SmartHealth Plus

IN-NETWORK - Multiplan PHCS
$25 co-pay for all outpatient physician office visits at primary care physician office, specialist, urgent care, or retail medical clinic. Plan pays up to $200 for services rendered per visit after co-pay. Max. benefit 4 or 6 visits per insured/year

OUT-OF-NETWORK
$25 co-pay for all outpatient physician office visits at primary care physician office, specialist, urgent care, or retail medical clinic. Plan pays up to 125% of Medicare for services rendered per visit after co-pay. Max. benefit 4 or 6 visits per insured/year

IN-NETWORK - Multiplan PHCS
No cost for all covered wellness and preventive care services. Max. benefit: 1 exam per year per insured History, Physical Exam, Measurements (height, weight, body mass index).

OUT-OF-NETWORK: Not covered.

IN-NETWORK - Multiplan PHCS
No cost for all covered wellness and preventive care services.

OUT-OF-NETWORK: Not covered.

Covered Preventive Services for Adults
(ages 18 and older)

• Abdominal Aortic Aneurysm Screening - One-time screening for age 65-75
• Blood Pressure screening - One-time per plan year
• Cholesterol screening - One-time per plan year
• Type 2 Diabetes screening - One-time per plan year
• Hepatitis B screening for adults at high risk - One-time per plan year
• Hepatitis C screening for adults at high risk - One-time per plan year
• HIV screening & counseling - One-time per plan year
• Immunization vaccines One-time per plan year per immunization (EACH) - hepatitis A & B, herpes zoster, human papillomavirus, influenza (flu shot), measles, mumps, rubella, meningococcal, pneumococcal, tetanus, diphtheria, pertussis, and varicella
• Obesity screening & counseling - One-time per plan year
• Sexually Transmitted Infection (STI) prevention counseling - One-time per plan year
• Syphilis screening - One-time per plan year

IN-NETWORK - Multiplan PHCS
No cost for all covered wellness and preventive care services.

OUT-OF-NETWORK: Not covered.

Covered Preventive Services for Women
(ages 18 and older)

• BRCA counseling and genetic testing - One-time per plan year for Women at higher risk
• Breast Cancer Mammography Screenings - One-time per plan year for women age 40+
• Breast Cancer Chemo prevention counseling - One-time per plan year
• Cervical Cancer screening - One-time per plan year
• Gestational Diabetes screening - One-time per plan year
• Hepatitis B screening - One-time per plan year
• HIV screening & counseling - One-time per plan year
• Human Papillomavirus (HPV) DNA test - One-time every 3 years for women with normal cytology age 30+
• Osteoporosis screening - One-time per plan year for women age 60+
• Well-woman visits - To obtain recommended preventive services

IN-NETWORK - Multiplan PHCS
No cost for all covered wellness and preventive care services.

OUT-OF-NETWORK: Not covered.

Covered Preventive Services for Children
(ages 18 and older)

• Immunization vaccines One-time per plan year per immunization (EACH) - hepatitis A & B, herpes zoster, human papillomavirus, influenza (flu shot), measles, mumps, rubella, meningococcal, pneumococcal, tetanus, diphtheria, pertussis, and varicella
• Autism screening - Limited to 2 screenings up to age 26 months
• Blood Pressure screening - One-time per plan year
• Congenital Hypothyroidism screening - One-time per plan year for Newborns up to age 3 months
• Phenylketonuria (PKU) screening - One-time per plan year for Newborns up to age 3 months
• Sexually Transmitted Infection (STI) prevention counseling & screening - One-time per plan year for adolescents aged 12 to 17 years
• Tuberculin testing - One-time per plan year
• Vision screening - One-time per plan year for children up to age 5

Every subscriber is assigned a primary care provider to support overall health and wellness as well as management of chronic medical conditions and the coordination of care with local medical providers (i.e., specialists).

For immediate diagnosis, treatment, or direction of acute medical conditions.

Preliminary diagnosis, counseling, and treatment and/or referrals to local mental health specialists as appropriate.

We first diagnose and treat all that is responsible to handle virtually and then guide our members to the highest value, lowest cost providers and resources in their geographic area, including prescriptions, local labs, imaging, and other diagnostic services.

Weight loss, smoking cessation, and overall lifestyle coaching and support.

Consultation with our maternal and fetal medicine specialists, advice, guidance, lactation consults and more.

We support the patient empowerment journey through online education, research tools, a medical grade symptom checker, and much more.

Comprehensive formulary with over 2000 medications. 200+ of the most commonly prescribe medications for $1. Accepted at over 70,000 participating pharmacies. Includes direct mail order delivery, international pharmacy access, prescription assistance program, pet medications, and discounted diabetic supplies. See Basic Rx Benefit Overview for details.

Thousands of at-home diagnostic lab tests and screening tests direct to you. Results delivered through our secure patient portal. Share and discuss your results with your Virtual Primary Care Physician.