The PatriotCare Premium Plan combines unlimited outpatient visits (primary care, specialists, urgent care), annual wellness exam and preventive care, prescription benefits, 24/7 virtual urgent care and virtual behavioral health beneifts with comprehensive healthcare benefits facilitated through a medical share plan which provides for emergency room visits, hospitalization, surgery, maternity and more.
Comprehensive Care benefits are facilitated through a medical share plan. There are no network requirements for comprehensive care needs. The maximum out-of-pocket expense (IUA) for comprehensive care needs is either $1000 or $2500. This out-of-pocket cost is limited to a maximum charge of 3 times within a 12 month calendar period from the date of first comprehensive care event. If there a more than 3 comprehensive care needs within the same 12 month period, no additional out-of-pocket expense is assessed and the plan covers 100% for all eligble comprehensive care needs. There are no annual or lifetime limits to the amount or frequency of comprehensive care benefits. | |||
Network Requirement | No network requirement for comprehensive care needs | ||
Max. Out-of-Pocket (IUA) | $1000 or $2500 IUA is applied per comprehensive care needs/per plan. Maximum 3 times within same 12 month period from the date of the first comprehensive care need. | ||
Inpatient Benefits | |||
Hospitalization includes admission and confinement | Covered 100% for all shareable medical needs after $1000 or $2500 IUA is met | ||
Intensive Care Unit and sub-acute ICU | Covered 100% for all shareable medical needs after $1000 or $2500 IUA is met | ||
Emergency Room admission | Covered 100% for all shareable medical needs after $1000 or $2500 IUA is met | ||
Surgery includes anesthesia | Covered 100% for all shareable medical needs after $1000 or $2500 IUA is met | ||
Diagnostic Labs and Imaging (PET, CT, MRI, X-ray, EEG, Lab Tests, Gastroenterology) | Covered 100% for all shareable medical needs after $1000 or $2500 IUA is met | ||
Physician and Specialist doctor visits during hospital stay | Covered 100% for all shareable medical needs after $1000 or $2500 IUA is met | ||
Outpatient Benefits | |||
Surgery includes anesthesia, physican, and facility fees | Covered 100% for all shareable medical needs after $1000 or $2500 IUA is met | ||
Physical rehabilitation therapy | Covered 100% for all shareable medical needs after $1000 or $2500 IUA is met | ||
Diagnostic Labs and Imaging (PET, CT, MRI, X-ray, EEG, Lab Tests, Gastroenterology) | Covered 100% for all shareable medical needs after $1000 or $2500 IUA is met | ||
Outpatient physican and specialist visits related to comprehensive care needs | Covered 100% for all shareable medical needs after $1000 or $2500 IUA is met | ||
Maternity Benefits | |||
Pre-natal Physician and OBGYN visits | Covered 100% for all shareable medical needs after $1000 or $2500 IUA is met | ||
Birth / Delivery (hospital, birthing center, at home) | Covered 100% for all shareable medical needs after $1000 or $2500 IUA is met | ||
Surgery (mother and child) | Covered 100% for all shareable medical needs after $1000 or $2500 IUA is met | ||
Hospital admission and confinement (mother and child) | Covered 100% for all shareable medical needs after $1000 or $2500 IUA is met | ||
NICA and sub-acute NICU | Covered 100% for all shareable medical needs after $1000 or $2500 IUA is met | ||
Emergency Room with admission | Covered 100% for all shareable medical needs after $1000 or $2500 IUA is met | ||
End of Life Benefits | |||
Shareable for all services required at time of detah for a particpating active member. End of life benefit is paid once per decedent. | |||
Primary member or spouse | $10,000 | ||
Child dependent | $2,500 |
Outpatient services not related to a comprehensive care need are facilitated through the Multiplan PHCS network. | |||
Primary Care Doctor Visits | $15 co-pay | In-network Benefit Only | |
Specialist Doctor Visits | $15 co-pay | In-network Benefit Only | |
Urgent Care Visit Visits | $50 co-pay | In-network Benefit Only | |
Annual Wellness Exam & Preventive Care | Covered 100% | In-network Benefit Only |
COVERED WELLNESS & PREVENTIVE CARE SERVICES ANNUAL WELLNESS EXAM
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PREVENTIVE SERVICES ADULTS (AGES 18+)
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PREVENTIVE SERVICES WOMEN (AGES 18+)
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PREVENTIVE SERVICES CHILDREN (AGES 0-17)
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Prescription drug benefits are subject to the formulary drug list. Co-pay amounts listed are based on a unit quantity of 30 for a 30-day supply. Pricing may vary based on quantity and supply. | |||
Tier I medications | $15 co-pay | ||
Tier II medications | $30 co-pay | ||
Tier III medications | $50 co-pay | ||
Tier IV medications | $75 co-pay |
Virtual Care program includes unlimited 24/7 access to virtual urgent care with board-certified doctors via phone, video or messaging and connects members with a Psychiatrist or Licensed Counselor through secure and private online video or phone sessions at $50 each (first 3 visits - $85 after). | |||
24/7 Virtual Urgent Care | 100% covered | ||
Virtual Behavioral Health | $50 fee (first 3 visits then $85 fee after) |