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Physicians Plus

Wise Choice
$25 office visit copays anywhere in our network. Age appropriate preventive care services are paid without applying copayment, deductible, or coinsurance.

Meriter Choice Reward Plan
Office visits are subject to a member copay at one of two tiers. If necessary inpatient and outpatient surgery & services are performed at a Meriter Choice facility, the deductible does not apply, saving the member up to $1,000 (family insurance plan) in annual out-of-pocket costs.

HMO
Office visits are subject to a member copay. HMO plans have an annual deductible for inpatient and outpatient surgery and services.

High-Deductible Health Plans (HSA-Compatible)
The member may contribute tax-advantaged dollars to a Health Savings Account (HSA) and pay health care costs from the account; unused funds can roll from one year into the next. The plan has an annual policy deductible that must be met before it pays toward most services.

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Prescription drugs- three drug plan designs are available:

  • $10 Generic Rx: The member pays a $10 copay for prescribed generics on the Physicians Plus drug formulary; Physicians Plus covers the balance. The member pays 100% for all other prescriptions.
  • $10/30%/50%: The member pays a $10 copay for Physicians Plus formulary generics, 30% of total cost for brand name formulary medications and 50% of total cost for drugs not on the formulary.
  • $10 Generic Rx/$50 Reverse Copay: The member pays a $10 copay for formulary generics; Physicians Plus pays up to $50 for brand name formulary prescriptions, the member pays the balance.

Behavioral Health & AODA

  • Behavioral Health (BH) & Alcohol and Other Drug Abuse (AODA) services are covered according to policy copays, deductibles, coinsurance and maximums.

Maternity Health Insurance

  • The member pays a $1,000 deductible then pays 20% coinsurance; there is no maximum out of pocket.
  • There is a 10-month waiting period before the benefit eligibility begins.
  • If the benefit is not added when you enroll, it cannot be added at a later date unless a new application is submitted for underwriting review.