Core Choice
For families and individuals who want health, dental, and vision benefits all in one plan.
Core Choice Individual Plan Overview
Deductible
|
Option 1 |
Option 2 |
|---|---|
|
$1,500 |
$3,000 |
Out-of-Pocket Max
|
Option 1 |
Option 2 |
|---|---|
|
$7,500 |
$15,000 |
Lifetime Benefit Max
Unlimited
Core Choice Family Plan Overview
Deductible
|
Option 1 |
Option 2 |
|---|---|
|
$1,500 |
$3,000 |
Out-of-Pocket Max
|
Option 1 |
Option 2 |
|---|---|
|
$15,000 |
$25,000 |
Lifetime Benefit Max
Unlimited
Overview
Calendar Year Deductible
|
In-Network/Out-Of-Network-Calendar Year Deductible (CYD) |
|
|---|---|
In-Network Out-Of-Pocket Maximum (OOP)
|
Individual Coverage |
Family Coverage |
|
|---|---|---|
|
$7,500 |
$15,000 |
|
|
$15,000 |
$25,000 |
Out-Of-Network Out-Of-Pocket Maximum (OOP)
|
Individual Coverage |
Family Coverage |
|
|---|---|---|
|
Option 1: $1,500 |
Unlimited |
Unlimited |
|
Option 2: $3,000 |
Unlimited |
Unlimited |
Lifetime Benefit Maximum
|
Individual Coverage |
Family Coverage |
|
|---|---|---|
|
Option 1 |
Unlimited |
Unlimited |
|
Option 2 |
Unlimited |
Unlimited |
Services
Office Visit
|
In-Network |
Out-Of-Network |
|
|---|---|---|
|
$30 copayment* per visit |
CYD/Coinsurance |
|
|
$40 copayment* per visit |
CYD/Coinsurance |
Coinsurance
|
In-Network |
Out-Of-Network |
|
|---|---|---|
|
Plan pays 100% |
||
|
Plan pays 80%, you pay 20% |
||
|
Plan pays 60%, you pay 40% |
||
|
You pay $300 deductible per visit |
You pay $300 deductible per visit |
|
|
No charge |
No coverage |
Preventative Care Benefits
|
(No Waiting Period) |
In-Network (Plan Pays) |
Out-Of-Network (Plan Pays) |
|---|---|---|
|
100% |
60% |
|
|
100% |
60% |
|
|
100% |
60% |
|
|
100% |
60% |
|
|
Routine Physical Exam |
100% |
60% |
Prescription Drug Coverage
|
$7,500 Calendar Year Maximum per Member |
|---|
Dental
|
Routine dental services, including two exams, x-rays and fillings per calendar year |
|---|
Vision
|
Pediatric Only – Routine vision benefits including eye exams, eyeglasses and contact lenses |
Members Age 19 and Above – Routine vision benefits including eye exams, eyeglasses and contact lenses |
|---|
1 Preventative health exam for adults and children and related services as outlined below and performed by the physician during the preventative health exam or referred by the physician as appropriate, including:
- Screenings and counseling services with an A or B recommendation by the United States Preventive Services Task Force (USPSTF)
- Bright Futures recommendations for infants, children and adolescents supported by the Health Resources and Services Administration (HRSA)
- Preventative care and screening for women as provided in the guidelines supported by HRSA
- Immunizations recommended by the Advisory Committee on Immunization Practices (ACIP) that have been adopted by the Centers for Disease Control and Prevention (CDC)
2 Annual well woman exam
- Routine well woman preventative exam office visit includes:
- Cervical cancer screening
- Screening mammography at age 40 and older, with one baseline mammogram between the ages of 35 and 39
- Other USPSTF screenings with an A or B rating
- Pap smears
- Bone density measurement screening
3 Colorectal cancer screening for members age 45 and older
4 Prostate cancer screening for men age 50 and older
Maternity Benefits
Maternity Benefits will be provided after a member’s coverage on a family contract has been in effect for nine consecutive months. Individual coverage has NO maternity benefits except for complications of pregnancy.
Pre-Existing Condition Waiting Period
Benefits will not be provided for any pre-existing condition until a member has completed a waiting period of at least six months for all contracts and nine months for maternity on family contracts. A pre-existing condition is defined in the contract as “An illness, injury, pregnancy or any other medical condition which existed at any time preceding the effective date of coverage under this contract for which medical advice or treatment was recommended by, or received from, a provider of health care services; or symptoms existed which would cause an ordinarily prudent person to seek diagnosis, care or treatment.” The pre-existing condition waiting period will apply to all members listed on the contract.
Additional waiting periods may apply as indicated in the contract.
Copayment Guidelines
*A copayment will be applied to each office visit for the covered services performed in the office and provided and billed by a physician who is an in-network provider. The remaining charges for covered services rendered during the office visit will be paid at 100% of the maximum allowable charge. If a physician who is an out-of-network provider is utilized for covered services, benefits will be determined on the basis of the out-of-network coinsurance percentage after deductible is met.
Copayments do not apply to the following services: advanced radiological imaging, allergy testing and injections, biopsy interpretation, bone density testing, cardiac diagnostic testing, chemotherapy services, chiropractic services, dental services except preventative and restorative for all members, diagnostic services sent out, durable medical equipment, growth hormone injections, IV therapy, Lupron injections, mammography, maternity services, nerve conduction studies, neuropsychological or neurological tests, nuclear cardiology, nuclear medicine, orthotics, preventative services as indicated in contract, prosthetics, provider administered specialty pharmacy products, sleep studies, surgery performed in a physician’s office and related surgical supplies, Synagis injections, therapeutic/rehabilitative services, ultrasounds and vision services.
These services are subject to the terms and conditions of the contract and deductibles and coinsurance will apply except where otherwise indicated. Copayments will not be applied toward deductibles or out-of-pocket maximums.
We use the UHC Choice Plus network. That means if you choose an in-network provider, your costs stay lower thanks to pre-negotiated rates with UnitedHealthcare. If you visit an out-of-network provider, you’ll likely face higher costs and may be responsible for amounts beyond what your plan covers.
Want to make sure you’re getting the most value? Check your provider’s network status before scheduling care.
Affordable Health Plans
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Individual & Family Plans
Farm Bureau Health Plans utilizes the UHC Choice Plus Network which is UnitedHealthcare’s largest provider network in Tennessee.