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| SmartHealth
is an authorized Lifewise agency. |
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Lifewise Choices
| Deductible |
Individual:(choose one) $1500, 2500, 5000, 7500 |
| Coinsurance |
20% after deductible |
| Out-of-Pocket Limit |
Individual: $7,500. Does not include deductible |
| Office Visit |
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| Primary Doctor: |
$20 Copay (deductible waived) |
| Specialist: |
$20 Copay (deductible waived) |
| Periodic Health Exam: |
$20 Copay (deductible waived) |
| Periodic OB-GYN Exam: |
Routine Mammograms: No Charge (deductible waived); Annual Exams:$20 Copay(deductible waived) |
| Well Baby Care: |
$20 Copay (deductible waived) |
| Chiropractic: |
$25 Copay (deductible waived); 12 visits PCY shared between Chiropractic |
| Mental Health: |
Not Covered |
| Perscription Drugs |
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| Generic: |
$20 Copay |
| Brand: |
50% |
| Non-Formulary: |
50% |
| Separate Rx Deductible: |
Medical Plan Deductible Applies to Brand, Non-Formulary Drugs |
| Mail Order: |
Available (View Details) |
| Outpatient Lab/X-Ray |
20% Coinsurance after deductible |
| Emergency Room |
$100 Copay (waived if admitted), Plus 20% Coinsurance after deductible |
| Out Patient Surgery |
20% Coinsurance after deductible |
| Hospitalization |
20% Coinsurance after deductible |
| Maternity |
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| Pre & Postnatal Office Visit |
20% Coinsurance after deductible |
| Labor & Delivery Hospital Stay |
20% Coinsurance after deductible |
| Lifemaximum |
$2 Million per Person |
For More Insurance Plan Details
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Contact the insurance carrier or your agent
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Downloads
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