4 / 15
EDM, Inc.
3
Medical Insurance to Keep You Healthy
FEATURES:
UNITED HEALTHCARE - ACEC
QEX / RX 282
In Network
Out of Network
Individual/Family Deductible:
$2,000/$4,000
$5,000/$10,000
Co-Insurance:
100%
80%
Out of Pocket Maximum: (Incl. Ded.,
Copayments and Coinsurance: Ind/Fam)
$3,500/$7,000
$10,000/$20,000
Lifetime Maximum Benefit:
Unlimited
Unlimited
Office Visits (PCP/SCP):
100% after Deductible 80% after Deductible
Virtual Visits:
100% after Deductible 80% after Deductible
Preventive Care:
100%
80% after Deductible
Diagnostic Services:
100% after Deductible 80% after Deductible
Lab/X-Ray (Office, Freestanding Lab):
Major Diagnostics:
100% after Deductible 80% after Deductible
Emergency Care:
Urgent Care
100% after Deductible 80% after Deductible
Emergency Room
100% after Deductible 100% after Deductible
Prescription Drug Coverage:
Tier 1
$10 Co-Pay
Tier 2
$35 Co-Pay
Tier 3
$60 Co-Pay
Mail Order Drug Coverage:
for a 90 Day Supply
$25/$87.50/$150