March 12, 2010

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Patriot Health – Patriot Class 4 – DISTRICT OF COLUMBIA

A comparison of the Patriot Class 4 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

  Network Non-Network
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Network See Provider See Provider
Application Patriot Class 4 Application Patriot Class 4 Application
Brochure Patriot Class 4 Brochure Patriot Class 4 Brochure
Copay
  • Doctor visit: $60/visit (Up to 5 visits on the individual plan and up to 8 vists per calendar year per family)
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  • Doctor visit: $60/visit (Up to 5 visits on the individual plan and up to 8 vists per calendar year per family)
    		•
    Office Visit
  • Doctor visit: $60/visit (Up to 5 visits on the individual plan and up to 8 vists per calendar year per family)
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  • Doctor visit: $60/visit (Up to 5 visits on the individual plan and up to 8 vists per calendar year per family)
    		•
    Deductible N/A N/A
    Coinsurance N/A N/A
    Coinsurance Limit N/A N/A
    Out-of-Pocket Maximum N/A N/A
    Lifetime Maximum Patriot Class 4 Patriot Class 4
    Prescription Drugs
  • Tier 1 & Tier 2- Thousands of select generic and brand name drug labels are available to members for a maximum $10 on tier 1 and $20 on tier 2.
  • Tier 3- Virtually all other drugs are available at negotiated rates.
  • Optional Mail Order- Additional savings on prescription medicine delivered to your door.
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  • Tier 1 & Tier 2- Thousands of select generic and brand name drug labels are available to members for a maximum $10 on tier 1 and $20 on tier 2.
  • Tier 3- Virtually all other drugs are available at negotiated rates.
  • Optional Mail Order- Additional savings on prescription medicine delivered to your door.
    		•
    Emergency Room $100/visit (Maximum of 3 visits per person per calendar year) $100/visit (Maximum of 3 visits per person per calendar year)
    Adult Preventative Care Patriot Class 4 Patriot Class 4
    Child Preventative Care Patriot Class 4 Patriot Class 4
    Lab / X-Ray
  • Lab Discounts: Members receive low contracted rates which offer from 20-70% off usual and customary fees on virtually all laboratory services including blood-work and lab screenings at any participating lab facility.
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  • Lab Discounts: Members receive low contracted rates which offer from 20-70% off usual and customary fees on virtually all laboratory services including blood-work and lab screenings at any participating lab facility.
    		•
    Maternity Patriot Class 4 Patriot Class 4
    Physical Therapy Patriot Class 4 Patriot Class 4
    Skilled Nursing Patriot Class 4 Patriot Class 4
    Home Health Care Patriot Class 4 Patriot Class 4
    Mental Health Patriot Class 4 Patriot Class 4
    Hospital Care
  • Hospital Stay: $500/day (Maximum of 180 days)
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  • Hospital Stay: $500/day (Maximum of 180 days)
    		•
    Optional Benefits Patriot Class 4 Patriot Class 4