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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
PRESCRIPTION DRUGS
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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