For costs and complete details, contact us at
505.727.5482 or 877.232.1982
For costs and complete details, contact us at
505.727.5482 or 877.232.1982
Our Individual High Deductible Health Plans are Health Savings Account (HSA) qualified and can offer tax advantages when paired with an HSA. These plans offer lower out-of-pocket expenses when the Lovelace Preferred Provider Network is used, but give you the freedom to go out-of-network if you choose. Preventive Care is covered at no cost to you. Prescription Drug coverage is included on the High Deductible Health Plans.
| BENEFITS | ||||
|---|---|---|---|---|
| HDHP 0% | HDHP 20% | |||
| In Network | Out of Network | In Network | Out of Network | |
| Annual Deductible Deductible must be met before Coinsurance applies. |
$3,500, $5,000 | $7,000, $10,000 | $1,200, $2,600 | $2,400, $5,200 |
| Coinsurance Out-of-Pocket Maximum | $3,500, $5,000 | $7,000, $10,000 | $2,500, $5,000 | $5,000, $10,000 |
| Preventive Care Services | $0 | 20% | $0 | 40% |
| Lifetime Maximum Benefit | Unlimited | Unlimited | ||
| Medical Office Visits | ||||
| Non-Specialist | 0% | 20% | 20% | 40% |
| Specialist | 0% | 20% | 20% | 40% |
| Emergency Care | 0% | 20% | ||
| Urgent Care | 0% | 20% | ||
| Hospital Services | ||||
| Inpatient & Outpatient | 0% | 20% | 20% | 40% |
| Acupuncture/Chiropractic Services | ||||
| $1,500 Maximum per service, per year | 0% | 20% | 20% | 40% |
| Prescription Drug Benefits Prescription Drugs on the HDHP Plans are subject to the plan's Annual Deductible |
Must use participating pharmacy | Must use participating pharmacy | ||
| Generic | 0% | 20% | ||
| Brand Name Preferred | 0% | 20% | ||
| Brand Name Non-Preferred | 0% | 20% | ||
| Specialty Medications | 0% | 20% | ||
This summary contains highlights only and is subject to change. The specific terms of coverage are listed in the Evidence of coverage Handbook, including details on Limitations and Exclusions. Additionally, some services require Prior Authorization.
Standardized Summary of Benefit and Coverage Document (SBC) - The Standardized Summary of Benefits and Coverage is available for you per the U.S. Department of Health and Human Services and the Patient Protection and Affordable Care Act (PPACA). It describes the plan's benefits and coverage.
Glossary - The Uniform Glossary is available to you per the U.S. Department of Health and Human Services and the Patient Protection and Affordable Care Act (PPACA). It's a glossary that defines health coverage and medical terminology used in the SBC.
If you would like a copy of the SBC, you can request it by calling the SBC Hotline at (505) 727-1707 or by emailing SBC@lovelace.com. When making a request, please include your name, member number, date of birth, and the address and/or email address where you would like to receive your copy of the SBC.
This summary contains highlights only and is subject to change. The specific terms of coverage are listed in the Evidence of coverage Handbook, including details on Limitations and Exclusions. Additionally, some services require Prior Authorization. For costs and complete details, contact us at 505.727.LOVE (5683) or 800.808.7363.