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.
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