Individual/Personal plan member profile...
"I am self-employed or unemployed and I do not have an employer to supplement my health coverage. I am interested in paying for health benefits on my own."

Individual/ Personal Plans

Preferred Care has two health care plans available to individuals who wish to purchase their own health insurance. These are the Personal HMO (Health Management Organization) plan and the Personal POS (Point-of-Service) plan. For more detail, click below on the plan you are interested or scroll down to see the benefits summaries for both plans.

Personal HMO plan
Personal POS (Point-of-Service) plan

Personal HMO plan offers individuals extensive medical coverage. It's a plan that makes getting health care simple and easy. A modest copayment is required for services performed in the doctor's office, and there are no claim forms to complete.

In order to receive the services offered below, care must be provided or arranged by a participating primary care physician (PCP) and approved by Preferred Care. The PCP is acting as your "family doctor," providing treatment and coordinating care. In addition to a family doctor, women are encouraged to choose an obstetrician/ gynecologist.

A summary of benefits is listed below.

• Services provided in your primary care physician's office ($15 copay)
• Specialists referred by your PCP ($15 copay)
• Periodic health assessments for adults ($15 copay)
• Well baby and well-child checkups through age 18 (no charge)
• Routine gynecological exams (one every 6 months- $15 copay)
• Diabetic care, equipment, and medications ($15 copay)
• Hospital coverage including unlimited days of semi-private room ($500 copay per confinement)
• Surgeon fees ($20 copayment up to $200)
• Operating room, recovery room, and special care units (no charge)
• X-ray, laboratory, and other diagnostic services (no charge)
• Pre-natal and postnatal care in the doctor's office (no charge)
• Inpatient admission and newborn nursery care in the hospital ($500 copay per confinement)
• Physician services in the delivery room (20% up to $200)
• Ambulance Transport when life-support services are needed during transport (no charge)
• Emergency room treatment of illness or injury with referral from PCP ($50 copay when not followed by hospitalization)
• Prescription drugs ($5 generic, $10 brand), after meeting deductible ($100 per member; $300 per family)
• Annual out-of-pocket maximum $1500 per member, $3,000 per family

Personal POS (Point-of-Service) plan combines the flexibility of traditional insurance with the best features of managed care. It's a plan that lets you select the doctors you want to see and choose the level of benefits you receive. Copayments and other out-of-pocket expenses vary depending on whether treatment is received from in-network or out-of-network providers.

Keep in mind that, in order to receive the service covered under the in-plan benefits, care must be provided or arranged by a participating primary care physician (PCP) and approved by Preferred Care. Women are encouraged to choose an obstetrician/gynecologist in addition to a PCP. The PCP is the internist, family practitioner or pediatrician who acts as a family doctor, providing treatment and coordinating care.

A summary of benefits is listed below.

• Services provided in your primary care physician's office ($10 copay)
• Specialists referred by your PCP ($10 copay)
• Periodic health assessments for adults (in-plan coverage only - $10 copay)
• Well baby and well-child checkups through age 18 (no charge; in-plan coverage only)
• Routine gynecological exams (one every 6 months - $10 copay)
• Diabetic care, equipment, and medications ($10 copay)
• Hospital coverage including unlimited days of semi-private room (no charge when in-plan)
• Surgeon fees (no charge when in-plan)
• Operating room, recovery room, and special care units (no charge when in-plan)
• X-ray, laboratory, and other diagnostic services (no charge when in-plan)
• Pre-natal and postnatal care in the doctor's office (no charge when in-plan)
• Hospital care for mother and child (when child is added to policy), including delivery room and physician services
• Newborn nursery care in the hospital (no charge when in-plan)
• Ambulance Transport when life-support services are needed during transport (no charge when in-plan)
• Emergency room treatment of illness or injury with referral from PCP ($35 copay when not followed by hospitalization)
• Prescription drugs ($5 generic; $10 brand), after meeting deductible ($100 per member, $300 per family) (in-plan coverage only)
• Lifetime benefit maximum, no limit ($500,000 limit when out-of-plan)

For more information about our Personal plans, contact Preferred Care Member Services at  (800) 658-0460.

Si usted dice una lengua otra que el inglés, tenemos a representantes de Servicios de Miembro que son fluidos en una variedad de lenguas, incluso español.

If you speak a language other than English, we have Member Services representatives who are fluent in a variety of languages, including Spanish. TTY users may call (585) 325-2629 or (800) 252-2452.

Disclaimer:
This summary of benefits is only an overview of plan provisions. While every effort has been made to ensure that this summary accurately reflects the provisions of each plan, it is the plan contract that governs the operations of individual plans and payment of all benefits. Please check with your company's plan administrator for a more detailed plan description.

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Last updated: December 22, 2006