| Plan Name: Elevate Health PPO 2025 |
| Type: Preferred Provider Organization (PPO) |
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| Summary: |
| The Elevate Health PPO Plan offers flexibility in choosing healthcare providers. Members can visit any doctor or specialist without a referral, but in-network providers offer lower out-of-pocket costs. |
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| Key Benefits: |
| - Annual deductible: $1,500 individual / $3,000 family |
| - Out-of-pocket maximum: $6,000 individual / $12,000 family |
| - Primary care visits: $25 copay in-network |
| - Specialist visits: $50 copay in-network |
| - Emergency room: $250 copay |
| - Generic prescriptions: $10 copay |
| - Brand name prescriptions: $40 copay |
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| Wellness Programs: |
| - Free annual physical exams |
| - Telehealth services with no copay |
| - Mental health counseling (up to 10 visits/year covered) |
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| Covered Services: |
| - Preventive care (100% in-network) |
| - Maternity and newborn care |
| - Surgery and hospitalization |
| - Lab tests and X-rays |
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| Exclusions: |
| - Cosmetic procedures |
| - Fertility treatments |
| - Long-term custodial care |
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| Plan Name: CoreCare HMO 2025 |
| Type: Health Maintenance Organization (HMO) |
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| Summary: |
| CoreCare HMO Plan requires members to choose a Primary Care Physician (PCP) and get referrals for specialist care. This plan offers coordinated care at lower premiums. |
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| Key Benefits: |
| - Annual deductible: $500 individual / $1,000 family |
| - Out-of-pocket maximum: $4,000 individual / $8,000 family |
| - Primary care visits: $15 copay |
| - Specialist visits: $30 copay (with referral) |
| - Emergency room: $200 copay |
| - Generic prescriptions: $5 copay |
| - Brand name prescriptions: $25 copay |
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| Covered Services: |
| - Preventive and routine care |
| - Prenatal and maternity services |
| - Behavioral health support |
| - Diagnostic imaging and lab services |
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| Exclusions: |
| - Out-of-network care (except emergencies) |
| - Cosmetic procedures |
| - Alternative therapies (e.g., acupuncture) |
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| Contact Information: |
| For questions about coverage, contact Member Services at 1-800-555-1234. |
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