Page 5 - Lush Lawn Benefits Guide
P. 5
Lush Lawn Major Medical Plans
Priority Health
Priority Health HMO $3,000 Priority Health PPO $3,000
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Service Benefit Service Benefit
$3,000 Single / $6,000 $3,000 Single / $6,000
Deductible Deductible
Family Family
Coinsurance 20% - $3,500/$7,000 max Coinsurance 30% - $4,000/$8,000 max
$7,900 Single / $15,800 $7,900 Single / $15,800
Out of Pocket Maximum Out of Pocket Maximum
Family Family
Primary Care Visit Copay $30 Primary Care Visit Copay $40
Emergency Room Copay $250 After Deductible Emergency Room Copay $250 After Deductible
Urgent Care Copay $50 Urgent Care Copay $75
Lab & X-Ray 20% After Deductible Lab & X-Ray 30% After Deductible
Inpatient Services 20% After Deductible Inpatient Services 30% After Deductible
Outpatient Services 20% After Deductible Outpatient Services 30% After Deductible
Rx Copays $20/$60/$80/80%/80% Rx Copays $20/$60/$80/80%/80%
Please note: These are brief descriptions. Read plan certificates for limitation, exclusions,
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and plan specifics.
