• Primary Care Select Physician

  • You Pay:
    $40 copay
    Each member must designate a Primary Care Select Physician
  • We Pay:
    100% after the copay

• Specialist

  • You Pay:
    $65 copay
    Each member must be referred by designated Primary Care Select Physician
  • We Pay:
    100% after the copay

Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.

• Lower Member Cost Share

  • You Pay:
    $600 copay
  • We Pay:
    100% after the copay

• Higher Member Cost Share

  • You Pay:
    $1,000 copay
  • We Pay:
    100% after the copay

Understand Copays vs Coinsurance

Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.

• You Pay:
  $600 copay
• We Pay:
  100% after the copay

Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.

• Lower Member Cost Share

  • You Pay:
    20% coinsurance
  • We Pay:
    80% coinsurance

• Higher Member Cost Share

  • You Pay:
    25% coinsurance
  • We Pay:
    75% coinsurance

Understand Copays vs Coinsurance

Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.

• You Pay:
  0% after meeting the calendar year deductible
• We Pay:
  100% after meeting the calendar year deductible

Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.

• You Pay:
  Specialist: $65 copay
• We Pay:
  100% after the copay

Understand Copays vs Coinsurance

Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.

For complete coverage details see the Prescription Drug List for this plan.

• Tier 1

  • You Pay:
    $20 copay
  • We Pay:
    100% after copay/coinsurance

• Tier 2

  • You Pay:
    $30 copay
  • We Pay:
    100% after copay/coinsurance

• Tier 3

  • You Pay:
    $85 copay
  • We Pay:
    100% after copay/coinsurance

• Tier 4

  • You Pay:
    $150 copay or 50% coinsurance (whichever is greater)
  • We Pay:
    100% after copay/coinsurance

• Tier 5

  • You Pay:
    $250 copay
  • We Pay:
    100% after copay/coinsurance

• Tier 6

  • You Pay:
    $300 copay or 30% coinsurance (whichever is greater)
  • We Pay:
    100% after copay/coinsurance

Understand Copays vs Coinsurance

Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.

• You Pay:
  20% after meeting the calendar year deductible
• We Pay:
  80% after meeting the calendar year deductible

Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.

IMPORTANT: Use a Select Lab Network to provide services under your plan.

• Lower Member Cost Share

  • You Pay:
    $600 copay
  • We Pay:
    100% after the copay

• Higher Member Cost Share

  • You Pay:
    $1,000 copay
  • We Pay:
    100% after the copay

Understand Copays vs Coinsurance

Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.

Learn More About Preventive Services and Preventive Drugs coverage for this plan.

• You Pay:
  $0
• We Pay:
  100%

Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.

Limited to members up to the end of the month in which the member turns 19.

• Routine Dental Cleaning

  • You Pay:
    $0
  • We Pay:
    100%

• Yearly Eye Exam

  • You Pay:
    20% after meeting the calendar year deductible
  • We Pay:
    80% after meeting the calendar year deductible

Benefits listed apply to in-network services. In-Network services outside of Alabama may vary.