Prescription Drugs
For most plans, you pay only $15 each time
you fill a generic prescription at a participating
pharmacy. Under all plans, coverage is for the
price of generics—or for the price of brand name
prescriptions when a generic equivalent is not
available—at a participating pharmacy.
Preventive Services
Includes mammograms, Pap smears and PSA
screening—with no special limits—as well as benefits
up to $500 ($750 for MaxPlan) for other preventive
services including physical exams, laboratory tests,
immunizations, tuberculosis tests and colonoscopies.
Office Visits
Includes evaluation, diagnosis and management of
illness or injury, and allergy shots.
Imaging and Laboratory Services
Includes x-rays, ultrasounds, CAT scans, MRIs, lab
tests and interpretation.
Outpatient Hospital, Surgical Center and
Urgent Care Facilities
Includes the services of the facility and
miscellaneous supplies.
Professional Ground and Air Ambulance
Coverage is for emergency transportation—not just
to the closest hospital—but to the nearest hospital
equipped to provide appropriate care.
Emergency Room
Includes the services of the facility and miscellaneous
supplies. Benefits for covered emergency services
are always paid at the higher network benefit
percentage—even if you are out of network.
Health Care Practitioner Services
Includes the services of doctors, surgeons, assistant
surgeons, anesthesiologists, physician assistants
and nurses.
Outpatient Physical Medicine
Includes physical, speech and occupational therapies,
cardiac and pulmonary rehabilitation, and treatment
of developmental delay. Chiropractic is also covered
under most plans.
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Inpatient Hospital
Includes the services of the facility such as semiprivate
room and board, intensive care (including
specialty units such as neonatal and cardiac intensive
care) and miscellaneous supplies.
Transplants
MaxPlan, CoreMed and OneDeductible plans cover:
- Kidney, cornea and skin transplants with no
special limits.
- Transplants such as bone marrow, heart, liver
and lung with no special limits when performed
at a designated transplant provider—you and
your doctor select a provider from more than
80 facilities nationwide.
- Up to $10,000 toward travel expenses to a
designated transplant provider.
- Up to $10,000 toward donor expenses.
- Transplants other than kidney, cornea or skin that
are not performed at a designated provider––up to
a lifetime benefit maximum of $100,000 per person.
RightStart and SaveRight HSA plans cover
transplants up to the applicable annual maximums—
and include up to $10,000 toward donor expenses.
Complications of Pregnancy
MaxPlan, CoreMed and OneDeductible plans
cover emergency Caesarean section and any
sickness associated with pregnancy except
hyperemesis gravidarum.
RightStart and SaveRight HSA plans cover medically
necessary Caesarean section, ectopic pregnancy,
miscarriage, gestational diabetes mellitus and medical
conditions distinct from, but adversely affected by,
pregnancy.
And all these services as well:
- Dental injuries
- Diabetic services
- Durable and personal medical equipment
- Hospice care and related counseling services
(inpatient or home care)
- Inpatient rehabilitation
- Parenteral drug therapy
- Reconstructive surgery
- Skilled nursing and subacute rehabilitation facilities
- Sterilization ($500 lifetime maximum)
- Treatment of TMJ/CMJ ($1,000 lifetime maximum)
Some plans offer even more!
Look for these features included with plans that
provide the broadest coverage:
- Behavioral health and substance abuse
- Home health care
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