Peak Advantage Summit (PPO) Plan
Peak Advantage
Summit (PPO) Plan
2024 benefits include:
MEDICAL
Deductible: $0
Primary care office visit copay: $0
Specialist office visit copay: $20
See full list of benefits
Deductible: $0
Primary care office visit copay: $0
Specialist office visit copay: $20
See full list of benefits
PRESCRIPTION DRUGS
Deductible: $0
Copay: $0 (Tiers 1 & 2) at preferred pharmacies
Deductible: $0
Copay: $0 (Tiers 1 & 2) at preferred pharmacies
Brought to you by:
This plan also includes:
Flexible Spending Card
OTC Allowance
Dental Benefits
Vision & Eyewear
Hearing Aid Discounts
Fitness Membership
| PLAN HIGHLIGHTS | WHAT YOU PAY |
| Monthly Plan Premium | $18 |
| Medical Deductible | $0 |
| Primary Care Office Visit | $0 copay |
| Telehealth Visit | $0 copay |
| Specialist Office Visit | $20 copay (NO REFERRALS) |
| Prescription Drug Deductible | $0 |
| Routine Vision & Hearing Exams | $0 copay |
| Preventive Services | $0 copay |
| Occupational, Physical, Speech Therapy | $20 copay |
| Chiropractic Services | $20 copay (10 visits) |
| Podiatry Services | $20 copay (10 visits) |
| Outpatient Procedures | $0 – $250 copay |
| Urgent Care | $25 copay |
| Worldwide Emergency Care | $95 copay |
| Inpatient Hospital Stay (physical) | $350 copay/stay |
| Prescription Drugs | $0 copay (Tiers 1 & 2) for 30-day supply at preferred pharmacies |
| Dental Benefits | $4,000 annual allowance $0 copay for preventive services; 50% coinsurance for comprehensive services |
| Over-the-Counter Allowance | $480 annually ($120/quarter) |
| Flexible Spending Card | $350 (prepaid debt card) |
| Transportation Assistance | $0 copay (24 trips) |
| Annual Eyewear Allowance | $200 |
| Hearing Aids | Discounts |
| Fitness Membership | No cost to you good at over 100 locations in West Virginia |
| Meals-at-Home Program | 14 days following a hospital stay |
| Annual maximum out-of-pocket spending for health care | $6,250 |
More Information: |Helpful Resources|Enroll Now
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