Unified Life Health Plans

Plan Name:

Premier STM

  Plan Brochure
Deductible Options: $500-$5,000
Co-Insurance Options: 80%
Out of Pocket Max Options: $5,000 or $10,000
Lifetime Maximum Options: $25,000-$1 Million
Doctor Office Visits: $15-$25 Copay* – Unlimited Visits
Specialists Visits: $25-$40 Copay*
Urgent Care Visits: Deductible then Co-Insurance**
Prescriptions: Discount Card
X-Ray, Labs, Imaging: Deductible then Co-Insurance
E.R. and Hospitalization: Deductible then Co-Insurance***
Application Fee: $50.00
Additional Comments:

*

**

***

*View page 3 of Brochure – Copay option depends on the Maximum Benefit that is selected.

**View page 3 of Brochure – An additional $50.00 access fee applies for Urgent Care Visits.

***View Page 3 of Brochure – An additional $200 access fee applies to E.R. Visits.