Tonik Part Time Daredevil Plan:
The second level of coverage for Tonik plans is known as the Daredevil plan. This plan is a middle of the road plan for those who need a smaller premium and don’t mind having a larger deductible. The monthly premium for this plan is $73.
Here is what you can expect for coverage under this plan.
Annual Deductible - Your annual deductible with this plan is $3000. Once you have reached this deductible, many of the services mentioned below will not have any additional costs to you. The out-of-network deductible is $10,000.
Lifetime Maximum - As with the Calculated Risk Taker plan, the lifetime maximum amount of coverage this plan will provide is $5,000,000.
Office Visits - You are allotted four office visits per calendar year and will need to pay a $30 co-pay for each visit. Once you have exceeded this allotment, office visits are charged at 100% of the negotiated fee rate. Office visits to an out-of-network provider will cost 50% of the covered expenses plus any additional charges for the first four visits. After this point, you will need to pay for all expenses.
Professional Services - If you require professional services that are not classified as office visits, you will need to pay for these services until your deductible has been met. Once this occurs, you will not have to pay any additional charges during that year. Professional services from an out-of-network provider will require a payment of 50% of the covered expenses.
Inpatient and Outpatient Care - There is no charge for inpatient or outpatient care as long as you visit an in-network provider. If you go out-of-network, you will need to pay for all of the charges, minus $650 if the care is inpatient or $380 if the care is considered outpatient.
Emergency Room Visits - After you pay a $100 co-payment, all services from a participating emergency room provider are covered. An out-of-network emergency visit will require not only the $100 co-payment, but the payment of 100% of the excess expenses over the covered amount.
Vision Care - There is an annual $50 benefit under this plan for your vision care. After you reach that amount, you will need to pay for all charges.
Preventative Care - If you require annual pap tests, a mammography or cancer screenings, your co-pay will be $30 with an in-network provider for the first four visits. After you reach your deductible, these preventative care visits are completely covered. If you require more than four visits, you will then need to pay for 100% of the negotiated fee rate. Any preventative care that you receive from an out-of-network provider will result in having to pay 50% of the covered expenses plus any additional charges for the first four visits and 100% for any further visits.
Prescriptions - You can purchase generic prescriptions at a participating pharmacy for a co-pay of $10 for a 30-day supply. If you visit a non-participating pharmacy, you will need to pay 50% of the Drug Limited Fee Schedule Amount. You can also order your prescriptions online or through the mail and still pay only the $10 co-pay for a 30-day supply or $20 for a 60-day supply.
The premiums and lower co-pays make this plan a great middle-of-the road alternative for many people.
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