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Hospital Network (Memphis area): Baptist, St. Francis, Le Bonheur

In Network Benefits

You Pay

Office Visit- Primary Care Physician

20% after Deductible

Office Visit – Specialist

20% after Deductible

Office Visit – Wellcare

$0

Emergency Room

20% after Deductible

Hospital Services - Inpatient

20% after Deductible

Hospital Services - Outpatient

20% after Deductible

Prescription Drugs

20% after Deductible

Coinsurance

80 / 20

Deductible

$5,000 individual
$10,000 family

Out of Pocket Maximum

$6,000 individual
$12,000 family

Rate per month

 

Employee Only

$197.60

Employee + Spouse

$691.90

Employee + Child(ren)

$570.57

Family

$1112.11

Final rates could change slightly from the above listed rates.

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