Effective January 1, 2012, the Basic Health 5000 Plan features scaled-down benefits and a lower monthly rate — which means it may help you reduce your monthly healthcare expenses. But it may not be right for everyone.
The Basic Health 5000 Plan best fits:
- Healthy people.
- Individuals who see the doctor primarily for preventive care.
- Families looking for protection from the full cost of catastrophic claims.
- Someone who simply can’t afford a more costly plan.
If you have a chronic condition, take maintenance or brand name prescriptions, or need regular, more extensive healthcare, this plan may not be right for you. Like all of GuideStone’s medical plans, this plan covers eligible, in-network preventive care at 100%, not subject to the deductible.
It’s worth noting that while this plan features a lower monthly cost, it also has limited benefits, including:
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No family deductibles. Each covered participant is required to meet his/her $5,000 annual deductible before the plan pays coinsurance.
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Copays for a limited number of doctor visits. For your first three visits (per person, not per family), you pay $25 to visit a primary care physician. For every visit thereafter, your copay increases to $45 plus you pay 50% of the cost of care for most services other than wellness.
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Prescription drug benefits. After you meet your prescription drug deductible, you pay a copay for generic drugs. However, for brand-name (preferred and non-preferred), you pay 33% of drug costs up to a maximum amount per prescription.
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No coverage for chiropractic or mental health services. You are responsible for paying the full cost for these services.
| Basic Health 5000 |
In-network Benefits |
| Deductible for individual coverage |
$5,000 per person |
| Deductible for family coverage |
$5,000 per person |
| Plan coverage (after deductible) |
50% |
| Annual out-of-pocket maximum |
$7,000 per person |
| Primary care physician office visit |
Visits 1-3: $25 copay
Visits 4+: 50% after $45 copay |
| Specialist office visit (after deductible) |
50% |
Hospital admission and outpatient surgery
(after deductible) |
50% |
| Wellness and preventive care |
100% no copay, not subject
to deductible |
| Emergency room |
50% after $150 copay |
| Chiropractic services |
Not covered |
| Mental health — inpatient |
Not covered |
| Mental health — outpatient |
Not covered |
| Maternity (after deductible) |
50% |
| Lifetime maximum benefit |
Unlimited |
The Basic Health 5000 Plan is different than traditional PPO plans. Our compassionate customer relations specialists are happy to help you figure out if this plan is right for you. Simply call us toll-free at 1-888-98-GUIDE (1-888-984-8433) Monday through Friday, 7 a.m. to 6 p.m. CST. Or, send us an email.