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Additional Links |
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Click here for Power plan 2
Click here for Power plan 3
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| Monthly Price |
$250.00 |
| Services Provided in the Medical Offices (co-payment) |
| Office Visit |
$5.00 |
| Physical Exams |
$5.00 |
| Immunizations |
$5.00 |
| Lab |
$5.00 |
| X-rays |
$5.00 |
| and other test |
$5.00 |
| Emergency Services |
| In service area |
(no charge) |
| Out of service area |
(no charge) |
| Ambulance/Medical Transportation |
(no charge) |
| Prescriptions |
| Covered prescription drugs at plan pharmacies |
$5.00 |
| Hospital Care |
| Physicians’ services |
$5.00 |
| Room |
$5.00 |
| Testing |
$5.00 |
| Medications |
$5.00 |
| Supplies & Therapies |
$5.00 |
| Optometry Care/Visits |
| Eye Exam |
$5.00 |
| Glasses |
deductible of $20.00 |
| Chiropractic Services |
| Consulations and Procedures |
$5.00 |
| Teen Wellness Services |
| Alcoholism and Drug Dependency |
$5.00 |
| Self Image |
$5.00 |
| Teen Counseling |
$5.00 |
| Mental Care |
| Depression/Suicide |
$10.00 |
| Eating Disorders |
$10.00 |
| Anger Management |
$10.00 |
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