Connecting People to Affordable Healthcare
Connecting People to Affordable Healthcare
This form is a benefit highlight representing a brief description of the coverage available. Additional covered services, exclusions and limitations exist. Specific services including inpatient hospital, maternity and outpatient surgery are subject to pre-certification.
The out-of-pocket maximum refers to covered services only. Specific services, including emergency and hospital services, are subject to reference-
based pricing (see definition below) and patients may be billed beyond the out-of-pocket maximum for these services.
Offered through Recuro Health
Coinsurance applies after the deductible
Coinsurance applies after the deductible
Coinsurance applies after the deductible
Coinsurance applies after the deductible
Coinsurance applies after the deductible. (limit 1 per year)
(subject to above limits)
(limit 1 per year) (Subject to Reference-Based Pricing)4
(limit 5 days & 2 surgeries per year) (Subject to Reference-Based Pricing)4
(limit 1 per year) (Subject to Reference-Based Pricing)4
Coinsurance applies after the deductible (limit 1 per year) (Subject to Reference-Based Pricing)4
Coinsurance applies after the deductible (limit 8 combined per year)
Coinsurance applies after the deductible (limit 10 per year)
Coinsurance applies after the deductible (limit 10 per year)
(limit 8 per year) (Subject to Reference-Based Pricing)4
(limit 5 per year) (Subject to Reference-Based Pricing)4
Qualifying event would require a certificate of creditable coverage (COCC) and seek coverage on the individual exchange
(Subject to Reference-Based Pricing)4
(Subject to Reference-Based Pricing)4
Prescription drug benefits are subject to the formulary drug list. Copay amounts listed are based on a unit quantity of 30 for a 30-day supply. Pricing may vary based on quantity and supply.
1The out-of-pocket maximum refers to covered services only. Specific services are subject to Reference-Based Pricing (RBP) and patients may be billed beyond the out-of-pocket maximum for these services. 2Specific services, including advanced imaging, surgical procedures and maternity require pre-certification. Failure to obtain pre-certification will result in a denial of benefits. 3Medmo is a concierge scheduling service for radiology and imaging allowing members to maximize their benefits while minimizing costs to the patient. 4RBP reimburses providers using a percentage of Medicare coverage as the reference point for the reimbursement total. This plan pays up to 125% of the Medicare allowable coverage for applicable services. Patients will be responsible for paying any remaining balance beyond the provider reimbursement amount.
The plan outlined below is compliant with Employer Penalty “B” as outlined by ACA. It also satisfies the
individual mandate penalty in applicable states.
Minimum participation requirement of 5 lives enrolled in MV plans or 10 lives (5/5) when offered in combination with MEC plans. $750 annual fee paid at the time of
implementation and renewal.