MEDICAL COVERAGE
Zoe Pediatrics offers the following medical plans.
Insurance Carrier:
Imagine360 Medical Insurance
Plan Type:
Base Plan
Buy-Up Plan
Primary Care Visits
100%
100%
Specialist Care Visits
$60 Copay
$60 Copay
Urgent Care
100% after $75 Copay
100% after $75 Copay
Emergency Room Care
80%; Deductible applies
90%; Deductible applies
Preventative Visit Copay
100%; Deductible waived
100%; Deductible waived
Diagnostic Testing (X-Ray / Blood Work)
80%; Deductible applies
90%; Deductible applies
Advanced Imaging
80%; Deductible applies
90%; Deductible applies
Plan Coinsurance
80%
90%
Employee Deductible
$3,000
$1,500
Family Deductible
$9,000
$4,500
Employee Out-of-Pocket Max
$7,900 (includes deductible & copays)
$4,500 (includes deductible & copays)
Family Out-of-Pocket Max
$15,800 (includes deductible & copays)
$9,000 (includes deductible & copays)
Inpatient Hospital
80%; Deductible applies
90%; Deductible applies
Outpatient Hospital or Facility
80%; Deductible applies
90%; Deductible applies
Prescription Drugs 30-day supply
VeracityRx Select Pharmacies
VeracityRx Non-Select Pharmacies
Tier 1 - Generic
$15 Copay
$30 Copay
Tier 2 - Preferred
$35 Copay
$50 Copay
Tier 3 - Non-Preferred
$60 Copay
$75 Copay
Tier 4 - Specialty
Excluded; Refer to VeracityRx Program for Specialty Access
Employee Bi-Weekly Deduction Employee Only
$0.00
$25.89
Employee + Spouse
$254.50
$310.17
Employee + Child(ren)
$172.62
$218.71
Family
$427.12
$502.99
6 | Zoe Pediatrics 2024 Benefits Guide
Made with FlippingBook - professional solution for displaying marketing and sales documents online