Medical Coverage for a Healthier You See the below for a comparison of the medical plan options available to you. Please note with the MV Plan, you may be balance billed if the provider does not accept 125% of the Medicare Allowable Payment: MEC MEC PLUS MV In Network In Network In Network* Plan Features Deductible $0 $0 $0 (per calendar year) Out-of-Pocket Maximum N/A $1,850 $7,150/$14,300 (per calendar year) Unlimited Unlimited Unlimited Lifetime Maximum $15 copay/ $15 copay/ Office Visit Not covered $25 copay (specialists) $25 copay (specialists) Routine Physical Exams/ Covered 100% Covered 100% Covered 100% Immunizations Not covered $50 copay $50 copay X-rays Not covered $50 copay $50 copay Urgent Care Emergency Room Not covered Not covered $400 copay Not covered Not covered Not covered Outpatient Surgery Inpatient Hospital Services Not covered Not covered $1,000 copay, then 20% Maternity: Facility Not covered Not covered $1,000 copay, then 20% Transplant Services Not covered Not covered $1,000 copay, then 20% Prescription Drugs: Retail (up to a 30-day supply) Not covered $5 $40 Generic Only * Patient may be balance billed if provider does not accept 125% of Medicare Allowable Payment Supplemental Medical Coverage Supplement your medical coverage by receiving cash reimbursements for covered medical services with TransChoice Advance: Plan Features Plan Pays* Hospital Indemnity $100 (31 days per confinement) Plan Features $500 (1 day per confinement, 1 per calendar year) Hospital Confinement Plan Features $10/generic, $20/brand (1 day per month combined maximum) Prescription Drug $100 (1 day per accident/5 per calendar year) Off-the Job Accidental Injury Outpatient Diagnostic Lab $10 (2 days per calendar year) $50 (1 day per calendar year) Outpatient Select Diagnostic Test $200 (1 day per calendar year) Outpatient Advance Studies $60 (6 days per calendar year) Outpatient Physician Office Inpatient Surgical $500 $250 Outpatient Surgical $50 Outpatient Minor Surgical Additional 20% Outpatient Surgical Anesthesia * Dollar amounts listed here are one-time cash reimbursements
Medical Coverage for a Healthier You See the below for a comparison of the medical plan options available to you. Please note with the MV Plan, you may be balance billed if the provider does not accept 125% of the Medicare Allowable Payment: Plan Features MEC MEC PLUS MV In Network In Network In Network* Deductible (per calendar year) $0 $0 $0 Out-of-Pocket Maximum (per calendar year) N/A $1,850 $7,150/$14,300 Lifetime Maximum Unlimited Unlimited Unlimited Office Visit Not covered $15 copay/ $25 copay (specialists) $15 copay/ $25 copay (specialists) Routine Physical Exams/ Immunizations Covered 100% Covered 100% Covered 100% X-rays Not covered $50 copay $50 copay Urgent Care Not covered $50 copay $50 copay Emergency Room Not covered Not covered $400 copay Outpatient Surgery Not covered Not covered Not covered Inpatient Hospital Services Not covered Not covered $1,000 copay, then 20% Maternity: Facility Not covered Not covered $1,000 copay, then 20% Transplant Services Not covered Not covered $1,000 copay, then 20% Prescription Drugs: Retail (up to a 30-day supply) Generic Only Not covered $5 $40 * Patient may be balance billed if provider does not accept 125% of Medicare Allowable Payment Supplemental Medical Coverage Supplement your medical coverage by receiving cash reimbursements for covered medical services with TransChoice Advance: Plan Features Plan Features Plan Features Plan Pays* Hospital Indemnity $100 (31 days per confinement) Hospital Confinement $500 (1 day per confinement, 1 per calendar year) Prescription Drug $10/generic, $20/brand (1 day per month combined maximum) Off-the Job Accidental Injury $100 (1 day per accident/5 per calendar year) Outpatient Diagnostic Lab $10 (2 days per calendar year) Outpatient Select Diagnostic Test $50 (1 day per calendar year) Outpatient Advance Studies $200 (1 day per calendar year) Outpatient Physician Office $60 (6 days per calendar year) Inpatient Surgical $500 Outpatient Surgical $250 Outpatient Minor Surgical $50 Outpatient Surgical Anesthesia Additional 20% * Dollar amounts listed here are one-time cash reimbursements
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