Insurance Contact:
Derek Dick | Main: 785 584-6043
Fusion Health PPO $2000 Rx Benefit Summary Guide:
| Benefit | Primary Insurance | Supplemental Coverage | What You Owe? |
| Deductible/Benefit Individual/Family | $7,500/$15,000 | $5,500/$11,000 | $2000/$4000 |
| Plan Pays | 100% after deductible | 100% after deductible | $0 after deductible |
| Max Out-of-Pocket Individual/Family | $7,500/$15,000 (Includes deductible, copays, prescription drug copays, & other qualified expenses) | $2,000/$4,000 (Includes ONLY deductible expenses. Does NOT cover copays, prescriptions, & other qualified expenses) | $7,500/$15,000 (Includes deductible, copays, prescription drug copays, & other qualified expenses) |
| Primary Care Office Visits | $10 copay | No Coverage | $10 copay |
| Specialist Care Office Visits | $40 copay | No Coverage | $40 copay |
| Urgent Care Visit | $50 copay | No Coverage | $50 copay |
| Telemedicine | $0 copay | No Coverage | $0 copay |
| Emergency Room | $250 copay | No Coverage | $250 copay |
| Emergency Transportation | 100% after deductible | 100% after deductible | Up to $2,000 deductible |
| Preventive Care / Screening/Immunization | No Charge | No Coverage | $0 |
| Diagnostic Test (X-Ray, Blood Work) | $10 Copay | No Coverage | $10 Copay |
| Imaging (CT/PET scans/MRI’s) | 100% after deductible | 100% after deductible | Up to $2000 deductible (Can be $0 copay if using Rezilient steerage) |
| Outpatient Surgery (Ambulatory Surgery Center) | 100% after deductible | 100% after deductible | Up to $2,000 deductible (Can be $0 copay if using Rezilient steerage) |
| Physician/Surgeon Fees | 100% after deductible | 100% after deductible | Up to $2,000 deductible (Can be $0 copay if using Rezilient Steerage) |
| Mental Health, Behavioral Health, Substance Abuse Office Visit | $10 copay | No Coverage | $10 copay |
| Mental Health, Behavioral Health, Substance Abuse Outpatient Visit | 100% after deductible | 100% after deductible | Up to $2,000 deductible |
| Mental Health, Behavioral Health, Substance Abuse Inpatient Visit | 100% after deductible | 100% after deductible | Up to $2,000 deductible |