Individual MSRA (member shared responsibility amount)
You choose:
$1,000, $2,500 or $5,000
Preventative Care
Not Covered
Telemedicine (Available 24 hours a day)
You pay $0
Primary Care Visit
3 Visits
($50 Consult Fee)
Specialty Care
$75 Consult Fee + Cost of Visit
(You pay 20% after MSRA)
Urgent Care Visit
1 Visit
($100 Consult Fee)
Lab Testing
Not covered
Emergency Room 
(true Emergencies only)
You pay 20% after MSRA
High cost and infrequent services
(e.g. Hospital Stay or Out-Patient Surgery)
You pay 20% after MSRA
Prescription Discount
You pay 20% after MSRA
In-Patient Pharmacy
Not covered
Out-of-pocket Maximum
$5,000
Per Incident Maximum Limit
(the most the plan pays per incident)
$500,000
Lifetime Maximum Limit
(the most the plan pays per lifetime)
$1,000,000