Description of Coverage - Flex Plans
Plan Name
Basic
Plus
Plus+UC
Plan Type
Flex
Flex
Flex
Outpatient Benefits
Primary Care Physician (PCP)
$10 per visit
PCP Provided at Contracted PCP Offices
Specialty care (per exhibit A)
Not Covered
$40 per visit
 $40 per visit
Treatment rooms and all appropriate equipment
No charge
Application, changes, removal of dressings, splints, plaster cast and removal of sutures
No charge
Medical supplies for use at Provider's Office/Facility
No charge
Laboratory Examinations and Services
No charge or 50% of the Billed Amount
Periodic physical examinations
No charge
 Well child care and pediatric services
No charge
Health Education and Nutritional Counseling
No charge
Annual Routine and Preventive Gynecological Examination
No charge
Pediatric and Adult Immunizations
Co-payment*
Routine Vision and Hearing Examinations
No charge
Basic X-Rays: No Contrast X-Rays
No charge
X-Rays: Other contrast X-Rays
Co-payment*
Mammograms
$30 Co-payment
Inhalation Therapy
No charge
EKG
No charge
Echocardiogram/Doppler
$75 Co-payment*
Flex Sigmoidoscopy, Plain Stress Test
$100 Co-payment*
Ultrasound / Sonogram
$25 Co-payment*
Urgent Care Center
After Hours Urgent Care Centers Not Covered Not Covered $50 co-pay (max $250 per visit, 3 visits X year)
Prescriptions
When written by a contracted physician and Included on PMP's Health Flex Plan Formulary Drug List
PMP HFP Formulary - Generic $10 Co-payment up to 31 Day Supply
When written by a contracted physician and NOT-Included on PMP's Health Flex Plan Formulary Drug List
At the discretion of the contracted pharmacy, the pharmacy may offer up to 40% discount for generics and brand medication.
Optional Riders
Vision
add $5.00 / month
Dental
add $6.00 / month
*The sum of all co-payments will not exceed $5,000 per member per calendar year, except that these limits are not applicable to co-payments for Prescriptions and any coverage provided through selection of an Optical Rider. This plan has a maximum annual dollar benefit of $70,000 per member and a maximum lifetime dollar benefit of $200,000 per member. This Health Flex Plan is not a health maintenance organization plan or product. PMP does not own or operate any medical clinics or facilities. Covered services and benefits are provided directly by or arranged by the member's primary care physician and/or other contracted health care providers. The contracted healthcare providers are not employees or agents of PMP. This is not a contract. For a detailed description of benefits, co-payments, and limitations and exclusions of this Health Fle x Plan product, please see the current Preferred Medical Plan, Inc Health Flex Plan Evidence of Coverage. Above benefits based on Form No. HNDBK-HFP-001-(03/03). You may contact PMP if you have any questions.