Compare the PYMES plans and choose the coverage that best suits your needs.
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
Total maximum out-of-pocket expenses per year
| Individual | |
|---|---|
| Platinum | $3,500 |
| Gold 1 | $6,350 |
| Platino POS | $3,500 Preferred and Out-of-Network |
| Gold POS | $6,350 Preferred and Out-of-Network |
| Family | |
| Platinum | $7,000 |
| Gold 1 | $12,700 |
| Platino POS | $7,000 Preferred and Out-of-Network |
| Gold POS | $12,700 Preferred and Out-of-Network |
Immediate emergency care
| Accident | |
|---|---|
| Platinum | $25 |
| Gold 1 | FR $50 / RP $30 |
| Platino POS | $25 Preferred $75 Out-of-Network |
| Gold POS | $50 Preferred $100 Out-of-Network |
| Illness | |
| Platinum | $25 |
| Gold 1 | FR $50 / RP $30 |
| Platino POS | $25 Preferred $75 Out-of-Network |
| Gold POS | $50 Preferred $100 Out-of-Network |
Consultations and treatments without hospitalization
| Primary Care Physician | |
|---|---|
| Platinum | $5 |
| Gold 1 | $7 |
| Platino POS | $5 |
| Gold POS | $10 |
| Specialist | |
| Platinum | $10 |
| Gold 1 | $15 |
| Platino POS | $10 |
| Gold POS | $15 |
| Sub-specialist | |
| Platinum | $15 |
| Gold 1 | $20 |
| Platino POS | $15 |
| Gold POS | $20 |
| Psychiatrist | |
| Platinum | $10 |
| Gold 1 | $15 |
| Platino POS | $10 |
| Gold POS | $15 |
| Psychologist | |
| Platinum | $10 |
| Gold 1 | $15 |
| Platino POS | $10 |
| Gold POS | $15 |
| Podiatrist | |
| Platinum | $10 |
| Gold 1 | $15 |
| Platino POS | $10 |
| Gold POS | $15 |
| Chiropractor | |
| Platinum | $10 |
| Gold 1 | $15 |
| Platino POS | $10 |
| Gold POS | $15 |
| Audiologist | |
| Platinum | $10 |
| Gold 1 | $15 |
| Platino POS | $10 |
| Gold POS | $15 |
| Optometrist | |
| Platinum | $10 |
| Gold 1 | $15 |
| Platino POS | $10 |
| Gold POS | $15 |
| Nutritionist | |
| Platinum | Reimbursement up to $20 per visit, 4 per year |
| Gold 1 | Reimbursement up to $20 per visit, 4 per year |
| Platino POS | Reimbursement up to $20 per visit, 4 per year |
| Gold POS | Reimbursement up to $20 per visit, 4 per year |
| Ambulatory Surgery Center | |
| Platinum | $50 |
| Gold 1 | FR $150 / RP $0 |
| Platino POS | $50 Preferred $150 Out-of-Network |
| Gold POS | 30% Preferred 50% Out-of-Network |
| In-Office Diagnostic / Surgical Procedures | |
| Platinum | 20% |
| Gold 1 | 50% |
| Platino POS | 20% Preferred 50% Out-of-Network |
| Gold POS | 30% Preferred 50% Out-of-Network |
| Endoscopic Procedures | |
| Platinum | 20% |
| Gold 1 | 50% |
| Platino POS | 20% Preferred 50% Out-of-Network |
| Gold POS | 30% Preferred 50% Out-of-Network |
Diagnostic tests and medical studies
| Laboratory | |
|---|---|
| Platinum | 20% |
| Gold 1 | FR 30% / RP 0% |
| Platino POS | 20% Preferred 50% Out-of-Network |
| Gold POS | 30% Preferred 50% Out-of-Network |
| X-Ray | |
| Platinum | 20% |
| Gold 1 | FR 30% / RP 0% |
| Platino POS | 20% Preferred 50% Out-of-Network |
| Gold POS | 30% Preferred 50% Out-of-Network |
| PET Scan, CT Scan, MRI, or PET CT | |
| Platinum | 20% |
| Gold 1 | 50% |
| Platino POS | 20% Preferred 50% Out-of-Network |
| Gold POS | 30% Preferred 50% Out-of-Network |
Hospital stays and inpatient care
| Partial (including Mental Health) | |
|---|---|
| Platinum | $30 |
| Gold 1 | $100 |
| Platino POS | $30 Preferred $100 Out-of-Network |
| Gold POS | $75 Preferred $150 Out-of-Network |
| Full with Preauthorization (including Mental Health) | |
| Platinum | $50 |
| Gold 1 | FR $150 / RP $0 |
| Platino POS | $50 Preferred $200 Out-of-Network |
| Gold POS | $150 Preferred $250 Out-of-Network |
| Full without Preauthorization (including Mental Health) | |
| Platinum | $50 |
| Gold 1 | FR $150 / RP $0 |
| Platino POS | $50 Preferred $200 Out-of-Network |
| Gold POS | $150 Preferred $250 Out-of-Network |
| Skilled Nursing Facilities | |
| Platinum | $50 |
| Gold 1 | 35% |
| Platino POS | $50 Preferred and Out-of-Network |
| Gold POS | 30% Preferred and Out-of-Network |
| Surgical Assistance | |
| Platinum | Subscriber pays 20% of the surgery charge |
| Gold 1 | Subscriber pays 50% of the surgery charge |
| Platino POS | 20% Preferred 80% Out-of-Network |
| Gold POS | 30% Preferred 70% Out-of-Network |
Therapies and necessary medical equipment
| Physical therapy | |
|---|---|
| Platinum | $10 |
| Gold 1 | $7 |
| Platino POS | $10 Preferred 50% Out-of-Network |
| Gold POS | $15 Preferred 50% Out-of-Network |
| Respiratory therapy | |
| Platinum | $10 |
| Gold 1 | $7 |
| Platino POS | $10 Preferred 50% Out-of-Network |
| Gold POS | $15 Preferred 50% Out-of-Network |
| Home health care | |
| Platinum | 20% |
| Gold 1 | 50% |
| Platino POS | 20% Preferred 50% Out-of-Network |
| Gold POS | 30% Preferred 50% Out-of-Network |
| Durable medical equipment | |
| Platinum | 20% up to $5,000, excess 80% |
| Gold 1 | 50% up to $5,000, excess 80% |
| Platino POS | 30% up to $5,000, excess 80% |
| Gold POS | 40% up to $5,000, excess 80% |
| Chiropractic manipulations | |
| Platinum | $10 |
| Gold 1 | $7 |
| Platino POS | $10 Preferred 50% Out-of-Network |
| Gold POS | $15 Preferred 50% Out-of-Network |
Group therapy and emotional support
| Group therapy | |
|---|---|
| Platinum | $10 |
| Gold 1 | $15 |
| Platino POS | $10 Preferred 50% Out-of-Network |
| Gold POS | $15 Preferred 50% Out-of-Network |
| Collateral visits | |
| Platinum | $10 |
| Gold 1 | $15 |
| Platino POS | $10 Preferred 50% Out-of-Network |
| Gold POS | $15 Preferred 50% Out-of-Network |
Covered prescription medications
| Pharmacy Benefit | |
|---|---|
| Platinum | $0-$1,000: copays and coinsurance apply; $1,001+: 60% coinsurance |
| Gold 1 | $0-$800: copays and coinsurance apply; $801+: 80% coinsurance |
| Platinum POS | $0-$1,000: copays Preferred $1,001+: 60% Out-of-Network |
| Gold POS | $0-$1,000: copays Preferred $1,001+: 80% Out-of-Network |
| Generic Bioequivalent | |
| Platinum | $5 for $0-$1,000 |
| Gold 1 | $5 for $0-$800 / $801+ |
| Platinum POS | $5 for $0-$1,000 / $1,001+ Preferred |
| Gold POS | $10 for $0-$1,000 / $1,001+ Preferred |
| Preferred Brand | |
| Platinum | 20% min $20 for $0-$1,000, $1,001+ 60% |
| Gold 1 | 25% for $0-$800, $801+ 80% |
| Platinum POS | 20% min $20 for $0-$1,000, $1,001+ 60% Preferred |
| Gold POS | 25% min $20 for $0-$1,000, $1,001+ 80% Preferred |
| Non-Preferred Brand | |
| Platinum | 30% min $30 for $0-$1,000, $1,001+ 60% |
| Gold 1 | 50% for $0-$800, $801+ 80% |
| Platinum POS | 30% min $30 for $0-$1,000, $1,001+ 60% Preferred |
| Gold POS | 50% min $30 for $0-$1,000, $1,001+ 80% Preferred |
| Specialty Products | |
| Platinum | 50% for $0-$1,000, $1,001+ 60% |
| Gold 1 | 50% for $0-$800, $801+ 80% |
| Platinum POS | 50% for $0-$1,000, $1,001+ 60% Preferred |
| Gold POS | 50% for $0-$1,000, $1,001+ 80% Preferred |
| Over-the-Counter (OTC) Medications | |
| Platinum | $1 |
| Gold 1 | Not Covered |
| Platinum POS | Not Covered |
| Gold POS | Not Covered |
Preventive care and ongoing management
| Preventive Services | |
|---|---|
| Platinum | 0% |
| Gold 1 | 0% |
| Platinum POS | 0% Preferred 0% Out-of-Network |
| Gold POS | 0% Preferred 0% Out-of-Network |
| Preventive Vaccines | |
| Platinum | 0% |
| Gold 1 | 0% |
| Platinum POS | 0% Preferred 0% Out-of-Network |
| Gold POS | 0% Preferred 0% Out-of-Network |
| Respiratory Syncytial Virus (RSV) Vaccine | |
| Platinum | 20% |
| Gold 1 | 35% |
| Platinum POS | 20% Preferred 20% Out-of-Network |
| Gold POS | 30% Preferred 30% Out-of-Network |
Exams, lenses, and vision benefits
| Eye Exam (Refraction) | |
|---|---|
| Platinum | $0 |
| Gold 1 | $0 |
| Platinum POS | 0% Preferred and Out-of-Network |
| Gold POS | 0% Preferred and Out-of-Network |
| Pediatric Vision (Lenses & Frames) | |
| Platinum | 20% up to $250 per lenses; over $250: 80% |
| Gold 1 | 20% up to $250 per lenses; over $250: 80% |
| Platinum POS | 20% up to $250 per lenses; over $250: 80% |
| Gold POS | 20% up to $250 per lenses; over $250: 80% |
Adult Vision, Air Ambulance, coverage in the U.S.
| Refraction Exam (Adults) | |
|---|---|
| Platinum | $10 |
| Gold 1 | $15 |
| Platinum POS | $10 Preferred and Out-of-Network |
| Gold POS | $15 Preferred and Out-of-Network |
| Adult Vision | |
| Platinum | 100% reimbursement up to $125 for one pair of lenses and frames per year |
| Gold 1 | 100% reimbursement up to $125 for one pair of lenses and frames per year |
| Platinum POS | 100% reimbursement up to $125 for one pair of lenses and frames per year |
| Gold POS | 100% reimbursement up to $125 for one pair of lenses and frames per year |
| Air Ambulance in Puerto Rico | |
| Platinum | 20% |
| Gold 1 | 30% |
| Platinum POS | 20% Preferred and Out-of-Network |
| Gold POS | 30% Preferred and Out-of-Network |
| Emergency Services in the U.S. | |
| Platinum | 20% coinsurance |
| Gold 1 | 20% coinsurance |
| Platinum POS | 20% coinsurance |
| Gold POS | 20% coinsurance |
| Services in the U.S. (not available in PR) | |
| Platinum | 20% coinsurance |
| Gold 1 | 20% coinsurance |
| Platinum POS | 20% coinsurance |
| Gold POS | 20% coinsurance |
Procedure for severe obesity management
| Bariatric Surgery Procedure | |
|---|---|
| Platinum | $50 |
| Gold 1 | FR $150 / OON $0 |
| Platinum POS | $50 Preferred $200 Out-of-Network |
| Gold POS | $150 Preferred $250 Out-of-Network |
Diagnosis, prevention, and dental treatments
| Dental Benefit | |
|---|---|
| Platinum | $0-$1,000: applicable coinsurance; $1,001+: 60% coinsurance |
| Gold 1 | $0-$1,000: applicable coinsurance; $1,001+: 80% coinsurance |
| Platinum POS | $0-$1,000: applicable coinsurance; $1,001+: 60% Preferred $1,001+: 60% Out-of-Network |
| Gold POS | $0-$1,000: applicable coinsurance; $1,001+: 80% Preferred $1,001+: 80% Out-of-Network |
| Diagnostic & Preventive | |
| Platinum | 0% |
| Gold 1 | 0% |
| Platinum POS | 0% Preferred 0% Out-of-Network |
| Gold POS | 0% Preferred 0% Out-of-Network |
| Minor Restorative | |
| Platinum | 20% |
| Gold 1 | 20% |
| Platinum POS | 20% Preferred 20% Out-of-Network |
| Gold POS | 20% Preferred 20% Out-of-Network |
| Major Restorative | |
| Platinum | 50% |
| Gold 1 | 50% |
| Platinum POS | 50% Preferred 50% Out-of-Network |
| Gold POS | 50% Preferred 50% Out-of-Network |
Complete the form so we can help you with your questions.
Complete the form so we can help you with your questions.
Complete the form and we’ll help you choose the best option.
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.
Complete the form and we’ll help you choose the best option.