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Discover the Advantages of Defined Benefit Medical Plans
When you’re looking at health insurance, be sure to look beyond standard major medical plans and consider a defined- benefit health insurance plan. Our McKinney, TX team knows individual health insurance and family health insurance inside and out. We can help you find the perfect policy.
Compare How the 2 Plans Deal With Real Health Events
Major Medical Plan |
Defined Benefit Medical Plan |
|
|---|---|---|
| Outpatient surgery | deductible must be met | no deductible to meet |
| MRI, labs, and X-rays | deductible must be met | Immediate benefit and no deductible |
| Doctor visits | co-pays and or deductibles | Immediate benefit and no co-pays or deductibles |
| Prescription drugs | Rx co-pays of $15 for generics and $35 to $75 for brand-name drugs; Rx co-pay does not count towards calendar year deductible | Net Rx cost to patient equivalent or better than that of a co-pay |
| Emergency room | $100 to $1,100 access fee plus full deductible must be met for additional benefits | $400 to $800 benefit up front – $4,000 additional if there for accident |
| PPO network | mandatory use by client | you choose your doctor and hospital |
| Penalty | doubles your deductible and coinsurance penalty applied | no out-of-network penalties |
| Telemedicine | some charge fee per use | free and unlimited |
| Additional benefits | none offered | you choose coverage for catastrophic accidents, critical illnesses, and specified diseases |
Major Medical Plan |
|---|
| Outpatient surgery deductible must be met |
| MRI, labs, and X-rays deductible must be met |
| Doctor visits co-pays and or deductibles |
| Prescription drugs Rx co-pays of $15 for generics and $35 to $75 for brand-name drugs; Rx co-pay does not count towards calendar year deductible |
| Emergency room $100 to $1,100 access fee plus full deductible must be met for additional benefits |
| PPO network mandatory use by client |
| Penalty doubles your deductible and coinsurance penalty applied |
| Telemedicine some charge fee per use |
| Additional benefits none offered |
Defined Benefit Medical Plan |
|---|
| Outpatient surgery no deductible to meet |
| MRI, labs, and X-rays Immediate benefit and no deductible |
| Doctor visits Immediate benefit and no co-pays or deductibles |
| Prescription drugs Net Rx cost to patient equivalent or better than that of a co-pay |
| Emergency room $400 to $800 benefit up front – $4,000 additional if there for accident |
| PPO network you choose your doctor and hospital |
| Penalty no out-of-network penalties |
| Telemedicine free and unlimited |
| Additional benefits you choose coverage for catastrophic accidents, critical illnesses, and specified diseases |