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| SmartHealth
is an authorized Lifewise agency. |
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Lifewise Essentials
| Deductible |
Individual: $1500, 2500, 5000, 7500 |
| Coinsurance |
25% after deductible |
| Out-of-Pocket Limit |
Individual: $9,000. Does not include deductible |
| Office Visit |
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| Primary Doctor: |
$25 Copay (deductible waived) on first 6 visits; subsequent visits subject to deductible and 25% |
| Specialist: |
$25 Copay (deductible waived) on first 6 visits; subsequent visits subject to deductible and 25% |
| Periodic Health Exam: |
$25 Copay (deductible waived) on first 6 visits; subsequent visits subject to deductible and 25% |
| Periodic OB-GYN Exam: |
Routine Mammograms: No Charge (deductible waived); Annual Exams:$25 Copay (deductible waived) on first 6 visits; subsequent visits subject to deductible and 25% |
| Well Baby Care: |
$25 Copay (deductible waived) on first 6 visits; subsequent visits subject to deductible and 25% |
| Chiropractic: |
$25 Copay (deductible waived); 12 visits PCY shared between Chiropractic and Acupuncture |
| Mental Health: |
Not Covered |
| Perscription Drugs |
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| Generic: |
$20 Copay |
| Brand: |
Not Covered |
| Non-Formulary: |
Not Covered |
| Separate Rx Deductible: |
None |
| Mail Order: |
Available (View Details) |
| Outpatient Lab/X-Ray |
25%; No deductible applies |
| Emergency Room |
$100 Copay (waived if admitted), Plus 25% Coinsurance after deductible |
| Out Patient Surgery |
25% Coinsurance after deductible |
| Hospitalization |
25% Coinsurance after deductible |
| Maternity |
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| Pre & Postnatal Office Visit |
25% Coinsurance after deductible |
| Labor & Delivery Hospital Stay |
25% 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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