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Permian Basin Employer Health Plan A - High 1000 |
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Covered Services
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Member Responsibility |
| Aggregate Lifetime Maximum Benefit |
$1,000,000 |
| Calendar Year Deductible |
$1,000 per Member |
| Out-of-Pocket Maximum |
$10,000 per Member |
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| Doctor Office Visits
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Primary Care Physician |
$25 per visit |
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Specialty Care |
$55 per visit |
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Inpatient Services |
Tier 1 Hospital
(contracted, within the Service Area) |
$200 per day per admission
($1,000 max per admission) |
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Tier 2 Hospital
(contracted, outside the Service Area) |
30% of the allowable amount
after deductible |
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| Emergency Care Services |
Emergency Room |
$125 per visit |
| Urgent Care or Minor Emergency |
$50 per visit |
For more detailed information visit the plan documents:
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