Get a Plan that Gives You More

Primary Care Doctor Copay

$0

Primary Care Doctor Copay

$0
$10 Out-of-Network

Primary Care Doctor Copay

$0

Monthly Premium

$0

Monthly Premium

$0

Monthly Premium

$0

Specialist Copay

$20

Specialist Copay

$35 in-network,
$60 out-of-network*

Specialist Copay

$20

Inpatient Hospital Care

$150 copay per day for days 1-4;
$0 copay per day for days 5-90

Inpatient Hospital Care

$375 copay per day for days 1-5;
$0 copay per day for days 6-90 in-network
40% out-of-network

Inpatient Hospital Care

$325 copay per day for days 1-5;
$0 copay per day for days 6-90

Emergency Care

$125

Emergency Care

$125

Emergency Care

$125

Prescription Drug Coverage

Yes

Prescription Drug Coverage

Yes

Prescription Drug Coverage

No

Dental (Preventive & Comprehensive)

$2,500 P&C limit;
0% coinsurance

Dental (Preventive & Comprehensive)

$2,000 P&C limit;
0% coinsurance

Dental (Preventive & Comprehensive)

$1,500 P&C limit;
0% coinsurance
$25 deductible

One Pass ^® Fitness

Included

One Pass ^® Fitness

Included

One Pass ^® Fitness

Included

Transportation to and from Medical Appointments

Unlimited

Transportation to and from Medical Appointments

10 one-way rides for all members; Unlimited for qualifying chronic conditions

Transportation to and from Medical Appointments

Unlimited

OTC Allowances

$25 per quarter

OTC Allowances

$25 per quarter

OTC Allowances

$25 per quarter

Eligible Counties

Brazoria, Fort Bend, Galveston (excluding the island), Harris, Montgomery

Eligible Counties

Austin, Brazoria, Chambers, Fort Bend, Galveston (excluding the island), Grimes, Harris, Liberty, Montgomery, San Jacinto, Walker, Waller, Wharton

Eligible Counties

Austin, Brazoria, Chambers, Fort Bend, Galveston (excluding the island), Grimes, Harris, Liberty, Montgomery, San Jacinto, Walker, Waller, Wharton