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Menonita Directo

Conoce nuestros planes de salud diseñados para cubrir tus necesidades médicas y las de tu familia, con acceso a una amplia red de proveedores en toda la isla.

Beneficios

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Annual Medical Deductible / MOOP

Annual limit on the member’s medical expenses

Individual

N/A

Family

N/A

Annual Prescription Drug Deductible

Annual amount before prescriptions are covered

Individual

N/A

$250

N/A

Family

N/A

$250 por suscriptor

N/A

Combined MOOP (medical and prescriptions)

Total maximum out-of-pocket expenses per year

Individual

$3,500

$6,350

Family

$7,000

$12,700

Emergency Services

Immediate emergency care

Accident / Illness

$25

$0 / $50 Out-of-Network

$0 / $75 Fuera

$0 / $50 Out-of-Network

Outpatient Services

Consultations and treatments without hospitalization

Primary Care Physician

$5

$10

$5

Specialist

$10

$12

$15

$12

Sub-specialist

$15

$17

$20

Psiquiatría

$10

$12

$15

$12

Psychologist

$10

$12

$15

$12

Podiatrist

$10

$12

$15

$12

Chiropractor

$10

$12

$15

$12

Audiologist

$10

$12

$15

$12

Optometrist

$10

$12

$15

$12

Ambulatory Surgery Center

$50

$0 / $150 Out-of-Network

$0 / $250 Fuera

$0 / $200 Fuera

In-office diagnostic / surgical procedures

20%

50%

35%

Endoscopic procedures

20%

50%

35%

Servicios de Laboratorio y Rayos X

Diagnostic tests and medical studies

Laboratory

20%

$0 / 50% Out-of-Network

$0 / 35% Fuera

Rayos X

20%

$0 / 50% Out-of-Network

$0 / 35% Fuera

Ultrasound

20%

$0 / 50% Out-of-Network

$0 / 40% Fuera

PET Scan, CT Scan, MRI o PET CT

20%

50%

40%

Hospitalization

Hospitalización parcial y salud mental

Partial (including Mental Health)

$30

$100

$150

$100

Compra con Preautorización (Incluyendo Salud Mental)

$50

$0 / $150 Out-of-Network

$0 / $250 Fuera

$0 / $200 Fuera

Compra sin Preautorización (Incluyendo Salud Mental)

$50

$150

$250

$200

Skilled nursing care

$50

50%

Surgical assistant

Subscriber pays 20%

Subscriber pays 50%

Rehabilitation and Medical Equipment

Therapies and necessary medical equipment

Physical therapy

$10

$12

$15

$12

Respiratory therapy

$10

$12

$15

$12

Home health care

20%

50%

Durable medical equipment

20% hasta $5,000, exceso 80%

50% hasta $5,000, exceso 80%

Chiropractic Manipulations

$10

$12

$15

$12

Mental Health

Group therapy and emotional support

Group therapy

$10

$12

$15

$12

Collateral visits

$10

$12

$15

$12

Pharmacy

Covered prescription medications

Generic Bioequivalent – Level 1

$5

$7

Preferred Brand – Level 2

20% min $20 de $0-$1,200, $1,201+ 60%

25% de $0-$1,000, $1,001+ 80%

25% de $251-$1,000, $1,001+ 80%

25% de $0-$750,
$751+ 80%

Non-Preferred Brand – Level 3

30% min $30 de $0-$1,200, $1,201+ 60%

50% de $0-$1,000, $1,001+ 80%

50% de $251-$1,000, $1,001+ 80%

35% de $0-$750,
$751+ 80%

Productos Especializados - Nivel 4

50% de $0-$1,200, $1,201+ 60%

50% de $0-$1,000, $1,001+ 80%

50% de $251-$1,000, $1,001+ 80%

50% de $0-$750, $751+ 80%

Medicamentos Fuera del Recetario (OTC)

$1

Servicios Preventivos, Bienestar y Manejo de Emfermedades Crónicas

Preventive care and ongoing management

Servicios Preventivos
(Incl. Servicios Mujer)

0%

Preventive vaccines

0%

Respiratory Syncytial Virus vaccine

20%

50%

35%

Vision Services

Exams, lenses, and vision benefits

Examen de Refracción (Adultos)

$10

$12

$15

$12

Cubierta por Reembolso (Adultos)

Reembolso del 100% hasta $125 en un par de lentes y montura

Examen de Refracción (Pediátrico)

0%

Visión Pediátrica (Lentes y Marcos)

20% hasta $250 por lentes; sobre $250: 80%

Other Services

Visión, Ambulancia aérea, cobertura en EE. UU.

Ambulancia Aérea
en Puerto Rico

$10

$12

$15

$12

Servicios de Emergencias
en EU

20% coinsurance

Servicios en EE. UU.
(no disponibles en PR)

20% coinsurance

Bariatric Surgery for Morbid Obesity

Procedure for severe obesity management

Bariatric surgery procedure

$50

$0 / $150 Out-of-Network

$0 / $250 Fuera

$0 / $200 Fuera

Included Programs

Nutritionist and support programs

Nutritionist

Reembolso hasta $20 por visita
(máx. 4 al año)

Dental Coverage

Atención médica accesible cuando la necesitas

Preventive Diagnostics

0%

Minor Restorative

20%

Major Restorative

50%

Space maintainers

Not covered

Beneficios

Benefit / Service Category

Annual Medical Deductible / MOOP

Annual limit on the member’s medical expenses

Individual
Platino	N/A
Gold 1	N/A
Gold 2	N/A
Gold 3	N/A
Family
Platino	N/A
Gold 1	N/A
Gold 2	N/A
Gold 3	N/A

Annual Prescription Drug Deductible

Annual amount before prescriptions are covered

Individual
Platino	N/A
Gold 1	N/A
Gold 2	$250
Gold 3	N/A
Family
Platino	N/A
Gold 1	N/A
Gold 2	$250 por suscriptor
Gold 3	N/A

Combined MOOP (medical and prescriptions)

Total maximum out-of-pocket expenses per year

Individual
Platino	$3,500
Gold 1	$6,350
Gold 2	$6,350
Gold 3	$6,350
Family
Platino	$7,000
Gold 1	$12,700
Gold 2	$12,700
Gold 3	$12,700

Emergency Services

Immediate emergency care

Accident / Illness
Platino	$25
Gold 1	$0 / $50 Fuera
Gold 2	$0 / $75 Fuera
Gold 3	$0 / $50 Fuera

Outpatient Services

Consultations and treatments without hospitalization

Primary Care Physician
Platino	$5
Gold 1	$5
Gold 2	$10
Gold 3	$5
Specialist
Platino	$10
Gold 1	$12
Gold 2	$15
Gold 3	$12
Sub-specialist
Platino	$15
Gold 1	$17
Gold 2	$20
Gold 3	$20
Psiquiatría
Platino	$10
Gold 1	$12
Gold 2	$15
Gold 3	$12
Psicólogo
Platino	$10
Gold 1	$12
Gold 2	$15
Gold 3	$12
Podiatrist
Platino	$10
Gold 1	$12
Gold 2	$15
Gold 3	$12
Chiropractor
Platino	$10
Gold 1	$12
Gold 2	$15
Gold 3	$12
Audiologist
Platino	$10
Gold 1	$12
Gold 2	$15
Gold 3	$12
Optometrist
Platino	$10
Gold 1	$12
Gold 2	$15
Gold 3	$12
Ambulatory Surgery Center
Platino	$50
Gold 1	$0 / $150 Fuera
Gold 2	$0 / $250 Fuera
Gold 3	$0 / $200 Fuera
In-office diagnostic / surgical procedures
Platino	20%
Gold 1	50%
Gold 2	50%
Gold 3	35%
Endoscopic procedures
Platino	20%
Gold 1	50%
Gold 2	50%
Gold 3	35%

Laboratory and X-Ray Services

Diagnostic tests and medical studies

Laboratory
Platino	20%
Gold 1	$0 / 50% Fuera
Gold 2	$0 / 50% Fuera
Gold 3	$0 / 35% Fuera
X-Ray
Platino	20%
Gold 1	$0 / 50% Fuera
Gold 2	$0 / 50% Fuera
Gold 3	$0 / 35% Fuera
Ultrasound
Platino	20%
Gold 1	$0 / 50% Fuera
Gold 2	$0 / 50% Fuera
Gold 3	$0 / 40% Fuera
PET Scan, CT Scan, MRI o PET CT
Platino	20%
Gold 1	50%
Gold 2	50%
Gold 3	40%

Hospitalization

Hospital stays and inpatient care

Partial (including Mental Health)
Platino	$30
Gold 1	$100
Gold 2	$150
Gold 3	$100
Compra con Preautorización incluyendo Salud Mental
Platino	$50
Gold 1	$0 / $150 Fuera
Gold 2	$0 / $250 Fuera
Gold 3	$0 / $200 Fuera
Compra sin Preautorización incluyendo Salud Mental
Platino	$50
Gold 1	$150
Gold 2	$250
Gold 3	$200
Skilled nursing care
Platino	$50
Gold 1	50%
Gold 2	50%
Gold 3	50%
Surgical assistant
Platino	El suscriptor paga 20% del cargo de cirugía
Gold 1	El suscriptor paga 50% del cargo de cirugía
Gold 2	El suscriptor paga 50% del cargo de cirugía
Gold 3	El suscriptor paga 50% del cargo de cirugía

Rehabilitation and Medical Equipment

Therapies and necessary medical equipment

Physical therapy
Platino	$10
Gold 1	$12
Gold 2	$15
Gold 3	$12
Respiratory therapy
Platino	$10
Gold 1	$12
Gold 2	$15
Gold 3	$12
Home health care
Platino	20%
Gold 1	50%
Gold 2	50%
Gold 3	50%
Durable medical equipment
Platino	20% hasta $5,000, exceso 80%
Gold 1	50% hasta $5,000, exceso 80%
Gold 2	50% hasta $5,000, exceso 80%
Gold 3	50% hasta $5,000, exceso 80%
Chiropractic Manipulations
Platino	$10
Gold 1	$12
Gold 2	$15
Gold 3	$12

Mental Health

Group therapy and emotional support

Group therapy
Platino	$10
Gold 1	$12
Gold 2	$15
Gold 3	$12
Collateral visits
Platino	$10
Gold 1	$12
Gold 2	$15
Gold 3	$12

Pharmacy

Covered prescription medications

Generic Bioequivalent – Level 1
Platino	$5
Gold 1	$5
Gold 2	$5
Gold 3	$7
Preferred Brand – Level 2
Platino	20% min $20 de $0-$1,200, $1,201+ 60%
Gold 1	25% de $0-$1,000, $1,001+ 80%
Gold 2	25% de $251-$1,000, de $1,001+: 80%
Gold 3	25% de $0-$750 de $751+: 80%
Non-Preferred Brand – Level 3
Platino	30% min $30 de $0-$1,200, $1,201+ 60%
Gold 1	50% de $0-$1,000, $1,001+ 80%
Gold 2	50% de $251-$1,000, de $1,001+: 80%
Gold 3	35% de $0-$750 de $751+: 80%
Productos Especializados - Nivel 4
Platino	50% de $0-$1,200, $1,201+ 60%
Gold 1	50% de $0-$1,000, $1,001+ 80%
Gold 2	50% de $251-$1,000, de $1,001+: 80%
Gold 3	50% de $0-$750 de $751+: 80%
Over-the-Counter (OTC) medications
Platino	$1
Gold 1	$1
Gold 2	$1
Gold 3	$1

Prevention, Wellness, and Chronic Conditions

Preventive care and ongoing management

Preventive services including women’s services
Platino	0%
Gold 1	0%
Gold 2	0%
Gold 3	0%
Preventive vaccines
Platino	0%
Gold 1	0%
Gold 2	0%
Gold 3	0%
Vacuna para Virus Respiratorio Sincitial
Platino	20%
Gold 1	50%
Gold 2	50%
Gold 3	35%

Vision Services

Exams, lenses, and vision benefits

Exámen de Refracción (Adultos)
Platino	$10
Gold 1	$12
Gold 2	$15
Gold 3	$12
Cubierta por reembolso (Adultos)
Platino	Reembolso del 100% hasta $125 en un par de lentes y montura
Gold 1	Reembolso del 100% hasta $125 en un par de lentes y montura
Gold 2	Reembolso del 100% hasta $125 en un par de lentes y montura
Gold 3	Reembolso del 100% hasta $125 en un par de lentes y montura
Exámen de Refracción (Pediátrico)
Platino	0%
Gold 1	0%
Gold 2	0%
Gold 3	0%
Visión Pediátrica (Lentes y Marcos)
Platino	20% hasta $250 por lentes; sobre $250: 80%
Gold 1	20% hasta $250 por lentes; sobre $250: 80%
Gold 2	20% hasta $250 por lentes; sobre $250: 80%
Gold 3	20% hasta $250 por lentes; sobre $250: 80%

Other Services

Air ambulance and U.S. coverage

Air ambulance in Puerto Rico
Platino	$10
Gold 1	$12
Gold 2	$15
Gold 3	$12
Emergency services in the U.S.
Platino	Coaseguro de 20%
Gold 1	Coaseguro de 20%
Gold 2	Coaseguro de 20%
Gold 3	Coaseguro de 20%
Services in the U.S. (not available in PR)
Platino	Coaseguro de 20%
Gold 1	Coaseguro de 20%
Gold 2	Coaseguro de 20%
Gold 3	Coaseguro de 20%

Bariatric Surgery for Morbid Obesity

Procedure for severe obesity management

Bariatric surgery procedure
Platino	$50
Gold 1	$0 / $150 Fuera
Gold 2	$0 / $250 Fuera
Gold 3	$0 / $200 Fuera

Included Programs

Nutritionist and support programs

Nutritionist
Platino	Reembolso hasta $20 por visita (máx. 4 al año)
Gold 1	Reembolso hasta $20 por visita (máx. 4 al año)
Gold 2	Reembolso hasta $20 por visita (máx. 4 al año)
Gold 3	Reembolso hasta $20 por visita (máx. 4 al año)

Dental Coverage

Diagnosis, prevention, and dental treatments

Preventive Diagnostics
Platino	0%
Gold 1	0%
Gold 2	0%
Gold 3	0%
Minor Restorative
Platino	20%
Gold 1	20%
Gold 2	20%
Gold 3	20%
Major Restorative
Platino	50%
Gold 1	50%
Gold 2	50%
Gold 3	50%
Space maintainers
Platino	No Cubierto
Gold 1	No Cubierto
Gold 2	No Cubierto
Gold 3	No Cubierto