Plan Summary - AnyHealthInsurance.com

RightPlan PPO 40 (Generic Rx)

Amounts shown for covered services are your share of costs In-Network Benefits
	RightPlan PPO 40 (Generic Rx)
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Insurance Company
Plan Type - PPO \| HMO \| HSA	PPO
Annual Deductible	$0
Annual Out-Of-Pocket (includes Annual Deductible)	$7,500
Doctor Visit	$40 copay
Lifetime Maximum	$5,000,000
Inpatient	40% coinsurance + $500 copay each day for first 4 days, then 40% coinsurance
Outpatient	40% coinsurance + $500 copay
Maternity	Not covered
Emergency Services	$100 copay (waived if admitted as inpatient) + 40% coinsurance
Ambulance	40% coinsurance
X-Ray & Lab	40% coinsurance
Annual Check up	$25 or $75 copay for basic or premium screening at HealthyCheckSM Centers (deductible waived)
Pap Smear/Mammogram	$40 copay office visit + 40% coinsurance
Physical Therapy	40% coinsurance (up to 24 visits per year, combined with chiropractic care)
Acupuncture	All charges except $30 per visit, up to 24 visits per year
Chiropractic Care	40% coinsurance (up to 24 visits per year, combined with physical therapy)
Generic Rx	$15 copay
Brand Name Rx	Not covered
Term Life Coverage	Optional
Dental	Optional
Vision	Not covered
Eligibility	Reside in California at least 3 months
Available Effective Date	Any Day
Plan Limitations And Restrictions	PDF
Insurance Company
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	RightPlan PPO 40 (Generic Rx)