Page 10 - Draken Intl. 2022 OE Flipbook

Health Reimbursement

Arrangement

The Difference Card

What is the Difference Card?
• The Difference Card is a MasterCard that is funded by Draken.
• If you elect medical coverage, you will automatically be enrolled in The Difference Card.
• The company funds specific (medical) plan out-of-pocket expenses for you and your family to save you those
expenses.
• Your Difference Card can be used to help pay for office visit copays, emergency room copays, deducible and
coinsurance expenses.

How to use your Difference Card for copays
Step 1: Your doctor/facility will request the copay amount from your plan.
Step 2: You will pay your portion of the copay first. This amount is listed under the “You Pay” column on your
Summary of Benefits chart.
Step 3: Ask the provider to swipe your Difference Card for the remaining amount. This amount is listed under
the “Difference Card Pays” column on your Summary of Benefits chart.

Type of Visit You Pay Difference Card Pays Carrier Benefit
In-Network Individual
Deductible $1,000 $4,000 $5,000
In-Network Family Deductible $2,000 $8,000 $10,000
Out-of-Network Individual
Deductible $7,000 $3,000 $10,000
Out-of-Network Family $14,000 $6,000 $20,000
Deductible
Primary Care Office
Visit Copay $0 $10 $10

Specialist Office Visit Copay $20/$65 $0/$35 $20 (Value Choice)/$100
Preventative Care/Screening/
Immunization No Charge No Charge No Charge
Tier 1 Rx Retail Copay $0 $10 $10
Tier 2 Rx Retail Copay $40 $10 $50
Tier 3 Rx Retail Copay $70 $10 $80
Outpatient Surgery Deductible Remaining Deductible & Coins. Deductible & Coinsurance
Remaining Deductible,
Emergency Room Care Deductible & $200 Deductible, Coinsurance, $250
Coinsurance, $50
Urgent Care $60 $15 $75

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