Individual ISA (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
$35
Annual Physical*
You pay $0
Specialist Care Visit Consult Fee
$75 Visit Fee
Urgent Care Visit Consult Fee
$75
Lab Testing (at PCP or Urgent Care)
70% after ISA
X-Rays Read Fee
70% after ISA
Emergency Room
$300 visit fee
Maternity
$5000 Maximum
High cost and infrequent services
(e.g. Hospital Stay or Out-Patient Surgery)
(e.g. Hospital Stay or Out-Patient Surgery)
70% after ISA
2 month waiting Period
2 month waiting Period
Drug Discount Program
Included EnvisionRX
Maximum Limit Per Incident
N/A
Lifetime Maximum Limit
$1,000,000