible waived, no waiting period or calendar year max, Annual Pap/Mammogram N/A application
PPO - details 3733 PPO Value 5000 5000.0000 / 10000 $30 copay for 1st 2 visits, 30% after deductible for subsequent visits (non-specialist and specialist visits combined) $30 copay for 1st 2 visits, 30% after deductible for subsequent visits (non-specialist and specialist visits combined) No charge, deductible waived (no waiting period, no calendar max, annual pap/mammogram) $1 million application
HSA - details 8282 Preventative & Hospital Care 3000 (HSA Compatible) 3000.0000 / 6000 Not covered Not covered No charge, deductible waived, no waiting period or calendar year max, Annual Pap/Mammogram N/A application
HSA - details 3732 Preventative & Hospital Care 3000 (HSA Compatible) 3000.0000 / 6000 Not covered Not covered No charge, deductible waived (no waiting period, no calendar max, annual pap/mammogram) $1 million application
Anthem PPO - details 7328 CoreShare 10000 10000.0000 / 20000 No cost after deductible No cost after deductible No cost after deductible $2 million application
PPO - details 7323 CoreShare 1500 1500.0000 / 3000 50% after deductible 50% after deductible 50% after deductible $2 million application
PPO - details 7329 CoreShare 15000 15000.0000 / 30000 No cost after deductible No cost after deductible No cost after deductible $2 million application
PPO - details 7324 CoreShare 2500 2500.0000 / 5000 50% after deductible 50% after deductible 50% after deductible $2 million application
PPO - details 7330 CoreShare 25000 25000.0000 / 50000 No cost after deductible No cost after deductible No cost after deductible $2 million application
PPO - details 7325 CoreShare 3500 3500.0000 / 7000 50% after deductible 50% after deductible 50% after deductible $2 million application
PPO - details 7326 CoreShare 5000 5000.0000 / 10000 50% after deductible 50% after deductible 50% after deductible $2 million application
PPO - details 7322 CoreShare 750 750.0000 / 1500 50% after deductible 50% after deductible 50% after deductible $2 million application
PPO - details 7327 CoreShare 7500 7500.0000 / 15000 No cost after deductible No cost after deductible No cost after deductible $2 million application
HSA - details 7331 Lumenos HSA 1500 1500.0000 / 3000 50% after deductible 50% after deductible 50% after deductible $7 million application
HSA - details 5876 Lumenos HSA 1500 Plan 3 1500.0000 / 3000 No charge after deductible No charge after deductible No charge $7 million application
HSA - details 5877 Lumenos HSA 1750 Plan 4 1750.0000 / 3500 20% after deductible 20% after deductible 20% after deductible $7 million application
HSA - details 7332 Lumenos HSA 2500 2500.0000 / 5000 No charge after deductible No charge after deductible No charge after deductible $7 million application
HSA - details 5878 Lumenos HSA 3000 Plan 3 3000.0000 / 6000 No charge after deductible No charge after deductible No charge $7 million application
HSA - details 5879 Lumenos HSA 3500 Plan 5 3500.0000 / 7000 No charge after deductible No charge after deductible No charge after deductible $7 million application
HSA - details 5880 Lumenos HSA 5000 Plan 3 5000.0000 / 10000 No charge after deductible No charge after deductible No charge $7 million application
HSA - details 7333 Lumenos HSA 5500 5500.0000 / 11000 No charge after deductible No charge after deductible No charge after deductible $7 million application
PPO - details 5948 Premier 10000 Upgrade RX 10000.0000 / 20000 $30 copay $40 copay $30/$40 (includes immunizations, unlimited PSA, pap smears, digital rectal exams, colorectal cancer, mammograms, fecal occult blood, flexible sigmoidoscopy, colonoscopy, radiologic imaging) other immunizations, lab, x-rays covered at 20% $7 million application
PPO - details 5889 Premier 10000 with Standard RX 10000.0000 / 20000 $30 copay $40 copay $30/$40 (includes immunizations, unlimited PSA, pap smears, digital rectal exams, colorectal cancer, mammograms, fecal occult blood, flexible sigmoidoscopy, colonoscopy, radiologic imaging) other immunizations, lab, x-rays covered at 20% $7 million application
PPO - details 7317 Premier 1500 Standard RX (No Office Copay) 1500.0000 / 3000 20% after deductible 20% after deductible 20%, deductible waived (includes immunizations, PSA screenings, pap tests, mammograms and other nationally recommended preventive care services) $7 million application
PPO - details 5943 Premier 1500 Upgrade RX 1500.0000 / 3000 $30 copay $40 copay $30/$40 (includes immunizations, unlimited PSA, pap smears, digital rectal exams, colorectal cancer, mammograms, fecal occult blood, flexible sigmoidoscopy, colonoscopy, radiologic imaging) other immunizations, lab, x-rays covered at 20% $7 million application
PPO - details 7318 Premier 1500 Upgrade RX (No Office Copay) 1500.0000 / 3000 No charge after deductible No charge after deductible 20%, deductible waived (includes immunizations, PSA screenings, pap tests, mammograms and other nationally recommended preventive care services) $7 million application
PPO - details 5884 Premier 1500 with Standard RX 1500.0000 / 3000 $30 copay $40 copay $30/$40 (includes immunizations, unlimited PSA, pap smears, digital rectal exams, colorectal cancer, mammograms, fecal occult blood, flexible sigmoidoscopy, colonoscopy, radiologic imaging) other immunizations, lab, x-rays covered at 20% $7 million application
PPO - details 7319 Premier 2500 0% Standard RX (No Office Copay) 2500.0000 / 5000 No charge after deductible No charge after deductible No charge, deductible waived (includes immunizations, unlimited PSA, pap smears, digital rectal exams, colorectal cancer, mammograms, fecal occult blood, flexible sigmoidoscopy, colonoscopy, radiologic imaging) other immunizations, lab, x-rays covered $7 million application
PPO - details 5945 Premier 2500 0% Upgrade RX 2500.0000 / 5000 $30 copay $40 copay $30/$40 (includes immunizations, unlimited PSA, pap smears, digital rectal exams, colorectal cancer, mammograms, fecal occult blood, flexible sigmoidoscopy, colonoscopy, radiologic imaging) other immunizations, lab, x-rays covered at 20% $7 million application
PPO - details 7320 Premier 2500 0% Upgrade RX (No Office Copay) 2500.0000 / 5000 No charge after deductible No charge after deductible No charge, deductible waived (includes immunizations, unlimited PSA, pap smears, digital rectal exams, colorectal cancer, mammograms, fecal occult blood, flexible sigmoidoscopy, colonoscopy, radiologic imaging) other immunizations, lab, x-rays covered $7 million application
PPO - details 5886 Premier 2500 0% with Standard RX 2500.0000 / 5000 $30 copay $40 copay $30/$40 (includes immunizations, unlimited PSA, pap smears, digital rectal exams, colorectal cancer, mammograms, fecal occult blood, flexible sigmoidoscopy, colonoscopy, radiologic imaging) other immunizations, lab, x-rays covered at 20% $7 million application
PPO - details 5944 Premier 2500 20% Upgrade RX 2500.0000 / 5000 $30 copay $40 copay $30/$40 (includes immunizations, unlimited PSA, pap smears, digital rectal exams, colorectal cancer, mammograms, fecal occult blood, flexible sigmoidoscopy, colonoscopy, radiologic imaging) other immunizations, lab, x-rays covered at 20% $7 million application
PPO - details 5885 Premier 2500 20% with Standard RX 2500.0000 / 5000 $30 copay $40 copay $30/$40 (includes immunizations, unlimited PSA, pap smears, digital rectal exams, colorectal cancer, mammograms, fecal occult blood, flexible sigmoidoscopy, colonoscopy, radiologic imaging) other immunizations, lab, x-rays covered at 20% $7 million application
PPO - details 5946 Premier 3500 Upgrade RX 3500.0000 / 7000 $30 copay $40 copay $30/$40 (includes immunizations, unlimited PSA, pap smears, digital rectal exams, colorectal cancer, mammograms, fecal occult blood, flexible sigmoidoscopy, colonoscopy, radiologic imaging) other immunizations, lab, x-rays covered at 20% $7 million application
PPO - details 5887 Premier 3500 with Standard RX 3500.0000 / 7000 $30 copay $40 copay $30/$40 (includes immunizations, unlimited PSA, pap smears, digital rectal exams, colorectal cancer, mammograms, fecal occult blood, flexible sigmoidoscopy, colonoscopy, radiologic imaging) other immunizations, lab, x-rays covered at 20% $7 million application
PPO - details 5947 Premier 5000 Upgrade RX 5000.0000 / 10000 $30 copay $40 copay $30/$40 (includes immunizations, unlimited PSA, pap smears, digital rectal exams, colorectal cancer, mammograms, fecal occult blood, flexible sigmoidoscopy, colonoscopy, radiologic imaging) other immunizations, lab, x-rays covered at 20% $7 million application
PPO - details 5888 Premier 5000 with Standard RX 5000.0000 / 10000 $30 copay $40 copay $30/$40 (includes immunizations, unlimited PSA, pap smears, digital rectal exams, colorectal cancer, mammograms, fecal occult blood, flexible sigmoidoscopy, colonoscopy, radiologic imaging) other immunizations, lab, x-rays covered at 20% $7 million application
PPO - details 7310 SmartSense 1000 Standard RX 1000.0000 / 2000 $35 copay for 1st 3 visits, 50% after deductible for subsequent visits (non-specialist and specialist visits combined) $35 copay for 1st 3 visits, 50% after deductible for subsequent visits (non-specialist and specialist visits combined) Not covered, except Mammography or Pap Test at 50% after deductible $7 million application
PPO - details 5867 SmartSense 1000 Standard RX 1000.0000 / 2000 $35 copay for 1st 3 visits, 30% after deductible for subsequent visits (non-specialist and specialist visits combined) $35 copay for 1st 3 visits, 30% after deductible for subsequent visits (non-specialist and specialist visits combined) Not covered, except Mammography or Pap Test at 30% after deductible $7 million application
PPO - details 5866 SmartSense 1000 Upgrade RX 1000.0000 / 2000 $35 copay for 1st 3 visits, 30% after deductible for subsequent visits (non-specialist and specialist visits combined) $35 copay for 1st 3 visits, 30% after deductible for subsequent visits (non-specialist and specialist visits combined) Not covered, except Mammography or Pap Test at 30% after deductible $7 million application
PPO - details 7309 SmartSense 1000 Upgrade RX 1000.0000 / 2000 $35 copay for 1st 3 visits, 50% after deductible for subsequent visits (non-specialist and specialist visits combined) $35 copay for 1st 3 visits, 50% after deductible for subsequent visits (non-specialist and specialist visits combined) Not covered, except Mammography or Pap Test at 50% after deductible $7 million application
PPO - details 5875 SmartSense 10000 Standard RX 10000.0000 / 20000 $35 copay for 1st 3 visits, 30% after deductible for subsequent visits (non-specialist and specialist visits combined) $35 copay for 1st 3 visits, 30% after deductible for subsequent visits (non-specialist and specialist visits combined) Not covered, except Mammography or Pap Test at 30% after deductible $7 million application
PPO - details 5874 SmartSense 10000 Upgrade RX 10000.0000 / 20000 $35 copay for 1st 3 visits, 30% after deductible for subsequent visits (non-specialist and specialist visits combined) $35 copay for 1st 3 visits, 30% after deductible for subsequent visits (non-specialist and specialist visits combined) Not covered, except Mammography or Pap Test at 30% after deductible $7 million application
PPO - details 7312 SmartSense 1500 Standard RX 1500.0000 / 3000 $35 copay for 1st 3 visits, 50% after deductible for subsequent visits (non-specialist and specialist visits combined) $35 copay for 1st 3 visits, 50% after deductible for subsequent visits (non-specialist and specialist visits combined) Not covered, except Mammography or Pap Test at 50% after deductible $7 million application
PPO - details 5869 SmartSense 1500 Standard RX 1500.0000 / 3000 $35 copay for 1st 3 visits, 30% after deductible for subsequent visits (non-specialist and specialist visits combined) $35 copay for 1st 3 visits, 30% after deductible for subsequent visits (non-specialist and specialist visits combined) Not covered, except Mammography or Pap Test at 30% after deductible $7 million application
PPO - details 5868 SmartSense 1500 Upgrade RX 1500.0000 / 3000 $35 copay for 1st 3 visits, 30% after deductible for subsequent visits (non-specialist and specialist visits combined) $35 copay for 1st 3 visits, 30% after deductible for subsequent visits (non-specialist and specialist visits combined) Not covered, except Mammography or Pap Test at 30% after deductible $7 million application
PPO - details 7311 SmartSense 1500 Upgrade RX 1500.0000 / 3000 $35 copay for 1st 3 visits, 50% after deductible for subsequent visits (non-specialist and specialist visits combined) $35 copay for 1st 3 visits, 50% after deductible for subsequent visits (non-specialist and specialist visits combined) Not covered, except Mammography or Pap Test at 50% after deductible $7 million application
PPO - details 7314 SmartSense 2500 Standard RX 2500.0000 / 5000 $35 copay for 1st 3 visits, 50% after deductible for subsequent visits (non-specialist and specialist visits combined) $35 copay for 1st 3 visits, 50% after deductible for subsequent visits (non-specialist and specialist visits combined) Not covered, except Mammography or Pap Test at 50% after deductible $7 million application
PPO - details 5871 SmartSense 2500 Standard RX 2500.0000 / 5000 $35 copay for 1st 3 visits, 30% after deductible for subsequent visits (non-specialist and specialist visits combined) $35 copay for 1st 3 visits, 30% after deductible for subsequent visits (non-specialist and specialist visits combined) Not covered, except Mammography or Pap Test at 30% after deductible $7 million application
PPO - details 7313 SmartSense 2500 Upgrade RX 2500.0000 / 5000 $35 copay for 1st 3 visits, 50% after deductible for subsequent visits (non-specialist and specialist visits combined) $35 copay for 1st 3 visits, 50% after deductible for subsequent visits (non-specialist and specialist visits combined) Not covered, except Mammography or Pap Test at 50% after deductible $7 million application
PPO - details 5870 SmartSense 2500 Upgrade RX 2500.0000 / 5000 $35 copay for 1st 3 visits, 30% after deductible for subsequent visits (non-specialist and specialist visits combined) $35 copay for 1st 3 visits, 30% after deductible for subsequent visits (non-specialist and specialist visits combined) Not covered, except Mammography or Pap Test at 30% after deductible $7 million application
PPO - details 7316 SmartSense 3500 Standard RX 3500.0000 / 7000 $35 copay for 1st 3 visits, 30% after deductible for subsequent visits (non-specialist and specialist visits combined) $35 copay for 1st 3 visits, 30% after deductible for subsequent visits (non-specialist and specialist visits combined) Not covered, except Mammography or Pap Test at 30% after deductible $7 million application
PPO - details 7315 SmartSense 3500 Upgrade RX 3500.0000 / 7000 $35 copay for 1st 3 visits, 30% after deductible for subsequent visits (non-specialist and specialist visits combined) $35 copay for 1st 3 visits, 30% after deductible for subsequent visits (non-specialist and specialist visits combined) Not covered, except Mammography or Pap Test at 30% after deductible $7 million application
PPO - details 7308 SmartSense 500 Standard RX 500.0000 / 1000 $35 copay for 1st 3 visits, 50% after deductible for subsequent visits (non-specialist and specialist visits combined) $35 copay for 1st 3 visits, 50% after deductible for subsequent visits (non-specialist and specialist visits combined) Not covered, except Mammography or Pap Test at 50% after deductible $7 million application
PPO - details 5865 SmartSense 500 Standard RX 500.0000 / 1000 $35 copay for 1st 3 visits, 30% after deductible for subsequent visits (non-specialist and specialist visits combined) $35 copay for 1st 3 visits, 30% after deductible for subsequent visits (non-specialist and specialist visits combined) Not covered, except Mammography or Pap Test at 30% after deductible $7 million application
PPO - details 5864 SmartSense 500 Upgrade RX 500.0000 / 1000 $35 copay for 1st 3 visits, 30% after deductible for subsequent visits (non-specialist and specialist visits combined) $35 copay for 1st 3 visits, 30% after deductible for subsequent visits (non-specialist and specialist visits combined) Not covered, except Mammography or Pap Test at 30% after deductible $7 million application
PPO - details 7307 SmartSense 500 Upgrade RX 500.0000 / 1000 $35 copay for 1st 3 visits, 50% after deductible for subsequent visits (non-specialist and specialist visits combined) $35 copay for 1st 3 visits, 50% after deductible for subsequent visits (non-specialist and specialist visits combined) Not covered, except Mammography or Pap Test at 50% after deductible $7 million application
PPO - details 5873 SmartSense 5000 Standard RX 5000.0000 / 10000 $35 copay for 1st 3 visits, 30% after deductible for subsequent visits (non-specialist and specialist visits combined) $35 copay for 1st 3 visits, 30% after deductible for subsequent visits (non-specialist and specialist visits combined) Not covered, except Mammography or Pap Test at 30% after deductible $7 million application
PPO - details 5872 SmartSense 5000 Upgrade RX 5000.0000 / 10000 $35 copay for 1st 3 visits, 30% after deductible for subsequent visits (non-specialist and specialist visits combined) $35 copay for 1st 3 visits, 30% after deductible for subsequent visits (non-specialist and specialist visits combined) Not covered, except Mammography or Pap Test at 30% after deductible $7 million application
Coventry PPO - details 6238 Copay 100% $0 $25/$50 PCP/SP (dental included) 0.0000 / 0 $25 copay $50 copay $25pcp/$50spc copay $5 million application
PPO - details 6232 Copay 100% $0 (dental included) 0.0000 / 0 $20 copay $40 copay $20pcp/$40spc copay $5 million application
PPO - details 6234 Copay 100% $1200 (dental included) 1200.0000 / 2400 $20 copay $40 copay $20pcp/$40spc copay $5 million application
PPO - details 8099 Copay 80% $500 (dental included) 500.0000 / 1000 $20 Copay $40 Copay Office visits: $20 Copay, deductible waived, for Primary Care; $40 Copay, deductible waived, for Specialist; $30 Copay, deductible wavied, for Mammograms. $4 Million application
PPO - details 6235 Copay 90% $1000 $2K OOPM (dental included) 1000.0000 / 2000 $20 copay $40 copay $20pcp/$40spc copay $5 million application
PPO - details 6237 Copay 90% $2000 (dental included) 2000.0000 / 4000 $20 copay $40 copay $20pcp/$40spc copay $5 million application
PPO - details 6239 Deductible 80% $500 (dental included) 500.0000 / 1000 20% after deductible 20% after deductible 20% coinsurance $4 Million application
PPO - details 7168 HealthAmericaOne Hea1thGear 2500 2500.0000 / 5000 $40 copay after deductible $60 copay after deductible $40/$60, $30 Copay for Routine Mammograms $3 million application
PPO - details 7169 HealthAmericaOne Hea1thGear 3500 3500.0000 / 7000 $40 copay after deductible $60 copay after deductible $40/$60, $30 Copay for Routine Mammograms $3 million application
PPO - details 7170 HealthAmericaOne Hea1thGear 5000 5000.0000 / 10000 $40 copay after deductible $60 copay after deductible $40/$60, $30 Copay for Routine Mammograms $3 million application
HSA - details 4210 QHDHP 100% $1250 (dental included) 1250.0000 / 2500 $15 copay after deductible $25 copay after deductible $15 PCP/$25 Specialist $4 million Participating; $500,000 Non-Participating application
HSA - details 4211 QHDHP 100% $2500 (dental included) 2500.0000 / 5000 No charge after deductible No charge after deductible No charge $4 million Participating; $500,000 Non-Participating application
HSA - details 4212 QHDHP 100% $3750 (dental included) 3750.0000 / 7500 $15 copay after deductible $25 copay after deductible $15 PCP/$25 Specialist $4 million Participating; $500,000 Non-Participating application
HSA - details 1635 QHDHP 90% $1200 (dental included) 1200.0000 / 2400 10% after deductible 10% after deductible 10% coinsurance $4 Million application
HSA - details 1641 QHDHP 90% $3000 (dental included) 3000.0000 / 6000 10% after deductible 10% after deductible 10% coinsurance $4 Million application
Golden Rule Network - details 6804 Copay Saver SM 1500.0000 / 2 person maximum History and exam: '$35, X-ray & Lab not covered, 2 visits per person per year, including wellness visits History and exam: '$35, X-ray & Lab not covered, 2 visits per person per year, including wellness visits $35 (3 month waiting period), X-ray & Lab not covered, 2 visits per person per year, including wellness visits (In-Network coverage only) $3 million per covered person application
Network - details 6805 Copay Saver SM 2500.0000 / 2 person maximum History and exam: '$35, X-ray & Lab not covered, 2 visits per person per year, including wellness visits History and exam: '$35, X-ray & Lab not covered, 2 visits per person per year, including wellness visits $35 (3 month waiting period), X-ray & Lab not covered, 2 visits per person per year, including wellness visits (In-Network coverage only) $3 million per covered person application
Network - details 6806 Copay Saver SM 5000.0000 / 2 person maximum History and exam: '$35, X-ray & Lab not covered, 2 visits per person per year, including wellness visits History and exam: '$35, X-ray & Lab not covered, 2 visits per person per year, including wellness visits $35 (3 month waiting period), X-ray & Lab not covered, 2 visits per person per year, including wellness visits (In-Network coverage only) $3 million per covered person application
Network - details 6807 Copay Saver SM 7500.0000 / 2 person maximum History and exam: '$35, X-ray & Lab not covered, 2 visits per person per year, including wellness visits History and exam: '$35, X-ray & Lab not covered, 2 visits per person per year, including wellness visits $35 (3 month waiting period), X-ray & Lab not covered, 2 visits per person per year, including wellness visits (In-Network coverage only) $3 million per covered person application
Network - details 6808 Copay Saver SM 10000.0000 / 2 person maximum History and exam: '$35, X-ray & Lab not covered, 2 visits per person per year, including wellness visits History and exam: '$35, X-ray & Lab not covered, 2 visits per person per year, including wellness visits $35 (3 month waiting period), X-ray & Lab not covered, 2 visits per person per year, including wellness visits (In-Network coverage only) $3 million per covered person application
Network - details 5199 Copay Select SM 100% 500.0000 / 2 person maximum History and exam: $35 copay History and exam: $35 copay $35, 3 month waiting period, waived for Preventive Mammogram. Pap Smear (In Network coverage only) $3 million per covered person application
Network - details 5200 Copay Select SM 100% 1000.0000 / 2 person maximum History and exam: $35 copay History and exam: $35 copay $35, 3 month waiting period, waived for Preventive Mammogram. Pap Smear (In Network coverage only) $3 million per covered person application
Network - details 5201 Copay Select SM 100% 1500.0000 / 2 person maximum History and exam: $35 copay History and exam: $35 copay $35, 3 month waiting period, waived for Preventive Mammogram. Pap Smear (In Network coverage only) $3 million per covered person application
Network - details 5202 Copay Select SM 100% 2500.0000 / 2 person maximum History and exam: $35 copay History and exam: $35 copay $35, 3 month waiting period, waived for Preventive Mammogram. Pap Smear (In Network coverage only) $3 million per covered person application
Network - details 6809 Copay Select SM 100% 3500.0000 / 2 person maximum History and exam: $35 copay History and exam: $35 copay $35, 3 month waiting period, waived for Preventive Mammogram. Pap Smear (In Network coverage only) $3 million per covered person application
Network - details 5203 Copay Select SM 100% 5000.0000 / 2 person maximum History and exam: $35 copay History and exam: $35 copay $35, 3 month waiting period, waived for Preventive Mammogram. Pap Smear (In Network coverage only) $3 million per covered person application
Network - details 5204 Copay Select SM 100% 7500.0000 / 2 person maximum History and exam: $35 copay History and exam: $35 copay $35, 3 month waiting period, waived for Preventive Mammogram. Pap Smear (In Network coverage only) $3 million per covered person application
Network - details 5205 Copay Select SM 100% 10000.0000 / 2 person maximum History and exam: $35 copay History and exam: $35 copay $35, 3 month waiting period, waived for Preventive Mammogram. Pap Smear (In Network coverage only) $3 million per covered person application
Network - details 5185 Copay Select SM 20% 500.0000 / 2 person maximum History and exam: $35 copay History and exam: $35 copay $35, 3 month waiting period, waived for Preventive Mammogram. Pap Smear (In Network coverage only) $3 million per covered person application
Network - details 5186 Copay Select SM 20% 1000.0000 / 2 person maximum History and exam: $35 copay History and exam: $35 copay $35, 3 month waiting period, waived for Preventive Mammogram. Pap Smear (In Network coverage only) $3 million per covered person application
Network - details 5187 Copay Select SM 20% 1500.0000 / 2 person maximum History and exam: $35 copay History and exam: $35 copay $35, 3 month waiting period, waived for Preventive Mammogram. Pap Smear (In Network coverage only) $3 million per covered person application
Network - details 5188 Copay Select SM 20% 2500.0000 / 2 person maximum History and exam: $35 copay History and exam: $35 copay $35, 3 month waiting period, waived for Preventive Mammogram. Pap Smear (In Network coverage only) $3 million per covered person application
Network - details 6810 Copay Select SM 20% 3500.0000 / 2 person maximum History and exam: $35 copay History and exam: $35 copay $35, 3 month waiting period, waived for Preventive Mammogram. Pap Smear (In Network coverage only) $3 million per covered person application
Network - details 5189 Copay Select SM 20% 5000.0000 / 2 person maximum History and exam: $35 copay History and exam: $35 copay $35, 3 month waiting period, waived for Preventive Mammogram. Pap Smear (In Network coverage only) $3 million per covered person application
Network - details 5190 Copay Select SM 20% 7500.0000 / 2 person maximum History and exam: $35 copay History and exam: $35 copay $35, 3 month waiting period, waived for Preventive Mammogram. Pap Smear (In Network coverage only) $3 million per covered person application
Network - details 5191 Copay Select SM 20% 10000.0000 / 2 person maximum History and exam: $35 copay History and exam: $35 copay $35, 3 month waiting period, waived for Preventive Mammogram. Pap Smear (In Network coverage only) $3 million per covered person application
Network - details 5192 Copay Select SM 30% 500.0000 / 2 person maximum History and exam: $35 copay History and exam: $35 copay $35, 3 month waiting period, waived for Preventive Mammogram. Pap Smear (In Network coverage only) $3 million per covered person application
Network - details 5193 Copay Select SM 30% 1000.0000 / 2 person maximum History and exam: $35 copay History and exam: $35 copay $35, 3 month waiting period, waived for Preventive Mammogram. Pap Smear (In Network coverage only) $3 million per covered person application
Network - details 5194 Copay Select SM 30% 1500.0000 / 2 person maximum History and exam: $35 copay History and exam: $35 copay $35, 3 month waiting period, waived for Preventive Mammogram. Pap Smear (In Network coverage only) $3 million per covered person application
Network - details 5195 Copay Select SM 30% 2500.0000 / 2 person maximum History and exam: $35 copay History and exam: $35 copay $35, 3 month waiting period, waived for Preventive Mammogram. Pap Smear (In Network coverage only) $3 million per covered person application
Network - details 6811 Copay Select SM 30% 3500.0000 / 2 person maximum History and exam: $35 copay History and exam: $35 copay $35, 3 month waiting period, waived for Preventive Mammogram. Pap Smear (In Network coverage only) $3 million per covered person application
Network - details 5196 Copay Select SM 30% 5000.0000 / 2 person maximum History and exam: $35 copay History and exam: $35 copay $35, 3 month waiting period, waived for Preventive Mammogram. Pap Smear (In Network coverage only) $3 million per covered person application
Network - details 5197 Copay Select SM 30% 7500.0000 / 2 person maximum History and exam: $35 copay History and exam: $35 copay $35, 3 month waiting period, waived for Preventive Mammogram. Pap Smear (In Network coverage only) $3 million per covered person application
Network - details 5198 Copay Select SM 30% 10000.0000 / 2 person maximum History and exam: $35 copay History and exam: $35 copay $35, 3 month waiting period, waived for Preventive Mammogram. Pap Smear (In Network coverage only) $3 million per covered person application
HSA - details 5155 HSA 100® 1250.0000 / 2500 History and exam: No charge after deductible History and exam: No charge after deductible $35, 3 month waiting period, waived for Preventive Mammogram. Pap Smear $3 million per covered person application
HSA - details 5156 HSA 100® 2500.0000 / 5000 History and exam: No charge after deductible History and exam: No charge after deductible $35, 3 month waiting period, waived for Preventive Mammogram. Pap Smear $3 million per covered person application
HSA - details 6812 HSA 100® 3000.0000 / 6000 History and exam: No charge after deductible History and exam: No charge after deductible $35, 3 month waiting period, waived for Preventive Mammogram. Pap Smear $3 million per covered person application
HSA - details 5157 HSA 100® 3500.0000 / 7000 History and exam: No charge after deductible History and exam: No charge after deductible $35, 3 month waiting period, waived for Preventive Mammogram. Pap Smear $3 million per covered person application
HSA - details 5158 HSA 100® 5000.0000 / 10000 History and exam: No charge after deductible History and exam: No charge after deductible $35, 3 month waiting period, waived for Preventive Mammogram. Pap Smear (In-Network coverage only) $3 million per covered person application
HSA - details 5159 HSA 70 SM 1250.0000 / 2500 History & Exam: 30% after deductible History & Exam: 30% after deductible $35, 3 month waiting period, waived for Preventive Mammogram. Pap Smear (In-Network coverage only) $3 million per covered person application
HSA - details 5160 HSA 70 SM 2500.0000 / 5000 History & Exam: 30% after deductible History & Exam: 30% after deductible $35, 3 month waiting period, waived for Preventive Mammogram. Pap Smear (In-Network coverage only) $3 million per covered person application
HSA - details 6813 HSA 70 SM 3000.0000 / 6000 History & Exam: 30% after deductible History & Exam: 30% after deductible $35, 3 month waiting period, waived for Preventive Mammogram. Pap Smear (In-Network coverage only) $3 million per covered person application
HSA - details 5161 HSA 70 SM 3500.0000 / 7000 History & Exam: 30% after deductible History & Exam: 30% after deductible $35, 3 month waiting period, waived for Preventive Mammogram. Pap Smear (In-Network coverage only) $3 million per covered person application
HSA - details 5162 HSA 70 SM 5000.0000 / 10000 History & Exam: 30% after deductible History & Exam: 30% after deductible $35, 3 month waiting period, waived for Preventive Mammogram. Pap Smear (In-Network coverage only) $3 million per covered person application
Network - details 5163 Plan 100® 1500.0000 / 2 person maximum History and exam: No charge after deductible History and exam: No charge after deductible No charge after deductible $3 million per covered person application
Network - details 5164 Plan 100® 2500.0000 / 2 person maximum History and exam: No charge after deductible History and exam: No charge after deductible No charge after deductible $3 million per covered person application
Network - details 5165 Plan 100® 5000.0000 / 2 person maximum History and exam: No charge after deductible History and exam: No charge after deductible No charge after deductible $3 million per covered person application
Network - details 5166 Plan 100® 7500.0000 / 2 person maximum History and exam: No charge after deductible History and exam: No charge after deductible No charge after deductible $3 million per covered person application
Network - details 5167 Plan 100® 10000.0000 / 2 person maximum History and exam: No charge after deductible History and exam: No charge after deductible No charge after deductible $3 million per covered person application
Network - details 5168 Plan 80 SM 1500.0000 / 2 person maximum History and exam: '20% after deductible History and exam: '20% after deductible 20% after deductible $3 million per covered person application
Network - details 5169 Plan 80 SM 2500.0000 / 2 person maximum History and exam: '20% after deductible History and exam: '20% after deductible 20% after deductible $3 million per covered person application
Network - details 5170 Plan 80 SM 5000.0000 / 2 person maximum History and exam: '20% after deductible History and exam: '20% after deductible 20% after deductible $3 million per covered person application
Network - details 5171 Plan 80 SM 7500.0000 / 2 person maximum History and exam: '20% after deductible History and exam: '20% after deductible 20% after deductible $3 million per covered person application
Network - details 5172 Plan 80 SM 10000.0000 / 2 person maximum History and exam: '20% after deductible History and exam: '20% after deductible 20% after deductible $3 million per covered person application
Network - details 5173 Saver 80 SM 500.0000 / 2 person maximum Not Covered Not Covered Testing: 20% after deductible $3 million per covered person application
Network - details 5174 Saver 80 SM 1000.0000 / 2 person maximum Not Covered Not Covered Testing: 20% after deductible $3 million per covered person application
Network - details 5175 Saver 80 SM 1500.0000 / 2 person maximum Not Covered Not Covered Testing: 20% after deductible $3 million per covered person application
Network - details 5176 Saver 80 SM 2500.0000 / 2 person maximum Not Covered Not Covered Testing: 20% after deductible $3 million per covered person application
Network - details 5177 Saver 80 SM 5000.0000 / 2 person maximum Not Covered Not Covered Testing: 20% after deductible $3 million per covered person application
Network - details 5178 Saver 80 SM 7500.0000 / 2 person maximum Not Covered Not Covered Testing: 20% after deductible $3 million per covered person application
Network - details 5179 Saver 80 SM 10000.0000 / 2 person maximum Not Covered Not Covered Testing: 20% after deductible $3 million per covered person application
Humana PPO - details 2756 Autograph Share 80 Plus Rx 5000.0000 / 10000 $35 copay for 6 visits (conbined with specialty care visits), then 20% after deductible for subsequent visits $50 copay for 6 visits (combined with primary care visits), then 20% after deductible for subsequent visits 20% coinsurance ($300 of covered expenses per year); a 90 day waiting period applies $5 million application
PPO - details 2757 Autograph Share 80 Plus Rx 6000.0000 / 12000 $35 copay for 6 visits (conbined with specialty care visits), then 20% after deductible for subsequent visits $50 copay for 6 visits (combined with primary care visits), then 20% after deductible for subsequent visits 20% coinsurance ($300 of covered expenses per year); a 90 day waiting period applies $5 million application
HSA - details 2762 AutographTotal (HSA) 2000.0000 / 4000 No charge after deductible No charge after deductible No charge ($300 of covered expenses per year); a 90 day waiting period applies $2 million application
HSA - details 2763 AutographTotal (HSA) 3000.0000 / 6000 No charge after deductible No charge after deductible No charge ($300 of covered expenses per year); a 90 day waiting period applies $2 million application
HSA - details 2764 AutographTotal (HSA) 4000.0000 / 8000 No charge after deductible No charge after deductible No charge ($300 of covered expenses per year); a 90 day waiting period applies $2 million application
HSA - details 2765 AutographTotal (HSA) 5200.0000 / 10400 No charge after deductible No charge after deductible No charge ($300 of covered expenses per year); a 90 day waiting period applies $2 million application
HSA - details 2766 AutographTotal Plus Rx (HSA) 1500.0000 / 3000 No charge after deductible No charge after deductible No charge ($300 of covered expenses per year); a 90 day waiting period applies $5 million application
HSA - details 2767 AutographTotal Plus Rx (HSA) 2500.0000 / 5000 No charge after deductible No charge after deductible No charge ($300 of covered expenses per year); a 90 day waiting period applies $5 million application
HSA - details 2768 AutographTotal Plus Rx (HSA) 3500.0000 / 7000 No charge after deductible No charge after deductible No charge ($300 of covered expenses per year); a 90 day waiting period applies $5 million application
HSA - details 2769 AutographTotal Plus Rx (HSA) 5000.0000 / 10000 No charge after deductible No charge after deductible No charge ($300 of covered expenses per year); a 90 day waiting period applies $5 million application
PPO - details 2770 Monogram Total Plus Rx 7500.0000 / 15000 No charge after deductible No charge after deductible No charge ($300 of covered expenses per year); a 90 day waiting period applies $2 million application
PPO - details 2754 Portrait Share 80 Plus RX Unlimited 1000.0000 / 2000 $35 copay $50 copay 20% coinsurance ($300 of covered expenses per year); a 90 day waiting period applies $5 million application
PPO - details 2755 Portrait Share 80 Plus RX Unlimited 2500.0000 / 5000 $35 copay $50 copay 20% coinsurance ($300 of covered expenses per year); na 90 day waiting period applies $5 million application