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Clearwater Copay Advanced
Health plan with preventive services, copays for doctor visits, prescription coverage, Teladoc membership and more. No limit to pre-existing conditions.
Plan provides 100% coverage for preventive services as outlined by the Affordable Care Act and shown on healthcare.gov. No copays, deductibles or other out of pocket costs for these services.
Plan provides access to the PHCS/Multiplan national PPO network of doctors. You can search for a provider at www.multiplan.com or call 800-922-4362.
Plan includes membership to Teladoc, the leading telemedicine provider in the USA. With Teladoc you have access to a licensed physician 24/7 with a $0 copay and unlimited consultations.
- General Medical - $0.00 cost for member
- Dermatology - $75.00 cost for member
- Sexual Health Pathology - $0.00 cost for member
Mental Health, Behavioral Health, Substance abuse services:
- Counseling - $85.00 cost for member
- Psychiatry - $95.00 cost for member AFTER $200 evaluation
|Service||In Network||Out of Network|
|Teladoc Consultation (unlimited) General Medical||$0 copay||$0 copay|
|Preventive Visit||$0 copay||Not Covered|
|Primary Care Physician Visit (limit 5)||$20 copay||$50 copay|
|Specialist Care Physician Visit (limit 5)||$50 copay||$100 copay|
|Urgent Care (limit 5)||$50 copay||$100 copay|
|Diagnostic X-ray (limit 5 tests)||$50 copay||$100 copay|
|Lab/Blood work (limit 10 tests)||$10 copay||$25 copay|
|CAT-Scan, MRI Imaging (limit 2)||$200 copay||$400 copay|
|Tier 1 – Low Cost||$10 copay|
|Tier 2 – Generics||$25 copay|
|Tier 3 – Preferred Brand||$50 copay|
*This is a summary and not a complete list of your health plan coverage and exclusions. For more information please refer to your plan SBC