Page 5 - 2016 WFF Guide 3
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Minimum Essential Coverage (MEC) Option
Your MEC plans offer 24-hour You’ll have access to enhanced discount plans with network access to
telephone access, at no additional major pharmacy distributors across the country. The MEC plans will
cost to you, to physicians for consult offer comprehensive drug formularies and each plan participant will
and diagnosis of approximately 550 receive their own prescription drugs ID card. Participants in the MEC
clinical conditions. Physicians are plans will not receive medical ID cards.
US based, licensed, board-certiied,
and available 24 hours per day Our MEC plans are considered indemnity plans. You’ll see in each
for questions, consultations, and design your plan is actually paying the member, not the provider, for
medication prescriptions (when services rendered. This chart provides an overview of the varying
appropriate). levels of coverage available to you in each MEC plan design. It’s
important to take considerable time to evaluate which plan design
offers the level of beneit that best its your family’s needs.
Bronze Gold
Annual deductible $0 $0
First day in hospital $300 $1,000
Second and third day in hospital $300 per day $500 per day
Daily in–hospital Member receives $100 per day (days Member receives $200 per day (days
4–60) 4–60)
Inpatient surgery Not covered Member receives $500
Outpatient surgery Not covered Member receives $250
Doctor’s ofice visit Member receives $25 per visit, 2 visits Member receives $50 per visit, 2 visits
per person/ per person/
4 per family per year 4 per family per year
Telemedicine program 100% paid by plan, unlimited visits 100% paid by plan, unlimited visits
Preventive care * 100% covered 100% covered
Emergency room Not covered Member receives $200 per visit, 2 visits
per person/
4 per family per year
Critical illness Not covered Not covered
Prescription Drugs
3-Tier Formulary through ProCare Rx
Tier 1 $10 copay $10 copay
Tier 2 $20 copay $20 copay
Tier 3 $40 copay $40 copay
* Preventive care must be received by a PHCS network provider. No beneits will be paid for non-network providers. Please visit www.phcs.com to
ind in-network providers in your area.
2016 Open Enrollment
Minimum Essential Coverage (MEC) Option
Your MEC plans offer 24-hour You’ll have access to enhanced discount plans with network access to
telephone access, at no additional major pharmacy distributors across the country. The MEC plans will
cost to you, to physicians for consult offer comprehensive drug formularies and each plan participant will
and diagnosis of approximately 550 receive their own prescription drugs ID card. Participants in the MEC
clinical conditions. Physicians are plans will not receive medical ID cards.
US based, licensed, board-certiied,
and available 24 hours per day Our MEC plans are considered indemnity plans. You’ll see in each
for questions, consultations, and design your plan is actually paying the member, not the provider, for
medication prescriptions (when services rendered. This chart provides an overview of the varying
appropriate). levels of coverage available to you in each MEC plan design. It’s
important to take considerable time to evaluate which plan design
offers the level of beneit that best its your family’s needs.
Bronze Gold
Annual deductible $0 $0
First day in hospital $300 $1,000
Second and third day in hospital $300 per day $500 per day
Daily in–hospital Member receives $100 per day (days Member receives $200 per day (days
4–60) 4–60)
Inpatient surgery Not covered Member receives $500
Outpatient surgery Not covered Member receives $250
Doctor’s ofice visit Member receives $25 per visit, 2 visits Member receives $50 per visit, 2 visits
per person/ per person/
4 per family per year 4 per family per year
Telemedicine program 100% paid by plan, unlimited visits 100% paid by plan, unlimited visits
Preventive care * 100% covered 100% covered
Emergency room Not covered Member receives $200 per visit, 2 visits
per person/
4 per family per year
Critical illness Not covered Not covered
Prescription Drugs
3-Tier Formulary through ProCare Rx
Tier 1 $10 copay $10 copay
Tier 2 $20 copay $20 copay
Tier 3 $40 copay $40 copay
* Preventive care must be received by a PHCS network provider. No beneits will be paid for non-network providers. Please visit www.phcs.com to
ind in-network providers in your area.
2016 Open Enrollment
