This plan is good for an individual who wants a reasonable deductible along with low copayments for common medical services. You'll receive your first three primary care doctor visits for $0 and any additional visits are $25. As with all Network Health plans, preventive services are $0. In addition, you get a $0 annual vision exam and dental exam for each covered member. The below chart details the benefits of this plan.
This plan is also available without dental and vision benefits.
Prestige Silver Essential Plan Highlights |
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DEDUCTIBLE |
Individual |
$4,600 |
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Family |
$9,200 |
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COINSURANCE |
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40% |
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OUT-OF- |
Individual |
$9,100 |
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Family |
$18,200 |
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BENEFITS |
Preventive Care |
$0 |
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Routine Vision Exam |
$0 |
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Annual Dental Exam |
Reimbursement |
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Personal Doctor Visit |
$0 for first three visits, per family member, then $25 per visit |
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Virtual Visit |
$0 per visit |
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Specialist Visit |
$80 per visit |
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Chiropractic |
40% after deductible |
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Hospital Stay |
40% after deductible |
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Emergency Room |
$500 after deductible per visit |
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X-ray and Diagnostic Imaging |
$60 per visit |
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All Network Health’s Prestige plans have built-in pharmacy benefits. See the chart below for prescription drug coverage information.
Prestige Silver Essential Pharmacy Benefit Highlights |
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Retail |
Preventive Drugs |
$0 |
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Tier 1 Generic and Adherence Generic Drugs Adherence Generics are limited to specific medications to treat certain conditions and are designated in the comprehensive drug list with the label “$0” and are available at no cost, subject to applicable deductible |
$20 |
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Tier 2 Preferred Brand Drugs |
$80 |
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Tier 3 Non-Preferred Brand Drugs |
50% after deductible |
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Tier 4 Preferred Specialty Drugs |
40% after deductible |
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Tier 5 Non-Preferred Specialty Drugs |
50% after deductible |
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