Golden Rule Copay Select Plans
| Insurance Benefit Highlights | Copay Select 500 |
| Calender Year Deductible | $500, $1,000 $1,500 $2,500 $5000 $7500 or $10,000 |
| Co-Insurance Choices | $0 $3000 $5000 |
| Lifetime Maximum Benefit | $3 million |
| Initial Rate Guarantee | 12 months |
| Physical (Illness & Injury) | |
| Office Visit | $35 no deductible |
| Prescription Drugs | $25/$35/$65 |
| Annual Maximum | $3,000.00 |
| Wellness/Preventive Care Benefits | |
| Doctor Office Visit | $35.00 |
| X-ray and lab | You Pay: chosen coinsurance |
| Child Immunizations | You Pay: chosen coinsurance |
| Preventative Mammogram, Pa Smear, PSA screen | You Pay: chosen coinsurance |
| Outpatient Expense Benefits | |
| X-ray and lab | You Pay: chosen coinsurance after deductible |
| Facility/Hospital for Outpatient Surgery | You Pay: chosen coinsurance after deductible |
| Surgeon, Assistant Surgeon, and Facility Fees | You Pay: chosen coinsurance after deductible |
| Hemodialysys, Radiation, Chemotherapy | You Pay: chosen coinsurance after deductible |
| Emergency Room Fees – Illness | You pay: $100 copay if not admitted |
| Emergency Room Fees – Injury | You Pay: chosen coinsurance after deductible |
| Spine and Back Disorders | You Pay: chosen coinsurance after deductible |
| Mental and Nervous Disorders | You Pay: chosen coinsurance after deductible |
| Inpatient Expense Benefits | |
| Room and Board | You Pay: chosen coinsurance after deductible |
| Intensive Care Unit | You Pay: chosen coinsurance after deductible |
| Operating Room | You Pay: chosen coinsurance after deductible |
| Recovery Room | You Pay: chosen coinsurance after deductible |
Convenient Doctor Office Copay Benefits
Designed for individuals and families, our copay plans are more like traditional employer plans with a copayment for routine health-care expenses. When you use a network doctor for an office visit, we pay 100% for history and exam. When you use a network doctor for an office visit, we pay 100% of history and exa fees after a $35 copay with Copay Select. Office visit expenses outside your network are not eligible for copay benefits.
Adult and Child Preventive Care Included
After a 3-month waiting period, you pay $35 for the doctor office visit with Copay Select. X-rays and lab tests are covered after you pay your chosen coinsurance (0%, 20%, or 30%)
Comprehensive Coverage for Inpatient and Outpatient Medical Expenses (Copay Select Only)
You choose $3 million or $5 million lifetime maximum benefits per covered person.
Covered inpatient and outpatient expenses are reimbursed after your chosen coinsurance and the dedutible.
Tags: Golden Rule Copay Select
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