Individual MSRA (member shared responsibility amount)
You choose:
$1,000, $2,500, $5,000 or $10,000
$1,000, $2,500, $5,000 or $10,000
Preventative Care
Eligible
Telemedicine (Available 24 hours a day)
You pay $0
Primary Care Visit
You pay 30% after MSRA
Specialty Care
$75 Consult Fee + Cost of Visit
(You pay 30% after MSRA)
(You pay 30% after MSRA)
Urgent Care Visit
Not Covered
Lab Testing
Not Covered
Emergency RoomÂ
(true Emergencies only)
(true Emergencies only)
You pay 30% after MSRA
High cost and infrequent services
(e.g. Hospital Stay or Out-Patient Surgery)
(e.g. Hospital Stay or Out-Patient Surgery)
You pay 30% after MSRA
Prescription Discount
Not Covered
In-Patient Pharmacy
Not Covered
Out-of-pocket Maximum
$10,000
Per Incident Maximum Limit
(the most the plan pays per incident)
(the most the plan pays per incident)
$250,000
Lifetime Maximum Limit
(the most the plan pays per lifetime)
(the most the plan pays per lifetime)
$1,000,000