Press here
to get more information about the coverage of this plan (in acrobat
format and only in spanish)
Press here
to review price and requisites.
Direct Payment's
Deductibles:
|
MCS
Personal
Care
with
Referral
from Personal
Doctor
|
MCS
Personal
Care
without
Referral
from Personal
Doctor
|
MCS
Personal
Access
Needs
Referral
from Personal
Doctor
|
|
|
PERSONAL
DOCTOR: |
|
|
|
|
GENERAL, FAMILY DOCTOR, INTERNISTS, PEDIATRIC, GYNECOLOGIST,
OBSTETRICS |
$
5.00 |
N/A |
$5.00 |
|
SPECIALIST
DOCTOR |
$15.00 |
$20.00 |
$10.00 |
|
SUB-SPECIALIST
DOCTOR |
$20.00 |
$25.00 |
$15.00 |
| HOSPITALIZATION |
Inside of Network $50.00 |
Outside of Network $200.00 |
Inside/Out
$50./$0.00 |
|
EMERGENCY
ROOM (ER) |
$0.00 |
$30.00 |
$30.00 |
| PODIATRIST |
$20.00 |
$20.00 |
$15.00 |
| QUIROPRACTIC |
$15.00 |
$15.00 |
$10.00 |
|
RESPIRATORY
AND
PHYSICAL
THERAPY |
$7.00 |
$7.00 |
$5.00 |
| INMUNIZATIONS |
$0.00 |
$0.00 |
$0.00 |
| LABORATORY
AND X RAYS |
30% |
30% |
25% |
| DENTAL |
|
|
|
| -
DIAGNOSTIC |
$0.00 |
|
$0.00 |
| -
PREVENTIVE |
$0.00 |
|
$0.00 |
| -
RESTORATIVE, ENDODONCY, PERIODONCY,
ORAL
SURGERY
|
30% |
|
30% |
| -
REMOVABLE
AND FIXED PROSTHESIS |
50% |
|
50% |
PHARMACY
INDIVIDUAL
MAXIMUM
: $1,000 a year
FAMILY MAXIMUM : $4,000 a
year |
|
|
|
| -
MANDATORY BIOEQUIVALENT (First
Choice) |
$10.00 |
10% |
10% |
| -
ORIGINAL BRAND (INSIDE OF GUIDE) |
25% |
25% |
25% |
| -
ORIGINAL BRAND (OUTSIDE
OF GUIDE) |
35% |
35% |
35% |
| -
MEDICINE BY MAIL (PER MEDICINE) |
$10.00 |
$10.00 |
N/A |
Press here
to apply for this plan and start enjoying the benefits of a
more secure life.
For
more information, free of charge, call
1-800-981-6545
MONDAY
THROUGH FRIDAY FROM
8:00-12:00 AM A 1:00-5:00 PM
or
press here
to design your
very own health plan.
|