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Essential KeyCare®'  |
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| The Basics – how your coverage works |
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| In-Network PPO Network of Providers. No gatekeepers or referrals. |
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| Deductible | Coinsurance | Expense Limit | |
| $500 $1,500 $2,500 Family deductible/out-of-pocket expense limit = 2x single deductible/out-of-pocket expense limit |
30% | $2,500 | |
| Out-of-Network Use any provider. You will be responsible for more of the cost with an out-of-network provider. No gatekeepers or referrals. |
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| Deductible | Coinsurance | Expense Limit | |
| $2,500 | 40% | $5,000 | |
| After the Deductible, you pay a Coinsurance amount, with an annual Out-of-Pocket Expense Limit. This Expense Limit helps control your annual out-of-pocket expenses by limiting the amount you pay in Coinsurance. | |||
| The Details – the benefits and your share of the cost Lifetime Maximum: $2 Million regardless of providers or facilities |
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| Hospital Inpatient & Outpatient Care |
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| In-Network | After deductible, you pay: 30% | ||
| Out-of-Network | After deductible, you pay: 40% | ||
| Emergency Care |
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| In-Network | After deductible, you pay 30% coinsurance, in or out-of-network3 | ||
| Out-of-Network | After deductible, you pay 30% coinsurance, in or out-of-network3 | ||
| Doctor Visits |
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| In-Network | First 3 yearly visits: $30 copayment. Covered before deductible. Remaining visits: 30% Covered after deductible. |
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| Out-of-Network | You pay: 40% | ||
| Prescription Drugs |
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| Separate $200 yearly deductible per person. You pay $15 or 40%, whichever is greater. Coverage for generic drugs only Yearly Benefit Maximum: $5,000 per person |
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| Routine Wellness |
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| In-Network | Doctor Visits for Routine Wellness Care One yearly visit per person. If included with first 3 yearly doctor visits, covered before deductible, and you pay $30 copayment. If after first 3 yearly doctor visits, covered after the deductible, and you pay 30%. Routine Screenings Covered after deductible. You pay 30%. |
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| Out-of-Network | After deductible, you pay: 40% (combined with in-network visits) |
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| Preventive Care and Immunizations for Children Coverage for immunizations only. Optional coverage available. |
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| In-Network | After deductible, you pay: 30% | ||
| Out-of-Network | After deductible, you pay: 40% | ||
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GET INSTANT QUOTES and APPLY ONLINE