Page 14 - Revelations Healthcare - Benefit Guide 2020 R9-20

Healthcare2U

Pan-American

How to Access (Non-Emergency) Benefits

1. For ANY non-emergency health care services – First Call: 800-496-2805

2. The Triage Operator will direct you to one of the following choices:

Option One – Direct Primary Care

Unlimited doctor visits with a $10 visit fee
Unlimited urgent care visits for a $25 fee

Option Two – In/Out of Network Providers

At your option, the plan also provides a $75 Allowance to use in any doctor’s

office visit (in or out of network) You have four visits per plan year in addition

to the Option One unlimited choices above.

Helathcare2U an American Life
P
Outpatient Services
Direct Primary Care Panamed Indemnity
Routine Office Visit Unlimited $10 Fee Per Visit $75 Per Visit 4 Times a Year Reimbursement
Wellness/Preventive N/A In-Network Only (UHC Plan Has UNLIMITED)
Emergency Urgent Care Center $25 Fee N/A (Plan 1) $100 Benefit (Plan 2)
Emergency Room $2,500 - $100 Ded. Per
Emergency Accident Urgent Care Center $25 Fee
Accident.
Telehealth Unlimited 24/7/365 N/A
Chronic Disease Management Unlimited $10 Fee Per Visit $75 Per Visit 4 Times a Year Reimbursement
Plan 1 Discount Program
Prescription Drugs N/A Plan 2 $25 Generic / $50 Name Brand
Limited 2 Days Per Month Each
COVID 19 N/A Provides inpatient/outpatient Therapies
Inpatient Room & Board and Surgi- N/A Limited Plan Benefits
cal

In Addition – Once Your Visit is Scheduled

1. Visit provider and present ID card
2. Provider files claim (In network doctors will not require payment up front)
3. PPO Network applies discounts and forwards claim to Pan-American Life (insurance carrier)
4. If the claim is less than the allowable benefit amount in your plan, you owe nothing
5. If the claim is more than the allowable benefit amount in your plan, you will owe the balance to the provider

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