Copay Base + Zion 5000

Plan Costs

Plan Costs

Click the down arrow to learn more about each of these.

  • Monthly Cost
    $(Get a Quote Below)

    Your monthly cost is the amount you pay for healthcare benefits each month.

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  • Max per Incident
    $5000

    This is the most you'll have to pay for healthcare services during your plan period (per incident – think of it as your safety net in the event of a major health problem. Watch Video

    • You have a max of 3 incidents where you pay the IUA in a 12 month period. If you have a 4th IUA and beyond the cost is $500 per incident.

    • Unlike a deductible or traditional max-out-of-pocket, the IUA is not reset until you are symptom-free for 12 months. If it took 5 years to go symptom-free, you would only pay the IUA once.

    Note: monthly member fees don’t count towards your max per incident.

  • Network Type
    PPO/Open

    This type of network is designed to give you the widest number of options for medical providers. Instead of a typical narrow network with only a few provider options, you can go to any provider that charges a fair price.

    To select a Verified Provider, simply call the number on the back of your card to find a Verified Provider or to verify the doctor you want to see is a Verified Provider. If you do not coordinate care with the Patient Concierge, you will likely pay more. This is similar to any health insurance plan when you go out of network, you pay more out of network or in some cases full price. So always use a Verified Provider unless it is a bona fide emergency.

  • Official Documents
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Doctor Visits

Doctor Visits

This applies to doctor visits when you have a condition or symptom. For preventive care visits, such as annual checkups, visits are free.

  • Primary care visit
    $20 copay

    Primary care visits are appointments with your primary care provider to look at symptoms, sickness, or injuries.

    This is different from preventive care visits - regular checkups or screenings are always free. The plan pays for a max of 5 visits per plan year.

  • Specialist visit
    $50 copay

    A specialist is a medical professional who specializes in a condition or area of the body. For example, a dermatologist (skin), cardiologist (heart), neurologist (brain), or oncologist (cancer). Plan pays for a max of 5 visits per plan year.

  • Preventive care visit
    $0 copay

    There are dozens of preventive care services available for free with every plan, including check-ups, counseling, screenings, and immunizations To learn more, scroll down to the Free Preventive Care section below.

  • Teladoc 24/365
    $0 copay
Prescriptions

Prescriptions

Prescription coverage is based on which category a drug falls into. To see how this plan categorizes prescriptions, browse its drug formulary.

  • Generic
    $10 copay

    A generic drug is identical to the brand name drug in form, safety, strength, quality, and intended use. Although identical, generic drugs are substantially cheaper than their brand-name counterparts. * Plan pays up to a maximum of $150 per Rx.

  • Brand
    $25 copay

    Brand drugs are more expensive than generic drugs. Not every brand drug has a generic equivalent. * Plan pays up to a maximum of $150 per Rx.

  • Non-preferred Brand
    $50 copay

    Generally, these are higher-cost drugs that have recently come on the market. In most cases, an alternative preferred drug is available. * Plan pays up to a maximum of $150 per Rx.

  • Specialty
    IUA Amount

    A specialty drug is a high-cost medication used to treat a chronic or complex health condition. Plan pays up to a maximum of $150 per Rx.

Labs & Imaging

Labs & Imaging

These are tests your doctor may run when diagnosing a condition.

Before IUA

After IUA

  • X-rays
    $50 Free

    This includes the use of X-rays to diagnose a condition.

  • Imaging (CT/PET/MRI)
    $200 Free

    Imaging includes diagnostic services such at CT scans, PET scans, and MRIs.

  • Blood work
    $10 Free

    Blood tests are often used to help diagnose a condition, or check levels such as cholesterol or blood sugar.

Hospital & Emergency

Hospital & Emergency

Before IUA is met

After IUA is met

  • Urgent Care
    $50 copay Free

    An urgent care center can be a convenient option if you have a non-life-threatening injury and your doctor is not available.

    Urgent care is usually less expensive than going to the Emergency Room, and will usually have shorter wait times for non-life-threatening injuries.

  • Emergency Room
    Full Price Free

    This includes services to check for an emergency medical condition* and treatment to keep it from getting worse. These emergency services may be provided in any licensed hospital’s emergency room or another place that provides care for emergency medical conditions. *An emergency medical condition is defined as an illness, injury, symptom (including severe pain), or condition severe enough to risk serious danger to your health if you didn't get medical attention right away.

  • Ambulance
    Full Price Free

    This covers emergency transportation and off-site treatment for emergency medical conditions* and may also cover non-emergency transportation between hospitals. *An emergency medical condition is defined as an illness, injury, symptom (including severe pain), or condition severe enough to risk serious danger to your health if you didn't get medical attention right away.

  • Hospital stay (facility)
    Full Price Free

    This is the amount you’re responsible for when using the facilities and equipment at a hospital.

  • Hospital stay (physician)
    Full Price Free

    This is the amount you’re responsible for when receiving services provided by a physician, surgeon, medical doctor, or other specialists.

  • Outpatient procedure (facility)
    Full Price Free

    This is the amount you’re responsible for when using the equipment and facilities at a hospital.

    Specifically, during a procedure that does not require overnight hospitalization.

  • Physical rehabilitation
    Full Price Free

    This includes physical and occupational therapy, speech pathology, and psychiatric rehabilitation services.

Mental Health & Substance Abuse

Mental Health & Substance Abuse

All plans cover behavioral health treatment (such as psychotherapy or counseling), mental and behavioral health inpatient services, and substance use treatment.

  • Therapist
    $85

    Our mental health services range from ongoing visits with a mental healthcare specialist to expert medical opinions for complex cases. With more than 33 million sessions completed by our licensed therapists, psychologists and counselors, Teladoc Health has helped people receive guidance, support and relief.

  • Psychologists
    $95

    Our mental health services range from ongoing visits with a mental healthcare specialist to expert medical opinions for complex cases. With more than 33 million sessions completed by our licensed therapists, psychologists, and counselors, Teladoc Health has helped people receive guidance, support, and relief. There is an initial $200 for the first visit and then it is $95 for every visit after that.

Pregnancy & Birth

Pregnancy & Birth

Every plan covers services provided before and after your child is born.

Before IUA is met

After IUA is met

  • Well baby care
    Free Free

    These services may include developmental screenings, counseling, behavioral assessments, and more.

  • Labor, delivery, hospital stay
    Full Price Free

    This includes labor, delivery (including c-section), and any recovery needed at a hospital.

Teladoc

Teladoc

All plans cover behavioral health treatment (such as psychotherapy or counseling), mental and behavioral health inpatient services, and substance use treatment.

  • Everyday Care
    Free

    Our pediatricians are available 24/7 for your family. Speak with a pediatrician for conditions like the flu, pink eye, rashes, and much more.

  • Expert Medical Opinion
    Free

    Advice and answers on a medical condition, diagnosis, treatment option, or surgery from a world-renowned specialist.

  • Therapist
    $85

    Our mental health services range from ongoing visits with a mental healthcare specialist to expert medical opinions for complex cases. With more than 33 million sessions completed by our licensed therapists, psychologists and counselors, Teladoc Health has helped people receive guidance, support and relief.

  • Psychologists
    $95

    Our mental health services range from ongoing visits with a mental healthcare specialist to expert medical opinions for complex cases. With more than 33 million sessions completed by our licensed therapists, psychologists, and counselors, Teladoc Health has helped people receive guidance, support, and relief. There is an initial $200 for the first visit and then it is $95 for every visit after that.

  • Dermatology
    $85

    We’ve made skin care easier. You no longer have to wait weeks for an appointment. Use your Teladoc account to upload images of your skin condition. Our U.S. board-certified dermatologists will give you a diagnosis and treatment plan customized to fit your specific needs.

Free Preventive Care

Free Preventive Care

Every plan includes over 74 preventive care services that are completely free on day one. These services keep you healthy before you become sick, including routine check-ups, counseling, screenings, and immunizations. For information on services covered click here.

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