The Affordable Healthcare Solution
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What it is: Everyday Health Care Needs
- Preventative Care
- Primary Care & Specialists Office Visits
- Urgent Care Visits
- Imaging, X-ray Services and Laboratory Services
- Prescription Drugs
- Hospital Coverage (Super MEC Plus only)
- No Pre-Existing Conditions
- Prescription Drugs
- Hospital Coverage (Super MEC Plus only)
- No Pre-Existing Conditions
| SUPER MEC | SUPER MEC PLUS | |
| Network |  | |
| Plan Anniversary | December 31, 2020 | December 31, 2020 |
| Enrollment Deadline | 18th of month Prior to Effective date | 18th of month Prior to Effective date |
| Issue Ages | 18-64 | 18-64 |
| States Available | Available in All States | Available in All States |
| Medical Benefits - Must utilize PHCS participating provider or facility | ||
| Preventative Services | 100% Coverage for Mandated Preventative Services All 21 Preventative Services for Adults All 28 Preventative Services for Woman All 31 Preventative Services for Children | 100% Coverage for Mandated Preventative Services All 21 Preventative Services for Adults All 28 Preventative Services for Woman All 31 Preventative Services for Children |
| Primary Care Office Visit | $20 Copay (Max 3 Visits Per Cal/Yr.) | $20 Copay (Max 3 Visits Per Cal/Yr.) |
| Specialist Office Visit | $50 Copay (Max 3 Visits Per Cal/Yr.) | $50 Copay (Max 3 Visits Per Cal/Yr.) |
| Urgent Care | $50 Copay (Max 3 Visits Per Cal/Yr.) | $50 Copay (Max 3 Visits Per Cal/Yr.) |
| Diagnostic X-Ray, Lab | $50 Copay (Max 5 Visits Per Cal/Yr.) | $50 Copay (Max 5 Visits Per Cal/Yr.) |
| *CT Scan or MRI | $200 Copay (Max 1 CT Scan or MRI Visits Per Cal/Yr.) | $200 Copay (Max 1 CT Scan or MRI Visits Per Cal/Yr.) |
| **Hospital, Surgical, Ambulance, Emergency Room | Not Covered | *** $0 Deductible 50% Coinsurance to $5,000 Max Benefit $2,500 See Below for Exclusions |
| * 3D MRIs or Contrast Services for MRIs and CT Scans are not covered, pre-authorization required prior to scans. ** Hospitalization services must be obtained at an authorized PHCS Facility. Pre-Authorization required prior to admission for all in-patient, out-patient and surgical procedures. *** Exclusions for Hospital Benefit, Radiation Oncology and Chemotherapy. **** If a plan benefit is listed as an indemnity reimbursement: An Indemnity plan reimburses an insured after they submit a claim for a covered medical expense. This reimbursement pays the insured in addition to and regardless of any other insurance the insured may have. | ||
| Prescription Drugs | ||
| Rx Formulary |  | |
| Tier 1 - Low Cost Generics | $1 Copay | $1 Copay |
| Tier 2 - Generics | 10% Coinsurance | 10% Coinsurance |
| Tier 3 - Preferred Brand | 20% Coinsurance | 20% Coinsurance |
| Tier 4 - Non-Preferred Brand | 40% Coinsurance | 40% Coinsurance |
| Tier 5 - Generic and Preferred Specialty | 10% Coinsurance | 10% Coinsurance (Pays 90% up to a max of $150 per RX) |
| Tier 6 - Non-Preferred Specialty | 20% Coinsurance (Pays 80% up to a max of $250 per RX) | 20% Coinsurance (Pays 80% up to a max of $250 per RX) |
Teladoc
Teladoc provides members with on-demand 24/7 phone, email, and video access to U.S.-based licensed physicians for information, advice, and treatment including prescription medication when appropriate. Teladoc’s services are available anytime, anywhere. Members can use it from home, work or on the road.
www.teladoc.com/
