Co-Pay Select 2500
Copyright 2008 First Mutual Insurance Group, Inc.
Features:
UnitedHealth One
$5,000,000 per person in Major Medical Coverage
One of the Strongest Rated Health Carriers in the Nation
PPO Coverage
UnitedHealth One
$5,000,000 per person in Major Medical Coverage
One of the Strongest Rated Health Carriers in the Nation
PPO Coverage
Medical Insurance
Individuals and Families
Group Insurance
Dental Insurance
Wellness..............................................................
Doctor Visits.........................................................
Specialists...........................................................
Urgent Care Center...............................................
Prescriptions........................................................
Emergency Room..................................................
Outpatient Surgeries/ Testing.................................
Inpatient Hospitalization.........................................
Annual Deductible Choice......................................
Co-Insurance Maximum Out Of Pocket....................
Doctor Visits.........................................................
Specialists...........................................................
Urgent Care Center...............................................
Prescriptions........................................................
Emergency Room..................................................
Outpatient Surgeries/ Testing.................................
Inpatient Hospitalization.........................................
Annual Deductible Choice......................................
Co-Insurance Maximum Out Of Pocket....................
$35 Co-pay, then 80% (No Deductible)
$35 Co-Pay, then 100% of History and Exam
$35 Co-Pay, then 100% of History and Exam
$35 Co-Pay, then 100% of History and Exam
Co-Pay Card Coverage
$100 Co-Pay, then 80% after annual Deductible
80% after Annual Deductible
80% after Annual Deductible
$2500 up to (2) per family
20% up to $3000 after Deductible
$35 Co-Pay, then 100% of History and Exam
$35 Co-Pay, then 100% of History and Exam
$35 Co-Pay, then 100% of History and Exam
Co-Pay Card Coverage
$100 Co-Pay, then 80% after annual Deductible
80% after Annual Deductible
80% after Annual Deductible
$2500 up to (2) per family
20% up to $3000 after Deductible
This is a simplified outline of benefits. Please refer to the plan brochure for full outline of benefits, limitations and exclusions.
Erik Marx
(800) 831-2958 ext. 103
(800) 831-2958 ext. 103