A Wise Plan

Plan Overview

Peak

$15/$25 office visits, 80% coverage after deductible for hospitalization.
The deductible does not apply to services with fixed copays such as office visits, urgent care visits, emergency room, etc.
Premiums are a little higher than the Peak Traditional plan, but fixed copays on many services help you control your out-of-pocket costs all year long.
Three-tier prescription coverage - No deductible.

Peak Traditional

Most services are covered at 80% after deductible is met.
Office visits to primary care type providers are paid at 90% coverage after deductible.
Lower premiums than the Peak plan.
Higher deductible options - this plan is perfect for those who want to keep their monthly premiums as low as possible and assume responsibility for a larger portion of their day-to-day medical expenses.
Three-tier prescription coverage - No deductible.

Both Plans

Utilize the "Premier Network" with over 2,700 providers.
Are Open Access - this means that you don't choose a Primary Care Physician and you don't

24-Hour Coverage is a available option.
Includes coverage for Chiropractic services.

The deductible does not count toward the out-of-pocket maximum.
Not all services count toward the out-of-pocket maximum.

Plan Options | Benefit Summary Comparison

Benefits

Peak

Peak Traditional

Calendar Deductible Options
*Deductibles do not apply to the Out-of-Pocket Maximum

Individual
$0
$250
$500

Family
$0
$500
$1,000

Individual
$500
$1,000
$2,000

Family
$1,000
$2,000
$4,000

Out-of-Pocket Maximum
*Not all benefits apply to the Out-of-Pocket Maximum.

$2,000/Individual
$4,000/Family

Lifetime Maximum

$2,000,000/Person

Pre-Existing Waiting Period

12 Months

Hospitalization

Room and Board

Inpatient Physician

Surgeon & Anesthesiologist

You Pay 20% After Deductible

Maternity

Outpatient Care

Physician Delivery Fee

Hospital Room & Board

$5,000 Deductible8 per occurrence;
100% Coverage Thereafter

Out-Patient Care

Preventive care - including annual physicals, immunizations, etc. when seen by Primary Care Provider

$15 copay* - No Deductible

You Pay 10% After Deductible

Office Visits - Primary Care

$15 copay* - No Deductible

You Pay 10% After Deductible

Office Visits - After Hours

$25 copay* - No Deductible

You Pay Applicable Primary Care or Specialist Coinsurance After Deductible.

Office Visits - Specialist

$25 copay* - No Deductible

You Pay 20% After Deductible

Minor Lab/X-ray (including Mammography)

100% coverage - No Deductible

You Pay 20% After Deductible

Major Lab/X-ray (including CT scan, MRI/MRA)

You Pay 20% After Deductible

Out-Patient Surgery

You Pay 20% After Deductible

Physiotherapy - Physical, occupational and speech, 10 visits each type per member per calendar year

You Pay 20% After Deductible

Outpatient Hospital Services - including chemotherapy, radiation therapy, dialysis

You Pay 20% After Deductible

Eye Exams - Optometrist

$15 copay* - No Deductible

You Pay 10% After Deductible

Urgent & Emergency Care

Emergency Room Care (in or out of area)

$75 per visit* - Participating Hospital
$150 per visit* - Non-Participating
Hospital - No Deductible

You Pay 20% After Deductible

Urgent Care at physician's office

$25 copay* - No Deductible

You Pay Applicable Primary Care or Specialist Coinsurance After Deductible.

Urgent Care at participating facility

$25 copay* - No Deductible

You Pay 20% After Deductible

Urgent Care - out-of-area

$25 copay* - No Deductible

You Pay 20% After Deductible

Ambulance, paramedics, air ambulance

You Pay 20% After Deductible

Other Benefits

Durable Medical Equipment - $5,000 max per member per calendar year

You Pay 20% After Deductible

Medical Supplies

You Pay 20% After Deductible

Accident-Related Dental Services - $1,000 lifetime maximum

You Pay 50% After Deductible

Allergy Conditions

Testing and treatment.....................

Injections.......................................

Serum............................................

$25 copay* - No Deductible

100% Coverage

You Pay 20% After Deductible

Skilled Nursing Facility - Limited to 30 days per calendar year

You Pay 20% After Deductible

Home Health Care - Limited to 30 visits per calendar year

You Pay 20% After Deductible

Hospice

You Pay 20% After Deductible

Infertility - Diagnostic only - Limited to $1,500 per member per calendar year, $5,000 lifetime maximum

You Pay 50% After Deductible

Neuropsychological Testing

You Pay 50% After Deductible

Adoption Benefit

Plan pays $3,155 per adoption

Chiropractic Care - 10 visits per member per calendar year

$25 copay* - No Deductible

You Pay 20% After Deductible

Mental Health / Substance Abuse

These Services are NOT COVERED

NOT COVERED

Prescription and Injectable Medications

Prescription Drugs

$10 generic, $25 formulary name-brand, $50 non-formulary* - No Deductible

$10 generic, 50% formulary name-brand, 50% non-formulary* - No Deductible

Injectable Medications - Rec'd from hospital, physician, home health or pharmacy

You Pay 20% After Deductible

Note: Services on the Peak plan with a fixed copay (office visits, emergency room and pharmacy) are not subject to the deductible and do not count toward the satisfaction of the out-of-pocket maximums. This is a partial representation of the benefits offered on these plans.
* DOES NOT apply to the Out-of-Pocket Maximum. You continue to pay copays or coinsurance for these services after you reach your Out-of-Pocket Maximum.