The Gold POS Plan offers solid coverage, affordable copays, and full access to the provider network.
Low and predictable copays
Protection against excessive expenses
Provider and pharmacy network
No-cost preventive care
Click any category to see detailed copays and coverage.
Total maximum out-of-pocket expenses per year
Immediate emergency care
Consultations and treatments without hospitalization
Diagnostic tests and medical studies
Hospital stays and inpatient care
Therapies and necessary medical equipment
Group therapy and emotional support
Covered prescription medications
Preventive care and ongoing management
Exams, lenses, and vision benefits
Adult Vision, Air Ambulance, coverage in the U.S.
Procedure for severe obesity management
Diagnosis, prevention, and dental treatments
Note: This is a summary of benefits. Consult your plan documents for complete information. Copayments and coinsurance are subject to the annual maximum limit.
Total maximum out-of-pocket expenses per year
| Individual | $6,350 Preferred and Out-of-Network |
| Family | $12,700 Preferred and Out-of-Network |
Immediate emergency care
| Accident | $50 Preferred, $100 Out-of-Network |
| Illness | $50 Preferred, $100 Out-of-Network |
Consultations and treatments without hospitalization
| Primary Care Physician | $10 Preferred, $10 Out-of-Network |
| Specialist | $15 Preferred, $15 Out-of-Network |
| Sub-Specialist | $20 Preferred, $20 Out-of-Network |
| Psychiatrist | $15 Preferred, $15 Out-of-Network |
| Psychologist | $15 Preferred, $15 Out-of-Network |
| Podiatrist | $15 Preferred, $15 Out-of-Network |
| Chiropractor | $15 Preferred, $15 Out-of-Network |
| Audiologist | $15 Preferred, $15 Out-of-Network |
| Optometrist | $15 Preferred, $15 Out-of-Network |
| Nutritionist | Reimbursement up to $20 per visit, 4 per year |
| Ambulatory Surgery Center | 30% Preferred, 50% Out-of-Network |
| In-Office Diagnostic / Surgical Procedures | 30% Preferred, 50% Out-of-Network |
| Endoscopic Procedures | 30% Preferred, 50% Out-of-Network |
Diagnostic tests and medical studies
| Laboratory | 30% Preferred, 50% Out-of-Network |
| X-Rays | 30% Preferred, 50% Out-of-Network |
| PET Scan, CT Scan, MRI, or PET CT (1 year) | 30% Preferred, 50% Out-of-Network |
Hospital stays and inpatient care
| Partial including Mental Health | $75 Preferred, $150 Out-of-Network |
| Full with Preauthorization including Mental Health | $150 Preferred, $250 Out-of-Network |
| Full without Preauthorization including Mental Health | $150 Preferred, $250 Out-of-Network |
| Skilled Nursing Facilities | 30% Preferred and Out-of-Network |
| Surgical Assistance | 30% Preferred, 70% Out-of-Network |
Therapies and necessary medical equipment
| Physical Therapy | $15 Preferred and Out-of-Network |
| Respiratory Therapy | $15 Preferred and Out-of-Network |
| Home Health Care | 30% Preferred, 50% Out-of-Network |
| Durable Medical Equipment | 40% up to $5,000, Excess 80% |
| Chiropractic Manipulations | $15 Preferred and Out-of-Network |
Group therapy and emotional support
| Group Therapy | $15 Preferred and Out-of-Network |
| Collateral Visits | $15 Preferred and Out-of-Network |
Covered prescription medications
| Pharmacy Benefit | $0-$1,000: applicable copays and coinsurance; $1,001+: 80% coinsurance |
| Generic Bioequivalent | $10 for $0-$1,000; $1,001+: 80% |
| Preferred Brand | 25% min $20 for $0-$1,000; $1,001+: 80% |
| Non-Preferred Brand | 50% min $30 for $0-$1,000; $1,001+: 80% |
| Specialty Products | 50% for $0-$1,000; $1,001+: 80% |
| Over-the-Counter (OTC) Medications | Not Covered |
Preventive care and ongoing management
| Preventive Services | 0% Preferred and Out-of-Network |
| Preventive Vaccinations | 0% Preferred and Out-of-Network |
| Respiratory Syncytial Virus (RSV) Vaccine | 30% Preferred and Out-of-Network |
Exams, lenses, and vision benefits
| Eye Exam (Refraction) | $0 Preferred and Out-of-Network |
| Pediatric Vision (Corrective Lenses or Frames) | 20% up to $250 per lenses; over $250: 80% |
Adult Vision, Air Ambulance, coverage in the U.S.
| Refraction Exam (Adults) | $15 Preferred and Out-of-Network |
| Adult Vision | 100% reimbursement up to $125 per pair of lenses and frame per year |
| Air Ambulance in Puerto Rico | 30% Preferred and Out-of-Network |
| Emergency Services in the US | 20% Coinsurance |
| Services in the US (not available in PR) | 20% Coinsurance |
Procedure for severe obesity management
| Bariatric Surgery Procedure | $150 Preferred, $250 Out-of-Network |
Diagnosis, prevention, and dental treatments
| Dental Benefit | $0-$1,000: coinsurance; $1,001+: 80% |
| Diagnostic & Preventive | $0 Preferred, Out-of-Network |
| Minor Restorative | 20% Preferred, 20% Out-of-Network |
| Major Restorative | 50% Preferred, 50% Out-of-Network |
Note: This is a summary of benefits. Consult your plan documents for complete information. Copayments and coinsurance are subject to the annual maximum limit.
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your interest in our health plans.
One of our Sales Representatives will be in touch with you to provide personalized guidance
and share details about the plan you are interested in.
Thank you for considering Plan de Salud Menonita as
your health insurance provider.
We have received your information and appreciate
your interest in our health plans.
One of our Sales Representatives will be in touch with you to provide personalized guidance
and share details about the plan you are interested in.
Thank you for considering Plan de Salud Menonita as
your health insurance provider.
Complete the form so we can help you with your questions.
Complete the form and we’ll help you choose the best option.