Page 5 - Solid Rock Benefits Guide
P. 5
Solid Rock Major Medical Plans
Total Health Care
Total Health Care HMO HDHP 5000/20 with 5000/2500 GAP
Download Medical and GAP Overview Here
Benefits THC HMO 5000/20 $5000/$2500 Split Bucket GAP
Deductible (single/family) $5,000/$10,000 Inpatient Benefit $5,000
Co-Insurance 20% Out Patient Benefit $2,500
Out of Pocket Maximum $6,900/$13,800 Pays "First Dollar" For:
Preventive Services 100%
Office Visits PCP* 20% after deductible * Deductible & Co Insurance
Office Visits Specialist* 20% after deductible
Urgent Care* 20% after deductible * Urgent Care
Emergency Room* 20% after deductible
In-Patient Hospital 20% after deductible * Emergency
Out-Patient Hospital 20% after deductible
Prescriptions $10/$40/$60/25%** AD * Includes $0 Copay Telemedicine
* Copays apply after deductible. ** Prescription copay after deductible
GAP plan pays to plan limit
($2,500 for Out Patient)
Please note: These are brief descriptions. Read plan certificates for limitation, exclusions,
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and plan specifics.
