Plan Details

Plan Details

Your healthcare coverage is important to us. Age, family status, medical conditions, hobbies, lifestyle and a myriad of other factors will help you determine if you need a lot or a very little amount of health coverage. This summary will help you understand your plan and its coverage.  


Summary of Medical Benefits

$3,000 Copay Plan

Tier 1: Missouri Health Cooperative

Tier 2: Healthlink/First Health

Out-of-Network

Deductible

Individual

Individual Under Family

Family

 

$0

$0

$0

 

$3,000

$3,000

$6,000

 

$6,000

$6,000

$12,000

Out-of-Pocket Maximum

Individual

Individual Under Family

Family

 

$0

$0

$0

 

$6,000

$6,000

$12,000

 

$12,000

$12,000

$24,000

Preventive Care Services

No Charge

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

No Charge

No Charge

No Charge

 

$35 Copay

$55 Copay

20%*

 

50%*

50%*

50%*

Urgent Care Services

No Charge

$75 Copay

$75 Copay

Complex Imaging: MRI/CT/PET Scans

No Charge

20%*

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

No Charge

No Charge

 

20%*

20%*

 

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

No Charge

No Charge

 

20%*

20%*

 

50%*

50%*

Emergency Room

Facility Fee

Physician Fee

Medical Transportation

 

No Charge

No Charge

No Charge

 

$500 Copay

No Charge

20%*

 

$500 Copay

No Charge

20%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

No Charge

No Charge

 

20%*

$35 Copay

 

50%*

50%*

Prescription Drug Coverage

Generic

Preferred Brand

Non-Preferred Brand

Specialty Drugs

Retail 30 Day Supply

No Charge

$35 Copay

$75 Copay

$200 Copay

Mail Order 90 Day Supply

No Charge

$70 Copay

$150 Copay

Not Available

 

 

 

 

 

NOTE: * Coinsurance after deductible

Please refer to your Summary Plan Description for actual coverage, limitation, and exclusion provisions

 

 

 

 

 

 


If you prefer talking with a HealthEZ representative, call 844-678-9688