Benefits in blue: Subject to MSRA
Benefits in black: Not subject to MSRA
Individual MSRA (member shared responsibility amount)
You choose: $1,000, $2,500, $5,000 or $10,000
Preventative Care
You pay $0
Telemedicine (Available 24 hours a day)
You pay $0
Primary Care Visit Consult Fee
$20
Annual Physical*
You pay $0
Specialist Care Visit Consult Fee
$75
Urgent Care Visit Consult Fee
$75
Lab Testing (at PCP or Urgent Care)
You pay $0
X-Rays Read Fee
You pay $0
Emergency Room
You pay up to $150 MSRA
High cost and infrequent services
(e.g. Hospital Stay or Out-Patient Surgery)
(e.g. Hospital Stay or Out-Patient Surgery)
You pay $0 after MSRA
up to $500,000 per incident
up to $500,000 per incident
Drug Discount Program
Included
Lifetime Maximum Limit
(the most the plan pays per lifetime)
(the most the plan pays per lifetime)
$1,000,000
- Surgical services do not include cosmetic surgery.
- Hospitalization, In-Patient and Out-Patient Surgery, Specialty Care, and Emergency Room services for pre-existing conditions have a 24 month waiting period. All other healthcare services for pre-existing conditions are eligible upon effective date.
- Eligibility for cancer conditions is provided after 12 months of continuous membership, if a pre-existing cancer condition did not exist prior to or at the time of application.
- The specialist consult fee does not apply toward your annual MSRA, but it is waived after you reach your MSRA. The specialist visit may require additional services which will incur out of pocket expenses beyond the consult fee; these additional expenses will be counted toward the MSRA.
- Maternity services are unavailable for the first 10 months of membership.
- ER visits are subject to review, and are meant only for life threatening situations. Maximum out-of-pocket is $300 for the Premium plan.
- Members under the age of 20 can qualify as dependents. Members ages 20–26 can qualify as a dependent if proven to be a full-time student.
* Annual physicals are available immediately at the cost of a Primary Care (PCP) visit. Free inclusive annual physicals are available after 9 months of continual membership; lifestyle lab testing not included.