Tonik Thrill Seeker Plan:

The last plan offered by Tonik is the Thrill Seeker Plan. It features the highest deductible and the lowest monthly premium amounts, which are only $64. In addition, it also features the lowest co-pay for office visits. Instead of the $40 co-pay offered with the Caclulated Risk Taker Plan, you will only need to pay $20 for your office visit co-pay.

Here’s what to expect under this plan:

Annual Deductible - Your annual deductible is $5000 for in-network providers. If you go out-of-network, this changes to $10,000.

Lifetime Maximum - The maximum amount of benefits you can expect under this plan is $5,000,000. For the average person, this is more than enough coverage.

Office Visits - Your co-pay for participating provider office visits is just $20 for the first four visits in a calendar year. After that point, you will need to pay the entire amount for the negotiated fee rate. If you visit a non-participating provider, you will need to pay 50% of the covered charges, as well as 100% of any additional charges for the first four visits. Once this is reached, you are then responsible for 100% of the charges for your office visits.

Professional Services - Once you have met your annual deductible, there is no charge for professional services received from a participating provider. However, if you go out-of-network, you will need to pay 50% of the covered expenses and all of the non-covered expenses.

Inpatient and Outpatient Hospital Care - After you meet your deductible, there is no charge for inpatient or outpatient care received from a participating provider. If you do not go to a participating provider, this amount jumps to 100% of the covered expenses, minus $650 per day for inpatient care or $380 per day for outpatient care.

Emergency Room Visits - A visit to the emergency room of a participating provider will require a $100 co-pay, but once you meet your deductible, all charges are covered. If you visit an non-participating provider, you will need to pay not only the co-pay, but also 100% of the excess of covered charges.

Vision Care - You will be required to pay 100% of your vision care, minus $50 for either participating or non-participating providers.

Preventative Care - This type of care counts towards your office visit quota of 4 visits per year. Each visit to a participating provider for preventative care will require a $30 co-pay. Once you meet your deductible, there is no charge or co-pay for these visits, as long as you remain under 4 annually. Once you reach your limit, you will be responsible for 100% of the negotiated fee rate. If you receive preventative care from a non-participating provider, for the first four visits of the year you will need to pay 50% of the covered charges. After the first four visits, you will then need to pay 100% of the covered charges.

Prescription Drugs - This plan offers a prescription benefit, but only for generic drugs. You will need to have your physician prescribe generic alternatives if you want to take advantage of this benefit. For generic drugs from a participating pharmacy, you will only need to pay $10 for a 30-day supply. If you visit a non-participating pharmacy, this amount jumps up to 50% of the Drug Limited Fee Schedule amount, which can be expensive.

Although this plan has a higher deductible, it does offer specific features that make it attractive. The prescription drug benefit alone may make it worth the cost and deductible for many people.


Dan Abrams California Health Insurance