MAJOR MEDICAL PLAN

OPEN ACCESS NETWORK*

Includes Multiplan Practitioner & Ancillary PPO for office visits & routine care**

Plan Rates Subject to Taxes and Admin Fees

COVERAGES

Co-Pays:

. Primary Care — $25 Copay

. Specialist — $50 Copay

. Urgent Care — $75 Copay

. Emergency Room — $750 Copay

Deductible:

. $2,500 Individual / $5,000 Family

Out of Pocket Maximum:

. $9,100 Individual / $18,200 Family

THIS PLAN INCLUDES

. Nationwide Access — See Any Doctor or Facility

. Preventive Care Covered at 100%

. Unlimited Telehealth Services

. Prescription Drug Coverage Included

. Advocacy Support for Billing Issues

For full coverage details, click MORE DETAILS below

*Hospital and facility care is paid at a set, nationwide benchmark rate rather than through a fixed network — so you’re never limited to a narrow list of hospitals. For office visits and routine care, using a Multiplan Practitioner & Ancillary provider gives you the simplest billing experience. If a facility doesn’t accept the benchmark rate, our team handles it directly on your behalf.

**Claims administrator is Imagine360 and not Multiplan.

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