12 Choice Plan Tier 1 ECU Health Alliance/In-Network Tier 2 MedCost/In-Network Tier 3 Out-of-Network Preventive Covered at 100% Covered at 100% Ded., then 50% coins. Plan Coinsurance Plan pays 85%, you pay 15% Plan pays 75%, you pay 25% Plan pays 50%, you pay 50% PCP Visit $10 copay $30 copay Ded., then 50% coins. Specialty Visit $15 copay $50 copay Ded., then 50% coins. Behavioral Health Office Visit $10 copay $10 copay Ded., then 50% coins. ECU HealthNow Covered at 100% Covered at 100% Covered at 100% Med Deductible (Single/Family) $850/$1,700 $1,250/$2,500 $3,500/$7,000 Med Max OOP (Single/Family) $3,300/$6,600 $4,500/$9,000 $8,000/$16,000 Rx Max OOP (Single/Family) $2,500/$5,000 $2,500/$5,000 $2,500/$5,000 OOP Max (Med + Rx) $5,800/$11,600 $7,000/$14,000 $10,500/$21,000 Emergency Room $200 copay + ded./ 15% coins. $200 copay + Tier 1 ded./ 15% coins.* $200 copay + Tier 1 ded./ 15% coins.* Urgent Care $40 copay $50 copay Ded., then 50% coins. In/Outpatient Hospital Ded., then 15% coins. Ded., then 25% coins. Ded., then 50% coins. * For these services, you first pay the Tier 1 deductible, and then the coinsurance. BE WELL
