Consultations and treatments without hospitalization
Primary Care Physician
$8
Specialist
$12
Sub-specialist
$18
Siquiatría
$12
Psychologist
$12
Qiropráctico
$12 Copay Limited to 20 sessions per year
(Combined with physical therapies)
Nutritionist
$12 Copay, Limited to 12 visits per year
Laboratorios y Rayos X
0% Preferred Network 30% Other Facilities
Specialized Studies
Diagnostic tests and medical studies
CT Scan
40%
Ultrasounds
0% Preferred Network
40% Other Facilities
STRESS Test, Electrocardiograma,
Estudios Neurológicos
40%
MRI, MRA
40%
Limited to 1 per contract year
Rehabilitation and Habilitation Services
Therapies and necessary medical equipment
Physical therapy
$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 $1,750 Luego aplica un 40%
Annual Benefit $1,750 then 40% applies
Bioequivalent Generic
Preferred Pharmacy $5 Non-Preferred Pharmacy $10
Preferred Brand
15% min $15 Preferred Pharmacy
20% min $20 Non-Preferred
Pharmacy
Non-Preferred Brand
25% min $25 Preferred Pharmacy
30% min $30 Non-Preferred
Pharmacy
Specialized Products
50%
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, hup to $150 per contract year. Covered by reimbursement
Dental Coverage
Diagnosis, prevention, and dental treatments
Periodic Oral Exam
Covered every 6 months
Restorative
30%
Endodontics
30%
Temporary Restorations (Crowns)
50%
Oral Surgery
30%
Note: This is a summary of benefits. Consult your plan documents for complete information. Copayments and coinsurance are subject to the annual maximum limit.
Benefit / Service Category
Emergency Services
Immediate emergency care
Red Preferida / Otras Facilidades
Accident
$0
Illness
$50
Hospitalization
Hospital stays and inpatient care
Total, including Mental Health
$0 Preferred Network
$100 Other Benefits
Partial Mental Health
$0 Preferred Network $75 Other Benefits
Outpatient Services
Consultations and treatments without hospitalization
Primary Care Physician
$8
Specialist
$12
Sub-Specialist
$18
Psychiatry
$12
Psychologist
$12
Chiropractic
$12 Copay, limited to 20 sessions per year. (Combined with physical therapies)
15% min $15 Preferred Pharmacy
20% min $20 Non-Preferred Pharmacy
Non-Preferred Brand
25% min $25 Preferred Pharmacy
30% min $30 Non-Preferred Pharmacy
Specialized Products
50%
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
Dental Coverage
Diagnosis, prevention, and dental treatments
Periodic Oral Exam
Covered every 6 months
Restorative
30%
Endodontics
30%
Temporary Restorations (Crowns)
50%
Oral Surgery
30%
Note: This is a summary of benefits. Consult your plan documents for complete information. Copayments and coinsurance are subject to the annual maximum limit.
Do you need guidance?
Complete the form and we’ll help you choose the best option.
Thank you for contacting us!
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.
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.