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Compare Our Plans

MediGold offers several HMO and PPO plan options to fit your needs. To help you determine which plan is best for you, use the chart below to compare the benefits available with each of our plans. If you would like more detailed information (Summary of Benefits) on any of the plans listed below, click on the plan name at the top of the chart.

2015

MediGold Essential Care (HMO)

MediGold Classic Preferred (HMO)

MediGold Medical Only (HMO)

MediGold Network Choice (PPO)

MediGold Value Choice (PPO)

Your Monthly Plan Premium

$0

$99

$45

$143

$43

You will pay No Deductibles

$0

$0

$0

$0

$0

You'll enjoy our Annual Out-of-Pocket Maximum for Added Protection

$3,200 $3,200 $3,200

$3,200 in-network
$5,000 combined in- and out-of-network

$3,200 in-network
$5,000 combined in- and out-of-network

Medical Benefits Included!

Your copay:

Your copay:

Your copay:

Your copay:

Your copay:

Preventive Care

$0

$0

$0

$0 in- and out-of-network

$0 in- and out-of-network

Fitness Center Membership

$0

$0

$0

$0 in-network only

$0 in-network only

Flu Shots

$0

$0

$0

$0 in- and out-of-network

$0 in- and out-of-network 

Diabetes Supplies

$0

$0

$0

$0 in- and out-of-network

$0 in- and out-of-network 

Office Visit (Primary Care Provider)

$10

$0

$0

$0 in-network
$20 out-of-network

$10 in-network
$25 out-of-network

Office Visit (Specialty Care Provider)

$45

$30

$30

$25 in-network
$40 out-of-network

$40 in-network
$45 out-of-network

Outpatient Lab Test

$15

$0

$0

$0 in- and out-of-network

$15 in- and out-of-network

Outpatient Diagnostic Test or X-ray

$60

$20

$40

$40 in-network
$60 out-of-network

$50 in-network
$65 out-of-network

Outpatient Surgery

$275

$125

$125

$225 in-network
$300 out-of-network

$250 in-network
$300 out-of-network

Urgent Care Visit

$45

$35

$25

$30 in- and out-of-network

$40 in- and out-of-network

Emergency Room Visit

$65 Worldwide

$65 Worldwide

$65 Worldwide

$65 Worldwide in- and out-of-network

$65 Worldwide in- and out-of-network

Inpatient Hospital Care (per stay)

Ask how we further limit your inpatient costs per year.

$285 per day for days 1-7


$0 after day 7

$0 per stay

$75 per day for days 1-7


$0 after day 7

$200 per day for days 1-7 in-network;

$0 after day 7 in-network

$250 per day for days 1-7 out-of-network;

$0 after day 7 out-of-network

$270 per day for days 1-5 in-network;

$0 after day 5 in-network

$300 per day for days 1-5 out-of-network;

$0 after day 5 out-of-network

Home Health Care

$0

$0

$0

$0 in- and out-of-network

$0 in- and out-of-network

Prescription Drug (Part D) Benefits Included!

Note: 30, 60 or 90-day supply of drugs may be obtained from participating retail or mail order pharmacies. Extra Savings at mail. Ask about it!

Your copay for a 30-day supply:

Your copay for a 30-day supply: 

 

Note: This option does not include Part D drug coverage.

Your copay for a 30-day supply:

 

Your copay for a 30-day supply:

 

Tier 1 - Preferred Generic Drugs

$4

$0

 

$0

$0

Tier 2 - Non-Preferred Generic Drugs

$12

$15

 

$12

$15

Tier 3 - Preferred Brand Drugs

$45

$38

 

$45

$45

Tier 4 - Non-Preferred Brand Drugs

$90

$50

 

$85

$90

Tier 5 - Specialty Drugs

33%

33%

 

33%

33%

Coverage Gap discounts or benefits?

YES

YES

 

YES

YES

Dental Benefits

MediGold's 2015 Dental Plan may be separately purchased by new and existing MediGold members. The plan is administered by Delta Dental for a monthly premium of $23. Learn more about MediGold's Dental Plan.

Last Updated 9/30/2014 10:19:25 AM