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