Tonik Calculated Risk Taker Plan:

The Calculated Risk Taker plan offered by Tonik is a great way to find health insurance coverage with a low deductible and a reasonable premium. When compared to similar health plans, this plan offers significant savings and a great deal of coverage. Here’s what you can expect under this plan.

Annual Deductible - Your annual deductible under this plan is $1500. Once you have met this deductible, most of your medical needs should be met without any additional out-of-pocket expense. The deductible for out-of-network providers is $10,000.

Lifetime Maximum - This plan has a $5,000,000 maximum benefit. This means that over the course of the life of the policy, you will be covered up to this amount. Unless you have a chronic condition that necessitates constant treatment or hospitalization, this should be more than enough coverage.

Office Visits - This plan offers an unlimited amount of office visits with a $40 co-pay, as long as you visit a participating in-network provider. If you go out-of-network, your cost will be 50% of the covered expenses and any additional expenses that are not covered. These visits are not subject to your deductible.

Professional Services - Once you meet your deductible, you will not have any additional charges for professional services received in-network. Once again, going out-of-network will result in having to pay for 50% of the covered expenses as well as any additional expenses.

Emergency Room Visits - An emergency room visit with a participating provider only requires a $100 co-payment. All other charges are then covered. A non-participating provider visit will require this co-pay and in addition you will need to pay for all charges in excess of the covered charges.

Inpatient Hospital - If you are in-network, you will not need to pay for any charges. An out-of-network hospital stay requires you to pay for all charges, minus $650 per day.

Outpatient Hospital - Again, if you are in-network, you will not need to pay for this care. Out-of-network outpatient care requires a payment of all charges, minus $380 per day.

Vision Care - You will need to pay for all charges, minus $50 regardless of the provider being in or out of the network.

Preventative Care - This type of care requires a $40 co-pay and includes a pap test, mammography, cancer screening and other tests. If you require professional services without an office visit, once you have met your deductible there are no additional charges.

HealthyCheck Centers - If you opt for the HealthyCheck plan, you will need to pay either $25 or $75, depending on the level of care you select.

Physical and Occupational Therapy - You will receive 12 covered visits per year. Once you meet your deductible, there are no additional charges. There are no required co-payments for this type of therapy.

Mental Health Care or Substance Abuse Care - You will need to pay for all of the charges for this care, except $25 per visit whether you are treated by an in or out of network provider.

Prescription Benefit - Generic prescriptions will cost $10 for a 30-day supply with a participating pharmacy. Costs for these prescriptions at a non-participating pharmacy are 50% of the Drug Limited Fee Schedule. If you require self-administered injectables, the cost is 30% of the negotiated fee, unless the injectable is insulin.

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