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Benefit Designs & Descriptions - Small Groups

 

AvMed Choice
 No referrals, no Primary Care Physician (PCP) designation required, service available in and out of network, emergency care is always covered.

 


Plan Name
(Click on link to view full benefit summary)
 		  

Deductible

  

Description

  

Summary of Benefit Design
CH-CH-5188 0 Deductible, Co-pay and Coinsurance with added out of network benefit Choice 4BB-08; RX$10/$30/$50/$75 w/OC
CH-CH-3703 250 Deductible, Co-pay and Coinsurance with added out of network benefit Choice 1BB; Rx $10/25/40/75 OC
CH-CH-3704 500 Deductible, Co-pay and Coinsurance with added out of network benefit Choice 2BB; Rx $15/30/50/75 OC
CH-CH-3706 500 Deductible, Co-pay and Coinsurance with added out of network benefit Choice 5B; Rx $10/25/40/75 OC
CH-CH-5189 500 Deductible, Co-pay and Coinsurance with added out of network benefit Choice 5BB-08; RX$20/$40/$60/$75 w/ OC
CH-CH-3705 750 Deductible, Co-pay and Coinsurance with added out of network benefit Choice 3BB; Rx $15/30/50/75 OC
CD-CH-3702 1000 Coinsurance after deductible is met, out of network benefits Choice CDHP 3A; Rx $15/30/50/75 OC
CH-CH-5190 1000 Deductible, Co-pay and Coinsurance with added out of network benefit Choice 6BB-08; RX$20/$40/$60/$75 w/ OC
CH-CH-5191 1500 Deductible, Co-pay and Coinsurance with added out of network benefit Choice 7BB-08; RX$20/$40/$60/$75 w/ OC
CH-CH-5196 1500 Deductible, Co-pay and Coinsurance with added out of network benefit Choice 11BB-08; RX$20/$40/$60/$75 w/ OC
HD-CH-3692 1500 Co-pay and Coinsurance after deductible is met, out of network benefits, HSA-qualified HDHP CHOICE 1A; Rx $10/20/30/75 OC
HD-CH-3693 1500 100% after deductible is met, out of network benefits, HSA-qualified HDHP CHOICE 1B; Rx - No Charge after Ded 
HD-CH-4079 2000 100% after deductible is met, out of network benefits, HSA-qualified HD-CH-4079 - POS12 - HDHP-CHOICE-1D; RX - NO CHARGE AFTER DED
CH-CH-5192 2500 Deductible, Co-pay and Coinsurance with added out of network benefit Choice 8BB-08; RX$20/$40/$60/$75 w/ OC
CH-CH-5194 3000 Deductible, Co-pay and Coinsurance with added out of network benefit Choice 9BB-08; RX$20/$40/$60/$75 w/ OC
HD-CH-3694 3000 100% after deductible is met, out of network benefits, HSA-qualified HDHP CHOICE 1C; Rx - No Charge after Ded
CH-CH-5195 5000 Deductible, Co-pay and Coinsurance with added out of network benefit Choice 10BB-08; RX$20/$40/$60/$75 w/ OC
HD-CH-5186 5000 100% after deductible is met, out of network benefits, HSA-qualified HDHP-CHOICE-4DD-08; RX - No Charge after Ded

 
Last modified January 03, 2008
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