Golden Rule of Iowa Saver 80 Plan Information
Golden Rule - Saver 80
Deductibles
You pay $500, $1,000, $1,500, $2,500, $5,000, $7,500 or $10,000
Coinsurance Choices are you pay 20%
Coinsurance Out-of-Pocket Maximum is $3,000
Initial Rate Guarantee is 12 months
Physicians (Illness & Injury):
Office Visit--History and Exam (Primary Care or Specialist, in-network only) is not covered
No Primary Care Physician/Specialist Referrals Required
Prescription Drugs:
Discount card (You may obtain RX drugs at an average savings of 20-25%. Disscounts vary by pharmacy,
geographic area, and drug.)
Preferred price card is not covered--Discount card is included
Annual Maximum is not applicable
Wellness/Preventive Care Benefits:
No waiting period
Doctor Office Visit, X-ray and lab, and Child Immunizations are not covered
Preventive Mammogram, Pap Smear, PSA screening you pay 20% after deductible
Outpatient Expense Benefits
X-ray and lab (performed in the doctor's office or a network facility) is 20% after deductible
(Must be performed within 14 days of surgery or confinement)
Facility/Hospital for Outpatient Surgery you pay 20% after deductible
Surgeon, Assistant Surgeon, and Facility Fees you pay 20% after deductible
Hemodialysis. Radiation, Chemotherapy, Organ Transplant Drugs, CAT Scans, and MRIs are 20% after deductible
Emergency Room Fees--Illness is $500 copay if not admitted, then you pay 20% after deductible
Emergency Room Fees--Injury is $500 copay if not admitted, then you pay 20% after deductible
Spine and Back Disorders (CAT Scans and MRI tests are not subject to this limitation) are not covered
Mental and Nervous Disorders are not covered
Other Outpatient Expenses are not covered
Inpatient Expense Benefits
Room and Board, ICU, Operating Room. Recovery Room, Prescription Drugs, Physician Visit, and Professional Fees of Doctors,
Surgeons, Nurses you pay 20% after deductible
Other Inpatient Services you pay 20% after deductible
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