Page 6 - Solid Rock Benefits Guide
P. 6
Solid Rock Major Medical Plans
Total Health Care
Total Health Care HMO 5000/30 with 5000/2500 GAP
Download Medical and GAP Overview Here
Benefits THC HMO 5000/30 $5000/$2500 Split Bucket GAP
Deductible (single/family) $5,000/$10,000 Inpatient Benefit $5,000
Co-Insurance 30% Out Patient Benefit $2,500
Out of Pocket Maximum $7,000/$14,000 Pays "First Dollar" For:
Preventive Services 100%
Office Visits PCP $30 Copay * Deductible & Co Insurance
Office Visits Specialist $60 Copay
Urgent Care $60 Copay * Urgent Care Copay
Emergency Room $250 Copay
In-Patient Hospital 30% after deductible * Emergency Room
Out-Patient Hospital 30% after deductible
Prescriptions $10/$50/$80/30% * Includes $0 Copay Telemedicine
Please note: These are brief descriptions. Read plan certificates for limitation, exclusions,
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and plan specifics.
