![Molina Healthcare (1) Molina Healthcare Gold Plan](https://www.ilhealthagents.com/wp-content/uploads/2023/07/Molina-Healthcare-1.png)
Services | Gold Plan 1 |
---|---|
Value Basics | |
Teladoc Virtual Care Visits 24/7/365 | FREE |
Annual Wellness Visit – Adults | FREE |
Routine Preventive Screenings – Children & Adults | FREE |
Routine Vision Exams & eyewear for Children (0-18) | FREE |
Preventive Prescription Drugs | FREE |
24 Hour Nurse Line | FREE |
Urgent Care at Same Cost as Primary Physician Visit | YES |
Plan Options with Adult Vision Services | YES |
Benefit & Cost Share Highlights | |
Deductible (Ind/Fam) | $2,100 / $4,200 |
Out-of-Pocket Max (Ind/Fam) | $8,550 / $17,100 |
Drug Deductible (Ind/Fam) | Combined Med/Rx Rx Tiers 3&4 Only |
Emergency Room Services | 20% after ded |
Hospital / Facility Services | |
Inpatient Hospital | 20% after ded |
Skilled Nursing Facility Services | 20% after ded |
Hospital Physician Services | 20% after ded |
Outpatient Surgery Services | 20% after ded |
Outpatient Services | |
Primary & Urgent Care Services | $10 |
Specialist Services | $50 |
Mental/Behavioral Health Services | $10 |
Imaging & Specialized Radiology | 20% after ded |
Rehabilitative Services -ST, OT, PT | $50 |
Routine Laboratory Services | $15 |
Routine X-Ray & Diagnostic Services | 20% after ded |
Prescription Drugs | |
Tier 1 – Preferred Generic Drugs | $10 |
Tier 2 – Preferred Brand Drugs | $50 |
Tier 3 – Non-Pref Brand & Generic Drugs | 30% after ded |
Tier 4 – Specialty Drugs | 30% after ded |
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