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The document provides detailed copay and coinsurance levels, deductible and out-of-pocket maximums, outpatient services, prescriptions by drug tier, and inpatient and emergency episode limits, including notes on ACA 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plan features are highlighted for the MediExcel Advantage large-group HMOs?","Question",{"text":63,"@type":64},"The plan emphasizes ACA-compliant HMO coverage, access to virtual or in-person care seven days a week, emergency and urgent care worldwide, a secure patient portal, and optional voluntary dental and vision plans.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What are the deductible and out-of-pocket maximum levels shown in the summary?",{"text":68,"@type":64},"The summary lists $0 overall annual deductible and an annual out-of-pocket maximum of $4,500/$9,000 for the VP-5, with corresponding values shown for VP-10 and VP-20.",{"name":70,"@type":61,"acceptedAnswer":71},"How does the summary describe emergency and urgent care cost sharing?",{"text":72,"@type":64},"Emergency and urgent care includes coinsurance and copay structure, notes coinsurance applies to the entire emergency episode, and caps outpatient emergency care costs at $250 unless a copay is already 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sales@mediexcel.com](421-1659 | sales@mediexcel.com)  \nCA Licensed & ACA Compliant HMO  \n Meets Minimum Value Standards & Provides Minimum Essential Coverage  \n Can Be Wrapped Alongside Your U.S. Carrier As A Lower Cost Bene t Option  \n Can Write Down To 1 Employee On Most Plans  \n Dependent Only Coverage Available  \n Virtual/In-Person Care Accessible 7 days a Week  \n Emergency & Urgent Care Coverage Worldwide  \n 100+ U.S. In-Network Urgent Care Providers  \n Excel Hospital in Tijuana is Open 24 hours for All Health Care Needs  \n Patient Portal-Secure & Con dential Option To Manage Bene ts & Appointments  \n SENTRI Pass Fee Reimbursement Program  \n Voluntary Dental & Vision Plans  \n Mobile App Available on   \n2023 Large Group Summary of Benefits & Coverage  \nIndividual/Family Overall Annual Deductible  \nIndividual/Family Annual Out-of-Pocket Maximum  \nMedical Event Service type  \nVP-5 HMO  \n$0  \n$4,500/$9,000  \nCopay  \nHealth Care Provider’s Officer or Clinic Visit  \nOffice Visits-Primary Care (incl. mental health) Office Visits-Specialist  \nOffice Visits-Other Healthcare Practitioners Preventive Care/Screening/Immunization Primary Care Telemedicine Consultation Dental Exam & Cleaning  \n$5 per visit  \n$10 per visit  \n$5 per visit No Copay  \nNo Copay  \nNo Copay  \nVP-10 HMO  \n$0  \n$4,500/$9,000  \nCopay  \n$10 per visit  \n$15 per visit  \n$10 per visit No Copay  \nNo Copay  \nNo Copay  \nVP-20 HMO  \n$0  \n$4,500/$9,000  \nCopay  \n$20 per visit  \n$20 per visit  \n$20 per visit No Copay  \nNo Copay  \nNo Copay  \n| Tests | Laboratory Tests | No Copay | $5 per visit | $5 per visit |\n| --- | --- | --- | --- | --- |\n|  | X-rays & Diagnostic Imaging | No Copay | $5 per visit | $5 per visit |\n|  | Imaging- (CT/Pet Scans, MRIs) | No Copay | $30 per visit | $30 per visit |\n| Outpatient Prescription Drug Coverage | Tier 1-Generic/Low-cost brands | $5 per drug | $10 per drug | $20 per drug |\n|  | Tier 2-Brand Formulary | $10 per drug | $15 per drug | $20 per drug |\n|  | Tier 3-Brand Non-Formulary | $15 per drug | $20 per drug | $30 per drug |\n|  | Tier 4-Specialty Drugs | 20%, up to $250 | 25%, up to $250 | 30%, up to $250 |\n| Outpatient Services | Surgery Facility Fee\u003Cbr>Physician/Surgeon Fee\u003Cbr>Outpatient Visit | No Copay\u003Cbr>No Copay\u003Cbr>10% | $50 per visit\u003Cbr>No Copay\u003Cbr>10% | $100 per visit\u003Cbr>No Copay\u003Cbr>20% |\n\nEmergency & Urgent Care*  \nEmergency Room Facility Fee Emergency Medical Transportation Urgent Care in Mexico  \nUrgent Care in the US/Outside of Mexico  \n15%, up to $250 $100 Copay  \n$15 per visit  \n$35 per visit  \n15%, up to $250 $150 copay $20 per visit  \n$40 per visit  \n20%, up to $250 15%$25 per visit  \n$50 per visit  \n\n| Hospital Stays | Inpatient Hospital Facility Fee\u003Cbr>Inpatient Physician/Surgeon Fee | No Copay\u003Cbr>No Copay | $50 per day\u003Cbr>No Copay | $150 per day\u003Cbr>No Copay |\n| --- | --- | --- | --- | --- |\n| Mental Health, | Outpatient Office Visits | $5 per visit | $10 per visit | $20 per visit |\n| Behavioral | Other Outpatient Items & Services | No Copay | No Copay | No Copay |\n| Health, or\u003Cbr>Substance | Inpatient Services (hospital room) | No Copay | $50 per day | $150 per day |\n| Abuse Needs | Inpatient Physician/Surgeon Fee | No Copay | No Copay | No Copay |\n| Pregnancy | Preconception Care & Prenatal Visits | No Copay | No Copay | No Copay |\n|  | Delivery & All Inpatient Services (professional & hospital) | No Copay | $50 per day | $150 per day |\n|  | Home Health Care | No Copay | No Copay | No Copay |\n\nHelp Recovering or Other Special Health Needs  \nOutpatient Rehabilitation/Habilitation Therapy Skilled Nursing Care  \nDurable Medical Equipment (incl. diabetic equip.) Prosthetics/Orthotics  \nHospice Services  \n$5 per visit No Copay  \n10%  \n10%  \nNo Copay  \n$10 per visit $25 per day 10%  \n10%  \nNo Copay  \n$20 per visit $75 per day  \n20%  \n20%  \nNo Copay  \nIn regard to ACA Compliancy, please note that all of the above plan designs provide Min","cbCaikYAhC8nONyV","https://ap.wps.com/l/cbCaikYAhC8nONyV","pdf",4568300,16,"English","# 2023 Large Group Summary of Benefits & Coverage\n## MediExcel Advantage and Plan Features\n## Deductibles, Out-of-Pocket Maximums, and Medical Services\n## Office Visits, Preventive Care, and Telemedicine\n## Tests and Outpatient Prescription Drug Coverage\n## Outpatient Services and Emergency/Urgent Care\n## Hospital Stays and Mental/Behavioral Health\n## Pregnancy and Special Health Needs\n## ACA Compliancy Notes and Effective Date","[{\"question\":\"What plan features are highlighted for the MediExcel Advantage large-group HMOs?\",\"answer\":\"The plan emphasizes ACA-compliant HMO coverage, access to virtual or in-person care seven days a week, emergency and urgent care worldwide, a secure patient portal, and optional voluntary dental and vision plans.\"},{\"question\":\"What are the deductible and out-of-pocket maximum levels shown in the summary?\",\"answer\":\"The summary lists $0 overall annual deductible and an annual out-of-pocket maximum of $4,500/$9,000 for the VP-5, with corresponding values shown for VP-10 and VP-20.\"},{\"question\":\"How does the summary describe emergency and urgent care cost sharing?\",\"answer\":\"Emergency and urgent care includes coinsurance and copay structure, notes coinsurance applies to the entire emergency episode, and caps outpatient emergency care costs at $250 unless a copay is already indicated.\"}]","MediExcel 2023 Large Group Summary of Benefits & Coverage - Health Plans | PDF",1790428346]