Direct
OFFICE VISITS
Physician, Specialist, or Urgent Care Visits
$25 Visit Fee for all eligible outpatient office visits with physician, specialist, or urgent care
provider.
Membership shares up to a maximum of $150 per eligible Office visit.
MAXIMUM OFFICE VISITS - Four (4) PER MEMBER, PER MEMBERSHIP YEAR.
*First Health Network, Healthee & Drexie
*Members can use any in or out of network provider with no reduction in sharing limits.
Direct
Member Responsibility Amount (MRA): Must be satisfied per member, per membership year.
*Additional Member Responsibility Amount (AMRA): Each member will meet 50% of the next $10,000 per member, per membership year. AMRAs apply per
member, per membership year. This does not include amounts applied to member’s MRA.
**Pre-existing: Any medical needs resulting from a disease or physical condition for which medical advice, care, services, treatment or diagnosis was received, any
prescription was written, taken, or there were signs and/or symptoms present with or without treatment, during the 24-month period preceding the member’s
effective date will be ineligible for member-to-member sharing. Pre-existing does not apply to services or treatment billed as an office visit or urgent care visit.
**90-Day Waiting Period: Certain medical needs are ineligible for member-to-member sharing for 90 days from the member’s effective date. The 90-day waiting
period does not apply to services or treatment billed as an office visit or urgent care visit, inpatient accidental injury, or eligible ER acute illness.
