Elite Health Plus
Elite Health Plus:
- Preventive Services
- Co-Pay Visits for PCP/SPC/UC
- Labs/Imaging
- Emergency Room
- Hospital Room & Board
- Enhanced Prescription Coverage
- Unlimited $0 Telehealth Consults
- Access to Rightway Healthcare. With Rightway, you have a dedicated (real, live) health guide that can help you find the best doctor and book your appointment, get upfront pricing on medical visits, review and dispute bills, answer your health insurance questions, and more. With this simple-to-use-app, your health guide is there to answer all of your healthcare questions, no matter how big or how small. You can use Rightway for free as part of your benefit purchase.
Click here for Vault Elite Health Plus brochure
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Elite Health Plus Pricing |
|
|
Member |
$377.68 |
|
Member + Spouse |
$652.65 |
|
Member + Child(ren) |
$567.16 |
|
Member + Family |
$857.16 |
|
Deductible |
|
|
Individual |
$2,500 |
|
Family |
$5,000 |
|
Out of Pocket Maximum |
|
|
Individual |
N/A |
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Family |
N/A |
|
Plan Benefits |
|
|
Preventive & Wellness Physicians Visits |
$0 Copay |
|
Telemedicine |
$0 Consult Fee |
|
Primary Care Office Visit |
$35 Copay |
|
Specialist Office Visit |
$75 Copay |
|
Laboratory Services - Per Panel Tested |
$100 Copay |
|
Radiology - Per Image Billed |
$50 Copay |
|
CT/MRI/MRA/PET Scans - Per Imaged Billed |
$500 Copay Per Image Billed |
|
Outpatient Services - Limited to Mental & Behavioral Health and Substance Abuse |
Specialist Office Visit Copay |
|
Other Outpatient Services |
Not Covered |
|
Urgent Care |
$150 Copay |
|
Emergency Room Services |
After deductible, $400 Copay then 50% coinsurance - Limited to 1 visit per plan year |
|
Hospital Inpatient Room & Board Per Admission (includes Mental & Behavioral Health or Substance Abuse) |
After deductible, $500 Copay then 60% coinsurance - Combined limit of 5 days |
|
Preventative Prescriptions Generic Drugs |
$0 Copay (Limited to Preventative Only) |
|
Prescription Benefits - InsuredRx |
Preferred Generic = $0 Copay Formulary Generic = $10 Copay Formulary Brand Name = $30 Copay Additional Preferred Brand & Generic = $50 or Less |
NOTE: Please refer to the Schedule of Benefits for a more in-depth list of Benefits Coverage, Limitations & Exclusions. If this document differs from the Schedule of Benefits, the Schedule of Benefits will govern.
Summary of Benefits and Description of Coverage
