Peak Advantage Vista (PPO) Plan

Vista (PPO) Plan

2024 benefits include:

MEDICAL
Deductible: $0
Primary care office visit copay: $0
Specialist office visit copay: $25
See full list of benefits

PRESCRIPTION DRUGS
Deductible: $0
Copay: $0 (Tiers 1 & 2) at preferred pharmacies
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Flexible Spending Card

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OTC Allowance

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Dental Benefits

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Vision & Eyewear

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Hearing Aid Discounts

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Fitness Membership

PLAN HIGHLIGHTS	WHAT YOU PAY
Monthly Plan Premium	$0
Medical Deductible	$0
Primary Care Office Visit	$0 copay
Telehealth Visit	$0 copay
Specialist Office Visit	$25 copay (NO REFERRALS)
Prescription Drug Deductible	$0
Routine Vision & Hearing Exams	$0 copay
Preventive Services	$0 copay
Occupational, Physical, Speech Therapy	$30 copay
Chiropractic Services	$25 copay (10 visits)
Podiatry Services	$25 copay (10 visits)
Outpatient Procedures	$0 - $275 copay
Urgent Care	$30 copay
Worldwide Emergency Care	$95 copay
Inpatient Hospital Stay (physical)	$200/day (days 1-3)
Prescription Drugs	$0 copay (Tiers 1 & 2) for 30-day supply at preferred pharmacies
Dental Benefits	$3,000 annual allowance $0 copay for preventive services; 50% coinsurance for comprehensive services
Over-the-Counter Allowance	$300 annually ($75/quarter)
Flexible Spending Card	$250 (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	$0 copay; 14 days following a hospital stay
Annual maximum out-of-pocket spending for health care	$7,000