Law 95 Comparison

Ley 95

Compare the Ley 95 plans and choose the coverage that best fits you and your family .

Benefits

Rubí

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Plata

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Mandatoria

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Prices

Rates for individual, couple, and family coverage

Individual

$213

$356

$779

Couple

$385

$842

$1,843

Family of 3 or more

$475

$1,128

$2,467

Emergency Services

Immediate emergency care

Red Preferida / Otras Facilidades

Toda la Red

Accident

$0

Illness

$30 Preferred Network
$75 Other Facilities

$50

$40

Hospitalization

Hospital stays and inpatient care

Total, including Mental Health

$0 Preferred Network
$250 Other Facilities

$0 Preferred Network
$100 Other Facilities

$75

Partial Mental Health

$0 Preferred Network
$150 Other Facilities

$0 Preferred Network
$75 Other Facilities

$75

Outpatient Services

Consultations and treatments without hospitalization

Primary Care Physician

$10

$8

$58

Specialist

$18

$12

$10

Sub-specialist

$20

$18

$15

Psychiatry

$18

$12

$10

Psychologist

$18

$12

$10

Chiropractic

$12 Copay Limited to 15 sessions per year.
(Combined with physical therapies)

$12 Copay Limited to 20 sessions per year.
(Combined with physical therapies)

$10 Copay Limited to 20 sessions per year.
(Combined with physical therapies)

Nutritionist

$12 copay, up to 12 visits per contract.

$10 copay, up to 12 visits per contract.

Laboratories and X-Rays

0% Preferred Network
50% Other Facilities

0% Preferred Network
30% Other Facilities

30%

Specialized Studies

Diagnostic tests and medical studies

CT Scan

40% Preferred Network
50% Other Facilities

40%

30%

Ultrasounds

0% Preferred Network
50% Other Facilities

0% Preferred Network
40% Other Facilities

30%

Stress Test, Electrocardiogram, Neurological Studies

50%

40%

30%

MRI, MRA

50%
Limited to 1 per contract year

40%
Limited to 1 per contract year

30%
Limited to 1 per contract year

Rehabilitation and Habilitation Services

Therapies and necessary medical equipment

Physical therapy

$7 Copay, limited to 15 sessions
(Combined with chiropractic manipulations)

$7 Copay, limited to 20 sessions
(Combined with chiropractic manipulations)

Respiratory therapy

$7 Copay

Major Medical Expenses

Major medical care and specialized equipment

Durable medical equipment

A 20% coinsurance applies. Pre-authorization required.

Pharmacy

Covered prescription medications

Beneficio Anual $750
Luego aplica un 80%

Beneficio Anual $1,750
Luego aplica un 40%

Beneficio Anual $2,000
Luego aplica un 40%

Annual Benefit $750
then 80% applies.

Annual Benefit $1,750
then 40% applies.

Annual Benefit $2,000
then 80% applies.

Bioequivalent Generic

Preferred Pharmacy $10 Non-Preferred Pharmacy $15

Preferred Pharmacy $5 Non-Preferred Pharmacy $10

10% min $5 Preferred Pharmacy 15% min $10 Non-Preferred Pharmacy

Preferred Brand

25% min $25 Preferred Pharmacy 30% min $30 Non-Preferred Pharmacy

15% min $15 Preferred Pharmacy 20% min $20 Non-Preferred Pharmacy

10% min $12 Preferred Pharmacy 15% min $15 Non-Preferred Pharmacy

Non-Preferred Brand

50% min $50 Preferred Pharmacy 55% min $55 Non-Preferred Pharmacy

25% min $25 Preferred Pharmacy 30% min $30 Non-Preferred Pharmacy

15% min $20 Preferred Pharmacy 20% min $25 Non-Preferred Pharmacy

Specialized Products

50%

30% hasta máximo $200

Preventive Services

Preventive care and ongoing management

Preventive Services
(Including Women's Services)

0%

Preventive Immunizations (Vaccines)

0% administration costs apply

Vision Services

Exams, lenses, and vision benefits

Eye Exam (Refraction)

Covered 100% of contracted rates after a $10 copay

Frame and Prescription

Covered 1 pair per subscriber, up to $150 per contract year. Covered by reimbursement.

Single Vision Lenses.$18 copay
Bifocal Lenses...........$20 copay
Contact Lenses.........$36 copay Frames.......................$18 copay

Dental Coverage

Diagnosis, prevention, and dental treatments

Periodic Oral Exam

Covered every 6 months

Restorative

50%

30%

20%

Endodontics

50%

30%

20%

Temporary Restorations (Crowns)

50%

30%

20%

Oral Surgery

50%

30%

20%

Rubí

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Plata

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Mandatoria

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Beneficios

Precios

Tarifas para cobertura individual, pareja y familiar

Individual
Rubí	$213
Plata	$356
Mandatoria	$779
Pareja
Rubí	$385
Plata	$842
Mandatoria	$1,843
Familiar de 3 o más
Rubí	$475
Plata	$1,128
Mandatoria	$2,467

Servicios de emergencia

Atención inmediata por emergencias

Accidente
Rubí	$0
Plata	$0
Mandatoria	$0
Enfermedad
Rubí	$30 Red Preferida $75 Otras Facilidades
Plata	$50
Mandatoria	$40

Hospitalización

Estancias y cuidados en hospital

Total incluyendo Salud Mental
Rubí	$0 Red Preferida $250 Otras Facilidades
Plata	$0 Red Preferida $100 Otras Facilidades
Mandatoria	$75
Parcial Salud Mental
Rubí	$0 Red Preferida $150 Otras Facilidades
Plata	$0 Red Preferida $75 Otras Facilidades
Mandatoria	$75

Servicios Ambulatorios

Consultas y tratamientos sin hospitalización

Generalista
Rubí	$10
Plata	$8
Mandatoria	$58
Especialista
Rubí	$18
Plata	$12
Mandatoria	$10
Sub-Especialista
Rubí	$20
Plata	$18
Mandatoria	$15
Siquiatría
Rubí	$18
Plata	$12
Mandatoria	$10
Sciólogo
Rubí	$18
Plata	$12
Mandatoria	$10
Qiropráctico
Rubí	Copago de $12 Limitado a 15 sesiones por año. (Combinadas con las terapias físicas)
Plata	Copago de $12 Limitado a 20 sesiones por año. (Combinadas con las terapias físicas)
Mandatoria	Copago de $10 Limitado a 20 sesiones por año. (Combinadas con las terapias físicas)
Nutricionista
Rubí	$12 de copago, hasta 12 visitas por contrato.
Plata	$12 de copago, hasta 12 visitas por contrato.
Mandatoria	$10 de copago, hasta 12 visitas por contrato.
Laboratorios y Rayos X
Rubí	0% Red Preferida 50% Otras Facilidades
Plata	0% Red Preferida 30% Otras Facilidades
Mandatoria	30%

Estudios Especializados

Pruebas diagnósticas y estudios médicos

CT Scan
Rubí	40% Red Preferida 50% Otras Facilidades
Plata	40%
Mandatoria	30%
Sonogramas
Rubí	0% Red Preferida 50% Otras Facilidades
Plata	0% Red Preferida 40% Otras Facilidades
Mandatoria	30%
STRESS Test, Electrocardiograma, Estudios Neurológicos
Rubí	50%
Plata	40%
Mandatoria	30%
MRI, MRA
Rubí	50% Limitado a 1 por año contrato
Plata	40% Limitado a 1 por año contrato
Mandatoria	30% Limitado a 1 por año contrato

Servicios de Rehabilitación y Habilitación

Terapias y equipos médicos necesarios

Terapia Física
Rubí	Copago de $7 limitado a 15 sesiones (Combinado con manipulaciones de quiropráctico)
Plata	Copago de $7 limitado a 20 sesiones (Combinado con manipulaciones de quiropráctico)
Mandatoria	Copago de $7 limitado a 20 sesiones (Combinado con manipulaciones de quiropráctico)
Terapia Respiratoria
Rubí	Copago de $7
Plata	Copago de $7
Mandatoria	Copago de $7

Gastos Médicos Mayores

Atención médica mayor y equipo especializado

Equipo Médico Duradero
Rubí	Aplica 20% coaseguro. Requiere pre-autorización.
Plata	Aplica 20% coaseguro. Requiere pre-autorización.
Mandatoria	Aplica 20% coaseguro después del deducible inicial.

Farmacia

Medicamentos recetados cubiertos

Genérico Bioequivalente
Rubí	Beneficio Anual $750 Luego aplica un 80%
Plata	Beneficio Anual $1,750 Luego aplica un 40%
Mandatoria	Beneficio Anual $2,000 Luego aplica un 80%
Rubí	Farmacia Preferida $10 Farmacia no Preferida $15
Plata	Farmacia Preferida $5 Farmacia no Preferida $10
Mandatoria	10% mínimo $5 Farmacia Preferida 15% mínimo $10 Farmacia no Preferida
Marca Preferida
Rubí	25% mínimo $25 Farmacia Preferida 30% mínimo $30 Farmacia no Preferida
Plata	15% mínimo $15 Farmacia Preferida 20% mínimo $20 Farmacia no Preferida
Mandatoria	10% mínimo $12 Farmacia Preferida 15% mínimo $15 Farmacia no Preferida
Marca no Preferida
Rubí	50% mínimo $50 Farmacia Preferida 55% mínimo $55 Farmacia no Preferida
Plata	25% mínimo $25 Farmacia Preferida 30% mínimo $30 Farmacia no Preferida
Mandatoria	15% mínimo $20 Farmacia Preferida 20% mínimo $25 Farmacia no Preferida
Productos Especializados
Rubí	50%
Plata	50%
Mandatoria	30% hasta máximo $200

Servicios Preventivos

Cuidado preventivo y manejo continuo

Servicios Preventivos (Incluyendo las de mujer)
Rubí	0%
Plata	0%
Mandatoria	0%
Inmunizaciones (vacunas) Preventivas
Rubí	0% aplica costos por administración
Plata	0% aplica costos por administración
Mandatoria	0% aplica costos por administración

Servicios de Visión

Exámenes, lentes y beneficios visuales

Examen de la vista (Refracción)
Rubí	Cubierto al 100% de las tarifas contratadas después del copago de 10$
Plata	Cubierto al 100% de las tarifas contratadas después del copago de 10$
Mandatoria	Cubierto al 100% de las tarifas contratadas después del copago de 10$
Montura y Receta
Rubí	Cubierto 1 par por suscriptor hasta $150 por año contrato. Cubierto por reembolso.
Plata	Cubierto 1 par por suscriptor hasta $150 por año contrato. Cubierto por reembolso.
Mandatoria	Lentes Visión sencilla..$18 copago Lentes Bifocales......$20 copago Lentes de Contacto.....$36 copago Monturas.................$18 copago

Cubierta Dental

Atención médica accesible cuando la necesitas

Exámen Oral Periódico
Rubí	Cubierto cada 6 meses
Plata	Cubierto cada 6 meses
Mandatoria	Cubierto cada 6 meses
Restaurativo
Rubí	50%
Plata	30%
Mandatoria	20%
Endodoncia
Rubí	50%
Plata	30%
Mandatoria	20%
Restauraciones Temporera (Coronas)
Rubí	50%
Plata	30%
Mandatoria	20%
Cirugía Oral
Rubí	50%
Plata	30%
Mandatoria	20%

Ley 95

Benefits

Rubí

View details

Plata

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Mandatoria

View details

Individual

$213

$356

$779

Couple

$385

$842

$1,843

Family of 3 or more

$475

$1,128

$2,467

Red Preferida / Otras Facilidades

Red Preferida / Otras Facilidades

Toda la Red

Accident

$0

$0

$0

Illness

$30 Preferred Network $75 Other Facilities

$50

$40

Total, including Mental Health

$0 Preferred Network $250 Other Facilities

$0 Preferred Network $100 Other Facilities

$75

Partial Mental Health

$0 Preferred Network $150 Other Facilities

$0 Preferred Network $75 Other Facilities

$75

Primary Care Physician

$10

$8

$58

Specialist

$18

$12

$10

Sub-specialist

$20

$18

$15

Psychiatry

$18

$12

$10

Psychologist

$18

$12

$10

Chiropractic

$12 Copay Limited to 15 sessions per year. (Combined with physical therapies)

$12 Copay Limited to 20 sessions per year. (Combined with physical therapies)

$10 Copay Limited to 20 sessions per year. (Combined with physical therapies)

Nutritionist

$12 copay, up to 12 visits per contract.

$12 copay, up to 12 visits per contract.

$10 copay, up to 12 visits per contract.

Laboratories and X-Rays

0% Preferred Network 50% Other Facilities

0% Preferred Network 30% Other Facilities

30%

CT Scan

40% Preferred Network 50% Other Facilities

40%

30%

Ultrasounds

0% Preferred Network 50% Other Facilities

0% Preferred Network 40% Other Facilities

30%

Stress Test, Electrocardiogram, Neurological Studies

$30 Preferred Network
$75 Other Facilities

$0 Preferred Network
$250 Other Facilities

$0 Preferred Network
$100 Other Facilities

$0 Preferred Network
$150 Other Facilities

$0 Preferred Network
$75 Other Facilities

$12 Copay Limited to 15 sessions per year.
(Combined with physical therapies)

$12 Copay Limited to 20 sessions per year.
(Combined with physical therapies)

$10 Copay Limited to 20 sessions per year.
(Combined with physical therapies)

0% Preferred Network
50% Other Facilities

0% Preferred Network
30% Other Facilities

40% Preferred Network
50% Other Facilities

0% Preferred Network
50% Other Facilities

0% Preferred Network
40% Other Facilities

50%
Limited to 1 per contract year

40%
Limited to 1 per contract year

30%
Limited to 1 per contract year

$7 Copay, limited to 15 sessions
(Combined with chiropractic manipulations)

$7 Copay, limited to 20 sessions
(Combined with chiropractic manipulations)

$7 Copay, limited to 20 sessions
(Combined with chiropractic manipulations)

Beneficio Anual $750
Luego aplica un 80%

Beneficio Anual $1,750
Luego aplica un 40%

Beneficio Anual $2,000
Luego aplica un 40%

Annual Benefit $750
then 80% applies.

Annual Benefit $1,750
then 40% applies.

Annual Benefit $2,000
then 80% applies.

Preventive Services
(Including Women's Services)

Single Vision Lenses.$18 copay
Bifocal Lenses...........$20 copay
Contact Lenses.........$36 copay Frames.......................$18 copay