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Short Term Health Plans? Call 1-800-712-4366

Short Term Plan in California

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Speak with a Healthcare Professional 1-800-712-4366

  • Gender: Female
  • Age: 37
  • Location: Los Angeles, CA
  • From $166 Monthly

Cost & Coverage

  • Plan Type: Indemnity
  • Office Visit for Primary Doctor The cost of the office visit expense will be payable subject to the Deductible and Coinsurance.
  • Office Visit for Specialist The cost of the office visit expense will be payable subject to the Deductible and Coinsurance.
  • Coinsurance 50% after deductible
  • Annual Deductible Individual: $7,500.00
    Family: $22,500.00
  • Separate Prescription Drugs Deductible Inpatient: Medical Plan Deductible Applies;Outpatient: No Coverage. Prescription drug copay and discount card included in product at no additional cost.
  • Prescription Drugs Generic: Inpatient drugs – 50% after deductible. Outpatient drugs not covered. Prescription drug copay & discount card included in product at no add’l cost.
    Brand Name: Inpatient drugs – 50% after deductible. Outpatient drugs not covered. Prescription drug copay & discount card included in product at no add’l cost.
    Non-formulary: Inpatient drugs – 50% after deductible. Outpatient drugs not covered. Prescription drug copay & discount card included in product at no add’l cost.
  • Annual Out-of-Pocket Limit Individual: $2,000.00
    Family: $6,000.00
  • Does Out-of-Pocket Limit include deductible? No
  • Lifetime Maximum $2,000,000.00
  • Out-of-Network Coverage Yes
  • Out of Country Coverage Y, Canada Only

Physicians

  • Primary Care Physician (PCP) Required No
  • Specialist Referrals Required No

Preventive Care Coverage

  • Periodic Health Exam No
  • Periodic OB-GYN Exam Yes
  • OB-GYN Exam Conditions Covered: Mammography Screening – Coverage shall be provided for mammography screenings if prescribed by a Doctor based on the following:
    A. A baseline mammogram for a woman who is thirty-five (35) but less than forty (40) years of age;
    B. A mammogram for a woman who is forty (40) but less than fifty (50) years of age, every two years, or more frequently based on the recommendation of the woman’s Doctor;
    C. A mammogram each year for a woman who is age fifty (50) or older
  • Well Baby Care No

Prescription Drug Coverage

  • Generic Prescription Drugs Generic Prescription DrugsInpatient drugs – 50% after deductible. Outpatient drugs not covered. Prescription drug copay & discount card included in product at no add’l cost.
  • Brand Prescription Drugs Inpatient drugs – 50% after deductible. Outpatient drugs not covered. Prescription drug copay & discount card included in product at no add’l cost.
  • Non-Formulary Prescription Drugs Coverage Inpatient drugs – 50% after deductible. Outpatient drugs not covered. Prescription drug copay & discount card included in product at no add’l cost.
  • Separate Prescription Drugs Deductible Inpatient: Medical Plan Deductible Applies; Outpatient: No Coverage. Prescription drug copay and discount card included in product at no additional cost.

Hospital Services Coverage

  • Emergency Room 50% Coinsurance after deductible; Extra $250 deductible applies for Sickness visits if not admitted
  • Outpatient Lab/X-Ray 50% Coinsurance after deductible
  • Outpatient Surgery: 50% Coinsurance after deductible
  • Hospitalization 50% Coinsurance after deductible

Maternity Coverage

  • Pre & Postnatal Office Visit Not Covered
  • Labor & Delivery Hospital Stay Only complications of pregnancy are covered as any other illness. 50% after deductible

Additional Coverage

  • Chiropractic CoverageNot Covered
  • Mental Health Coverage Not Covered

Health Network Group
1199 S. Federal Highway, STE 403,
Boca Raton, FL 33432
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