Plan Details

Summary Of Medical Benefits

MEC Plus

In-Network

Out-Of-Network

Deductible

Employee Only

Family

N/A

Out-Of-Pocket Maximum

Employee Only

Family

N/A

Annual Maximum Plan Payment per Member- Non-Preventive Services

Annual Maximum Plan Payment per Member- Generic, Non-Preventive Prescription Drug Services

$4,000

Preventive Care

100% Covered

No Coverage

Office Visits

Primary Services

Specialist Services

Chiropractic Services

$20 Copay

$50 copay

No Coverage

Urgent Care Services

$50 Copay

No Coverage

Emergency Services

Emergency Room

Emergency Medical Transportation

No Coverage

Hospital Services

No Coverage

Labs & Scans

Office Visit Lab

Outpatient Lab

Outpatient X-Ray

Outpatient Major Diagnostic

$20 Copay

$60 Copay

$200 Copay

No Coverage

Mental Health / Chemical Dependency

Inpatient

Outpatient

No Coverage

Telemedicine Benefits

General Consultations

Dermatology

Mental Health - Therapist

Mental Health - Psychiatrist, Initial Evaluation

Mental Health - Psychiatrist, Ongoing Session

$55 Copay

$85 Copay

$100 Copay

$220 Copay

$90 Copay

$55 Copay

$85 Copay

$100 Copay

$220 Copay

$90 Copay

Prescription Drug Coverage

Preventative

Non-Preventative Generic

Non-Preventative Preferred Brand

Non-Preventive Non-preferred brand

Non-Preventive Specialty

Retail 30 Day Supply

100% Covered

$10 Copay

No Coverage

Mail Order 90 day Supply

100% Covered

No Coverage

Not Available

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