Insurance companies reserve the right to change the terms of a policy upon proper notification. The insurance company always determines your actual premium. Your premium is subject to change based on the optional benefits you selected, if any, and other relevant factors, such as changes in rates that take effect before your coverage start date. The quotes or rates shown above are estimates only. Please check below for information regarding the plans and carriers you selected. These amounts are subject to change.Įach insurance carrier may have unique Notices, Disclaimers, and Fees. The Copayment, Deductible, and Coinsurance amounts are your share of the costs for covered benefits. The benefits listed may be contingent on your use of physicians, hospitals, and services within the specific insurance company's provider network. Only the terms and conditions of coverage benefits listed in the policy are binding. Review the official plan documents (such as evidence of coverage, plan brochure, or insurance policy) for a detailed description of coverage benefits, limitations, and exclusions. The information shown here is a summary of benefits for informational purposes only. Out-of-Network Annual Out-of-Pocket LimitĮlectronic Signature for Application Available No Charge, limited to 1 Visit(s) per Year No Charge, limited to 1 Visit(s) per 6 Months Inpatient Hospital Services: 40% Coinsurance after deductible Inpatient Physician and Surgical Services: 40% Coinsurance after deductibleĤ0% Coinsurance after deductible, limited to 100 Days per Benefit PeriodĤ0% Coinsurance after deductible, limited to 100 Visit(s) per Year Outpatient Rehabilitation Services (PT, OT, ST) Outpatient Lab: $40 Copay X-rays: 40% Coinsurance after deductible Outpatient Surgery Physician/Surgical Services: 40% Coinsurance after deductible Outpatient Facility Fee: 40% Coinsurance after deductible Generic Drugs: $18 Copay after deductible Preferred Brand Drugs: 40% Coinsurance after deductible Non-Preferred Brand Drugs: 40% Coinsurance after deductible Specialty Drugs: 40% Coinsurance after deductible
#ANTHEM BLUE CROSS URGENT CARE COPAY FULL#
$65 Copay for first 3 visits then $65 Copay after deductible first 3 combined visits for primary care, specialty care, urgent care, mental health, and substance use disorder treatment office visits covered in full Office Visit for Other Practitioner (Nurse, Physician Assistant) $95 Copay for first 3 visits then $95 Copay after deductible $65 Copay for first 3 visits then $65 Copay after deductible If you're unsure if your health plan covers mental-health services, call 65 and speak to a financial counselor who can help determine your coverage.Office Visit for Primary Doctor Find Doctors When you receive mental health services at El Camino Health, please be aware that you'll receive a separate bill for doctor's fees – psychiatrist fees are separate from hospital-program fees. Check your insurance ID card, and contact your insurance carrier to determine if your mental health benefits are carved out to another organization. For example, Health Net HMO members usually access MHN, a Health Net subsidiary. Some plans have a "carve out" for mental health benefits, which means these services are covered by a separate organization which you need to contact directly. Note – plans are subject to change without notice.Ĭoverage for mental health services varies by each health plan. Secure Horizons - Offered by UnitedHealthcareĮl Camino Health contracts with the following mental health insurance plans as of September 1, 2023. Covered California/Individual Family Planīlue Shield of California Promise Medicare Health Plan (Lithotripsy only)Įssence Healthcare (formerly known as Stanford Health Care Advantage)
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