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Special sponsor 20th annual Susan G. Komen Detroit Race for the Cure
HealthChoice Benefits at a GLANCE
Preventive Services:
- Health Maintenance Exam - $10.00 co-pay.
- Annual Gynecologic Exam - $10.00 co-pay.
- Pap Smear Screening - Office visit co-pay apply per visit.
- Mammography Screening - Office visit co-pay apply per visit.
- Well Baby and Child Care - $20.00 co-pay.
- Immunizations – Child/Adult Office visit co-pay apply per visit.
- Prostate Specific Antigen (PSA) Screen – Office visit co-pay apply per visit.
- Hearing Screening – Office visit co-pay apply per visit.
Emergency Medical Care
- ER visit – Participating Provider – At Participating Providers - $50 co-pay if not admitted – No co-pay if admitted.
- Urgent Care Center (24 hr. access) - $15.00 co-pay per visit.
- Ambulance Services – medically necessary Covered if admitted - $50 co-pay if not admitted.
Diagnostic Services
- Radiology Covered – No co-pay Diagnostic Laboratory Covered – No co-pay.
Maternity Services Provided by a Physician
- Pre-Natal and Post-Natal Care Covered - $20.00 co-pay Delivery and Nursery Care Covered – No co-pay.
Hospital Care
- Inpatient Physician/Nursing Care Covered – No co-pay; Subject to limitations.
- Hospital Services and Supplies Covered - $10.00 co pay.
Alternatives to Hospital Care
- Home Health Care Covered - $10.00 per visit Surgery-includes anesthesia/related Covered –No co-pay related to inpatient hospitalization
Mental Health Care and Substance Abuse Treatment
- Outpatient substance abuse care Not Covered – refer to Wayne County Mental Health.
- Outpatient mental health services Not Covered – refer to Wayne County Mental Health.
Other Rider Services (available if group purchased)
- Physical Therapy Covered - $10.00 per visit.
- Durable Medical Equipment Covered – 50% per prescribed equipment.
- Vision Exam and Glasses Covered
Physician Office Visit
- Office Visits - $10.00 co-pay.
- Specialist Visits - $20.00 co-pay.
Prescription Drugs
- Generic Drugs - $10.00 co-pay per prescription.
- Brand Name Drugs - $15,00 co-pay per prescription
- Psychotherapeutic Drugs – 50% of each prescription drug.
- Inpatient Drug & Alcohol Rehab Services Covered – Limit $20,00 per episode/per year.
- Additional Ten (10) inpatient days No co-pay.