The Gold 1 Plan provides strong coverage, affordable copays, and full access to
our provider network.
Hospitalización sin preautorización
Protección contra gastos escesivos
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
Visión Adultos, Ambulancia aérea, cobertura en EE. UU.
Procedure for severe obesity management
Diagnosis, prevention, and dental treatments
Total maximum out-of-pocket expenses per year
| Individual | $6,350 |
| Familiar | $12,700 |
Immediate emergency care
| Accidente | FR $50 / RP $30 |
| Enfermedad | FR $50 / RP $30 |
Consultations and treatments without hospitalization
| Generalista | $7 |
| Especialista | $15 |
| Sub-Especialista | $20 |
| Psiquiatra | $15 |
| Psicólogo | $15 |
| Podiatría | $15 |
| Quiropráctico | $15 |
| Audiólogo | $15 |
| Optómetra | $15 |
| Nutricionista | Reembolso hasta $20 por visita, 4 al año |
| Centro de Cirugía Ambulatoria | FR $150 / RP $0 |
| In-office diagnostic / surgical procedures | 50% |
| Endoscopic procedures | 50% |
Diagnostic tests and medical studies
| Laboratorio | FR 30% / RP 0% |
| Rayos X | FR 30% / RP 0% |
| PET Scan, CT Scan, MRI o PET CT (1 año) | 50% |
Hospital stays and inpatient care
| Partial including Mental Health | $100 |
| Completa con Preautorización incluyendo Salud Mental | FR $150 / RP $0 |
| Completa sin Preautorización incluyendo Salud Mental | FR $150 / RP $0 |
| Facilidades de Enfermería Diestra | 35% |
| Asistencia Quirúrgica | El Suscriptor paga 50% |
Therapies and necessary medical equipment
| Terapia Física | $7 |
| Terapia respiratoria | $7 |
| Home Health Care | 50% |
| Durable Medical Equipment | 50% up to $5,000, Excess 80% |
| Manipulaciones de Quiropráctico | $7 |
Group therapy and emotional support
| Terapia de Grupo | $15 |
| Visitas Colaterales | $15 |
Covered prescription medications
| Beneficio de Farmacia | $0-$800: copagos y coseguros aplicables; $801+: 80% coseguro |
| Genérico Bioequivalente | $5 de $0-$800; $801+: 80% |
| Marca Preferida | 25% de $0-$800, $801+: 80% |
| Marca no Preferida | 50% de $0-$800, $801+: 80% |
| Productos Especializados | 50% de $0-$800, $801+: 80% |
| Over-the-Counter (OTC) Medications | $1 |
Preventive care and ongoing management
| Servicios Preventivos | 0% |
| Preventive Vaccinations | 0% |
| Vacuna para Virus Respiratorio Sincitial | 35% |
Exams, lenses, and vision benefits
| Exámen de Vista (Refracción) | $0 |
| Visión Pediátrica (Lentes de Corrección Visual o Marcos) | 20% hasta $250 por lentes; sobre $250: 80% |
Visión Adultos, Ambulancia aérea, cobertura en EE. UU.
| Exámen de Refracción (Adultos) | $15 |
| Visión Adultos | Reembolso del 100% hasta $125 en un par de lentes y montura por año |
| Ambulancia Aérea en Puerto Rico | 30% |
| Emergency Services in the US | 20% Coinsurance |
| Services in the US (not available in PR) | 20% Coinsurance |
Procedure for severe obesity management
| Procedimiento de Cirugía Bariátrica | FR $150 / RP $0 |
Diagnosis, prevention, and dental treatments
| Beneficio Dental | $0-$1,000 aplican coseguros; $1,001+: 80% |
| Diagnóstico y Preventivo | 0% |
| Minor Restorative | 20% |
| Major Restorative | 50% |
Note: This is a summary of benefits. Consult your plan documents for complete information. Copayments and coinsurance are subject to the annual maximum limit.
Complete the form and we’ll help you choose the best option.
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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.