Welcome, Jane

Coverage Summary

Member ID: 1234500001234Member Name: Jane Sample
Plan Name: Buy Up PlanStatus: Active
Effective Date: 01.01.2019Term Date: N/A
Group Name: Sample Company, Inc.Group Number: 0000123456

MEMBER RESOURCES

  • PPO PROVIDER LOCATOR
  • TELEHEALTH
  • WALK-IN CLINIC LOCATOR
  • LAB SERVICE LOCATOR
  • DIABETIC MANAGEMENT
  • RADIOLOGY LOCATOR
  • PRECERTIFICATION
  • TRAVEL INSURANCE
  • WELLNESS DASHBOARD
  • BENEFIT VIDEOS
  • FAQs

Coverage Accumulator Balances

Individual – TypeMaximum AmountAmount Met
In-Network Deductible$1,500$750.00
Out-of-Network Deductible$1,500$0.00
Vision Deductible$25.00$25.00
Dental Deductible$25.00$25.00
50%
0%
100%
100%

Recent Claims

 
Claim NumberDescriptionAmountCo-Pay Amount
#000560Example Walk-In Clinic$750.00 $40.00
#123456ABC Dental Co.$150.00$25.00
#678900Example Vision Clinic$250.00$25.00
#123455Offices of Dr. Example$500.00$50.00