Click the down arrow to learn more about each of these. WATCH VIDEO
Your premium is the amount you pay for health insurance each month.
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.
Open means you can go to any hospital, specialist, provider, etc., and only be responsible for the IUA for that incident.
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 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. Plan pays for a max of 5 visits per plan year.
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.
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 Preventive Care section below.
Prescription coverage is based on which category a drug falls into. To see how this plan categorizes prescriptions, browse its drug formulary.
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 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.
Generally these are higher-cost drug 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.
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.
These are tests your doctor may run when diagnosing a condition.
This includes the use of X-rays to diagnose a condition.
Imaging includes diagnostic services such at CT scans, PET scans, and MRIs.
Blood tests are often used to help diagnose a condition, or check levels such as cholesterol or blood sugar.
Before IUA is met
After IUA is met
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.
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.
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.
This is the amount you’re responsible for when using the facilities and equipment at a hospital.
This is the amount you’re responsible for when receiving services provided by a physician, surgeon, medical doctor, or other specialist.
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.
This includes physical and occupational therapy, speech pathology, and psychiatric rehabilitation services.
All plans cover behavioral health treatment (such as psychotherapy or counseling), mental and behavioral health inpatient services, and substance use treatment.
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.
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.
Every plan covers services provided before and after your child is born.
Before IUA is met
After IUA is met
These services may include developmental screenings, counseling, behavioral assessments, and more.
This includes labor, delivery (including c-section), and any recovery needed at a hospital.
Our pediatricians are available 24/7 for your family. Speak with a pediatrician for conditions like the flu, pink eye, rashes, and much more.
Advice and answers on a medical condition, diagnosis, treatment option, or surgery from a world-renowned specialist.
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.
Enrolling takes just 5 minutes