Pinnacle
The Pinnacle Plan offers comprehensive health coverage with medical, hospitalization, and prescription benefits. Our three deductible options were created to fit your needs and budget, with access to the UnitedHealthcare Choice Plus Network. Preventive care is included, giving peace of mind and flexibility for both individuals and families.
Pinnacle 2026 Individual Plan Overview
Option 1
|
Deductible |
OOPM* |
|---|---|
|
$2,000 |
$8,000 |
Option 2
|
Deductible |
OOPM* |
|---|---|
|
$4,000 |
$10,000 |
Option 3
|
Deductible |
OOPM* |
|---|---|
|
$8,000 |
$20,000 |
Pinnacle 2026 Family Plan Overview
Option 1
|
Deductible |
OOPM* |
|---|---|
|
$2,000 |
$16,000 |
|
per individual |
per family |
Option 2
|
Deductible |
OOPM* |
|---|---|
|
$4,000 |
$20,000 |
|
per individual |
per family |
Option 3
|
Deductible |
OOPM* |
|---|---|
|
$8,000 |
$40,000 |
|
per individual |
per family |
*Out-of-pocket-maximum (OOPM)
Overview
Calendar Year Deductible
|
In-Network/Out-Of-Network-Calendar Year Deductible (CYD) |
|
|---|---|
In-Network Out-Of-Pocket Maximum (OOP)
|
Individual Coverage |
Family Coverage |
|
|---|---|---|
|
$8,000 |
$16,000 |
|
|
$10,000 |
$20,000 |
|
|
$20,000 |
$40,000 |
Out-Of-Network Out-Of-Pocket Maximum (OOP)
|
Individual Coverage |
Family Coverage |
|
|---|---|---|
|
Option 1: $2,000 |
Unlimited |
Unlimited |
|
Option 2: $4,000 |
Unlimited |
Unlimited |
|
Option 3: $8,000 |
Unlimited |
Unlimited |
Lifetime Benefit Maximum
|
Individual Coverage |
Family Coverage |
|
|---|---|---|
|
Option 1 |
Unlimited |
Unlimited |
|
Option 2 |
Unlimited |
Unlimited |
|
Option 3 |
Unlimited |
Unlimited |
Services
Office Visit
|
In-Network |
Out-Of-Network |
|
|---|---|---|
|
$40 copayment* per visit |
CYD/Coinsurance |
|
|
$60 copayment* per visit |
CYD/Coinsurance |
Coinsurance
|
In-Network (Plan Pays) |
Out-Of-Network (Plan Pays) |
|
|---|---|---|
|
70% of eligible charges |
50% of eligible charges |
|
|
You pay $500 deductible per visit |
You pay $500 deductible per visit |
|
|
$0 copay per visit |
No coverage |
Preventative Care Benefits
|
(Subject to CYD) |
In-Network (Plan Pays) |
Out-Of-Network (Plan Pays) |
|---|---|---|
|
All but copay for office visits |
0% |
|
|
All but copay for office visits |
0% |
|
|
70% |
50% |
|
|
70% |
50% |
Prescription Drug Coverage
|
In-Network (Plan Pays) |
Out-Of-Network (Plan Pays) |
|
|---|---|---|
|
Generic & Brand Name Prescriptions |
70% |
50% |
|
$10,000 Maximum per Calendar Year |
||
|
Home Delivery Service is Available |
1Preventative health exam for 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: Well Child visits for children through age 6 and specified immunizations.
2Annual well woman exam:
- Routine well woman preventative exam office visit, by Network Physician, is subject to copayment.
- Screening mammography at age 40 and older, with one baseline mammogram between the ages of 35 and 39; subject to CYD/ coinsurance.
- Annual routine Pap Smear if rendered by a In-Network physician’s office will be subject to copay. Services rendered in an Out-of- Network physician’s office will be subject to CYD and Out-of-Network coinsurance.
3Colorectal cancer screening at age forty-five (45) and older as follows: High-Sensitivity Guaiac Fecal Occult Blood Test (HSgFOBT), or Fecal Immunochemical Test (FIT) every year; tool DNA-FIT every one to three years; Computed Tomography Colonography every five years; Flexible Sigmoidoscopy every five years; Flexible Sigmoidoscopy every 10 years + annual FIT; and Colonoscopy screening every 10 years.
4Benefits will be provided, subject to deductible and coinsurance, for one routine Prostate-Specific Antigen (PSA) per calendar year, when services are rendered by an independent laboratory or other outpatient setting.
Maternity Benefits
Maternity benefits will be provided after an individual’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 an individual has completed a waiting period of at least 12 months. 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.”
Copayment Guidelines
*Copayments 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 will not be applied toward deductibles or out-of-pocket maximums.
Copayments do not apply to the following services: advanced radiological imaging, all maternity services, all therapeutic services, allergy testing and injections, biopsy interpretations, bone density testing, cardiac diagnostic testing, chemotherapy services, chiropractic services, complex diagnostic services, dental services, diagnostic testing sent out, DME and DME supplies, growth hormone injections, IV therapy, Lupron injections, mammography, nerve conduction studies, neuropsychological or neurological tests, nuclear cardiology, nuclear medicine, orthotics, prosthetics, provider administered specialty pharmacy products, sleep studies, surgery performed in a physician’s office and related surgical supplies, Synagis injections, and ultrasounds. These services will be covered under normal contract benefits, subject to the terms and conditions of this contract. Deductible and coinsurance will apply.
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
Have A Farm Bureau Health Plans Rep Contact You For More Information
Individual & Family Plans
Farm Bureau Health Plans utilizes the UHC Choice Plus Network which is UnitedHealthcare’s largest provider network in Tennessee.