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Covered Benefits

All of our group health plan designs provide the following benefits:

Physician Office Visits

Coverage for professional services performed in the doctor’s office such as exams, consultations and surgical services are subject to either deductible and/or co-insurance provisions, OR an office visit co-pay for primary care and specialist professional services. Eligible expenses above this amount are subject to deductible and co-insurance.

Preventive and Wellness Services

All eligible preventive and wellness-related services are covered at 100%.

Outpatient Lab Services

All outpatient lab services are covered at 100% through DirectHealth, the plan's preferred lab services organization. Otherwise outpatient lab services are subject to deductible and co-insurance provisions.

Therapy and Chiropractic Services

Subject to deductible and co-insurance, unless specific co-pay provisions have been built into the plan benefit design for the sponsoring employer.

 

Urgent Care and Emergency Room Services

Urgent Care and Emergency Room services are provided subject to co-pay in most plan designs.

Outpatient Diagnostic Services

Subject to deductible and co-insurance. A freestanding non-facility incentive is provided for all diagnostic services performed outside of a hospital setting.

Outpatient Surgery

Subject to deductible and co-insurance. A freestanding non-facility incentive is provided for all outpatient surgery services performed outside of a hospital setting.

Inpatient Hospital Services

Subject to deductible and co-insurance.

 

Prescription Benefits

Tiered co-pays and/or co-insurance based on formulary. Rx benefits may be subject to deductible and co-insurance for some benefit plans based on specific provisions.

Annual and Lifetime Benefits

Beginning in 2014, Annual Maximums are unlimited, as mandated by Federal Law.

The information outlined above provides the general plan of benefits designed into all Lifestyle Health Plan offerings. Detailed descriptions, eligible expenses, and exclusions are described in the Summary Plan Description. 

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