Basic Premier + SmartPay 5000

Plan Information

Doctor Visits

This applies to doctor visits when you have a condition or symptom. For preventive care visits, such as annual checkups, visits are free.

Prescriptions

Prescription coverage is based on which category a drug falls into. To see how this plan categorizes prescriptions, browse its drug formulary.

Labs & Imaging

These are tests your doctor may run when diagnosing a condition.

Hospital & Emergency

SmartPay shares in eligible emergency & hospital services. These medical services may include, but are not limited to major procedures, accidents, surgeries, ER, and hospital visits. For details about eligible medical expenses and limitations that may apply, please review the SmartPay Member Guidelines.

Mental Health

This plan includes membership with Amaze, providing unlimited access to providers 24/7 with no cost for a wide range of virtual services. Other members of your household, such as a spouse and children under 26, are still eligible for Amaze if even they are not on the plan with you. Amaze mental health professionals provide immediate and responsive interventions such as bridge therapy and medication management. They also assist in finding the right care for you and your financial situation, should you need additional support.

Pregnancy & Birth

This membership shares in services provided before and after your child is born. Conception that occurs prior to membership is not eligible for sharing.

Extra Coverage: Accident

The Accident supplemental benefit pays up to the scheduled maximum amount, after the deductible, for medical charges resulting from a covered accident. Benefits are paid directly to the primary member.

Extra Coverage: Critical Illness

Critical Illness supplemental benefit provides additional coverage for medical emergencies like heart attack, stroke, invasive cancer or ESRD. Critical Illness will pay a lump sum benefit as shown in the schedule upon the first diagnosis of a covered condition for each incident (including reoccurrence). Benefits are paid directly to the primary member and can be used however they choose. Covered spouses receive 100% of the benefit amount and covered children receive 50% of the benefit amount.

Telemedicine

This plan includes membership with Amaze, providing unlimited access to providers 24/7 with no cost for a wide range of virtual services. Other members of your household, such as a spouse and children under 26, are still eligible for Amaze if even they are not on the plan with you.

Free Preventive Care

Every plan includes over 74 preventive care services that are completely free on day one. These services keep you healthy before you become sick, including routine check-ups, counseling, screenings, and immunizations. For information on services covered click here.