OptiMed Limited Medical Plans
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13 Plans, scroll left to right (scroll bar below) and up and down (scroll bar at right)
Standard Plans | Select 20 | Select 20 Rx | Select 30 | Select 30 Rx | Med-Choice 40 | Med-Choice 40 Rx | Premier 50 Rx | Premier 60 Rx | Preferred 70 Rx+ | Preferred 80 Rx+ | Executive 80 Rx+ | Executive 90 Rx+ | Executive 100 Rx+ |
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Outpatient Physician Office Vists - Both General & Specialist | $20 Per Day (6 Days) | $20 Per Day (6 Days) | $30 Per Day (6 Days) | $30 Per Day (6 Days) | $40 Per Day (6 Days) | $40 Per Day (6 Days) | $50 Per Day (8 Days) | $60 Per Day (8 Days) | $70 Per Day (10 Days) | $80 Per Day (12 Days) | $80 Per Day (12 Days) | $90 Per Day (12 Days) | $100 Per Day (12 Days) |
ER- Sickness - 3 day max per benefit period | $50 Per Day | $50 Per Day | $50 Per Day | $50 Per Day | $50 Per Day | $50 Per Day | $50 Per Day | $50 Per Day | $50 Per Day | $75 Per Day | $75 Per Day | $100 Per Day | $100 Per Day |
Wellness Benefit - Under age 1 - 4 day benefit period max Age 1 and older - 3 day benefit period max | $50 Per day | $50 Per day | $50 Per day | $50 Per day | $50 Per day | $50 Per day | $50 Per day | $50 Per Day | $50 Per Day | $100 Per Day | $150 Per Day | $150 Per Day | $150 Per Day |
Hearing Exam Beneft - Benefit is payable one time per 24 consecutive month period per insured and dependent spouse and one time per 12 consecutive month period per dependent child | N/A | N/A | $70 Exam | $70 Exam | $70 Exam | $70 Exam | $70 Exam | $70 Exam | $70 Exam | $70 Exam | $70 Exam | $70 Exam | $70 Exam |
Outpatient Diagnostic Laboratory Test - 3 Day Max | N/A | N/A | N/A | N/A | N/A | N/A | $20 Per Day | $30 Per Day | $40 Per Day | $40 Per Day | $60 Per Day | $80 Per Day | $100 Per Day |
Outpatient Diagnostic Test - 3 Day Max | N/A | N/A | N/A | N/A | N/A | N/A | $50 Per Day | $50 Per Day | $50 Per Day | $50 Per Day | $60 Per Day | $80 Per Day | $100 Per Day |
Outpatient Advanced Diagnostic Testing Level 1 Ultrasound, Mammogram, Stress Test, Electroencephalogram(EEG) test, Electrocardiogram(EKG) test, Echocardiogram Level 2 CT(CAT) Scan, Magnetic Resonance Imaging(MRI) Scan, Magnetic Resonance Angiogram(MRA) Scan, Positron Emmission Tomography (PET) Scan - 3 Days per person per benefit period (Level 1 & Level 2 combined | N/A | N/A | N/A | N/A | N/A | N/A | $50 Per Day $150 Per Day | $100 Per Day $300 Per Day | $100 Per Day $300 Per Day | $150 Per Day $450 Per Day | $150 Per Day $450 Per Day | $200 Per Day $600 Per Day | $200 Per Day $600 Per Day |
AmbulanceTrip - Groud/Water 3 days per benefit period Air - 3X the ground/water benefit | N/A | N/A | N/A | N/A | $150 per day | $150 per day | $150 per day | $150 per day | $150 Per Day | $150 Per Day | $150 Per Day | $150 Per Day | $150 Per Day |
ER Injury - For treatment in ER if preformed within 72 hours of the accident / 3 Day benefit period Max | N/A | N/A | $300 Per Day | $300 Per Day | $300 Per Day | $300 Per Day | $500 Per Day | $500 Per Day | $1,000 Per Day | $1,000 Per Day | $1,000 Per Day | $1,000 Per Day | $1,000 Per Day |
In-Patient Surgery - 2 day per person max | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | $500 Per Day | $1,000 Per Day | $1,500 Per Day | $2,000 Per Day | $2,500 Per Day |
Out-Patient Surgery - 2 day per person max | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | $250 Per Day | $500 Per Day | $750 Per Day | $1,000 Per Day | $1,250 Per Day |
Anesthesia - Inpatient and Outpatient | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | 20% of surgical benefit | 20% of surgical benefit | 20% of surgical benefit | 20% of surgical benefit | 20% of surgical benefit |
Hospital Confinement Indemnity - Requires 24 hour stay - payable from first day of confinement | $100 Per Day | $100 Per Day | $100 Per Day | $100 Per Day | $100 Per Day | $100 Per Day | $200 Per Day | $500 Per Day | $500 Per Day | $800 Per Day | $1,000 Per Day | $1,000 Per Day | $1,000 Per Day |
Intensive Care Confinement Indemnity - Paid in addition to Daily Hospital Confinement. 30 Days Calendar Max - Per Person. | $100 Per Day | $100 Per Day | $100 Per Day | $100 Per Day | $100 Per Day | $100 Per Day | $200 Per Day | $500 Per Day | $500 Per Day | $800 Per Day | $1,000 Per Day | $1,000 Per Day | $1,000 Per Day |
Confinement Benefit for Skilled Nursing- after a 3+ hospital stay/ up to 60 days per stay/120 day lifetime max | $50 Per Day | $50 Per Day | $50 Per Day | $50 Per Day | $50 Per Day | $50 Per Day | $100 Per Day | $250 Per Day | $250 Per Day | $400 Per Day | $500 Per Day | $500 Per Day | $500 Per Day |
Life & AD&D (Employee Only) | N/A | N/A | N/A | N/A | 5000 | 5000 | 5000 | 5000 | 5000 | 5000 | 5000 | 10000 | 20000 |
OutPatient Prescription Drug - Average tier Insured Cost Generic $10 / Brand $50 Annual Maximums $3,000 per insured subject to drug formulary. Cost may vary by Formulary Tier and Pharmacy. Member pays 100% of discounted price for drugs not covered under the formulary Note: RX is not available in IL, ME and MD | Discount Card | Generic Only | Discount Card | Generic Only | Discount Card | Generic Only | Generic Only | Generic Only | Generic/Brand | Generic/Brand | Generic/Brand | Generic/Brand | Generic/Brand |
Guaranteed Issue | Included | Included | Included | Included | Included | Included | Included | Included | Included | Included | Included | Included | Included |
PPO Networks | Multiplan, First Health | Multiplan, First Health | Multiplan, First Health | Multiplan, First Health | Multiplan, First Health | Multiplan, First Health | MultiPlan, First Health | MultiPlan, PHCS, First Health | MultiPlan, PHCS, First Health | MultiPlan, PHCS, First Health | MultiPlan, PHCS, First Health | MultiPlan, PHCS, First Health | MultiPlan, PHCS, First Health |
Assignment of Benefits | Included | Included | Included | Included | Included | Included | Included | Included | Included | Included | Included | Included | Included |
Patient Advocacy Program | Included | Included | Included | Included | Included | Included | Included | Included | Included | Included | Included | Included | Included |
Enhanced Customer Care | Included | Included | Included | Included | Included | Included | Included | Included | Included | Included | Included | Included | Included |
WorkPlace Wellness | Included | Included | Included | Included | Included | Included | Included | Included | Included | Included | Iincluded | Included | Included |
Telemedicine | Included | Included | Included | Included | Included | Included | Included | Included | Included | Included | Included | Included | Included |
Cobra Administration | Included | Included | Included | Included | Included | Included | Included | Included | Included | Included | Included | Included | Included |
Section 125 Premium Only Plans | Included | Included | Included | Included | Included | Included | Included | Included | Included | Included | Included | Included | Included |
Rates: EE | $34.58 | $44.92 | $42.89 | $53.23 | $48.95 | $59.29 | $77.42 | $100.39 | $133.53 | $170.96 | $196.77 | $219.23 | $240.11 |
Rates: EE+1 | $52.98 | $69.16 | $69.18 | $85.36 | $80.13 | $96.31 | $131.92 | $177.03 | $241.99 | $315.50 | $366.19 | $409.35 | $448.46 |
Rates: Family | $70.32 | $92.35 | $92.87 | $114.90 | $107.95 | $129.98 | $179.58 | $242.43 | $334.67 | $437.08 | $507.70 | $567.66 | $621.78 |
Standard Plans | Select 20 | Select 20 Rx | Select 30 | Select 30 Rx | Med-Choice 40 | Med-Choice 40 Rx | Premier 50 Rx | Premier 60 Rx | Preferred 70 Rx+ | Preferred 80 Rx+ | Executive 80 Rx+ | Executive 90 Rx+ | Executive 100 Rx+ |