Page 5 - 2016 WFF Guide 1
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M inimum E ssential C ov erage ( M E C ) O ption
Your MEC plans offer 24-hour You’ll have access to enhanced discount plans with network access to
telephone access, at no additional major pharmacy distributors across the country. The MEC plans will
cost to you, to physicians for consult offer comprehensive drug formularies and each plan participant will
and diagnosis of approximately 550 receive their own prescription drugs ID card. Participants in the MEC
clinical conditions. Physicians are plans will not receive medical ID cards.
US based, licensed, board-certiied,
and available 24 hours per day Our MEC plans are considered indemnity plans. You’ll see in each
for questions, consultations, and design your plan is actually paying the member, not the provider, for
medication prescriptions (when services rendered. This chart provides an overview of the varying
appropriate). levels of coverage available to you in each MEC plan design. It’s
important to take considerable time to evaluate which plan design
offers the level of beneit that best its your family’s needs.
B ronz e G old
A nnual d ed uctible $ 0 $ 0
F irst d ay in hospital $ 3 0 0 $ 1 , 0 0 0
S econd and third d ay in hospital $ 3 0 0 per d ay $ 5 0 0 per d ay
D aily in– hospital M ember receiv es $ 1 0 0 per d ay ( d ays M ember receiv es $ 2 0 0 per d ay ( d ays
4 – 6 0 ) 4 – 6 0 )
I npatient surgery N ot cov ered M ember receiv es $ 5 0 0
O utpatient surgery N ot cov ered M ember receiv es $ 2 5 0
Doctor’s ofice visit M ember receiv es $ 2 5 per v isit, 2 v isits M ember receiv es $ 5 0 per v isit, 2 v isits
per person/ per person/
4 per family per year 4 per family per year
Telemed icine program 1 0 0 % paid by plan, unlimited v isits 1 0 0 % paid by plan, unlimited v isits
P rev entiv e care * 1 0 0 % cov ered 1 0 0 % cov ered
E mergency room N ot cov ered M ember receiv es $ 2 0 0 per v isit, 2 v isits
per person/
4 per family per year
C ritical illness N ot cov ered N ot cov ered
P rescription D rugs
3 - Tier F ormulary through P roC are R x
Tier 1 $ 1 0 copay $ 1 0 copay
Tier 2 $ 2 0 copay $ 2 0 copay
Tier 3 $ 4 0 copay $ 4 0 copay
* Preventive care must be received by a PHCS network provider. No beneits will be paid for non-network providers. Please visit www.phcs.com to
ind in-network providers in your area.
2016 Open Enrollment
M inimum E ssential C ov erage ( M E C ) O ption
Your MEC plans offer 24-hour You’ll have access to enhanced discount plans with network access to
telephone access, at no additional major pharmacy distributors across the country. The MEC plans will
cost to you, to physicians for consult offer comprehensive drug formularies and each plan participant will
and diagnosis of approximately 550 receive their own prescription drugs ID card. Participants in the MEC
clinical conditions. Physicians are plans will not receive medical ID cards.
US based, licensed, board-certiied,
and available 24 hours per day Our MEC plans are considered indemnity plans. You’ll see in each
for questions, consultations, and design your plan is actually paying the member, not the provider, for
medication prescriptions (when services rendered. This chart provides an overview of the varying
appropriate). levels of coverage available to you in each MEC plan design. It’s
important to take considerable time to evaluate which plan design
offers the level of beneit that best its your family’s needs.
B ronz e G old
A nnual d ed uctible $ 0 $ 0
F irst d ay in hospital $ 3 0 0 $ 1 , 0 0 0
S econd and third d ay in hospital $ 3 0 0 per d ay $ 5 0 0 per d ay
D aily in– hospital M ember receiv es $ 1 0 0 per d ay ( d ays M ember receiv es $ 2 0 0 per d ay ( d ays
4 – 6 0 ) 4 – 6 0 )
I npatient surgery N ot cov ered M ember receiv es $ 5 0 0
O utpatient surgery N ot cov ered M ember receiv es $ 2 5 0
Doctor’s ofice visit M ember receiv es $ 2 5 per v isit, 2 v isits M ember receiv es $ 5 0 per v isit, 2 v isits
per person/ per person/
4 per family per year 4 per family per year
Telemed icine program 1 0 0 % paid by plan, unlimited v isits 1 0 0 % paid by plan, unlimited v isits
P rev entiv e care * 1 0 0 % cov ered 1 0 0 % cov ered
E mergency room N ot cov ered M ember receiv es $ 2 0 0 per v isit, 2 v isits
per person/
4 per family per year
C ritical illness N ot cov ered N ot cov ered
P rescription D rugs
3 - Tier F ormulary through P roC are R x
Tier 1 $ 1 0 copay $ 1 0 copay
Tier 2 $ 2 0 copay $ 2 0 copay
Tier 3 $ 4 0 copay $ 4 0 copay
* Preventive care must be received by a PHCS network provider. No beneits will be paid for non-network providers. Please visit www.phcs.com to
ind in-network providers in your area.
2016 Open Enrollment
