Healthfirst Gold Leaf Plan - Benefits

Each Leaf Plan offers the same great health benefits, including checkups, maternity care, emergency services, hospitalization, prescription drugs, lab work, and more. The difference is that your monthly premium payment and other costs will vary based on the plan you choose. 

See below for more information on cost, covered benefits, and prescription drug coverage for the Healthfirst Gold Leaf Plan. For help understanding terms like deductible and coinsurance, please visit the Glossary.

Cost (Individual)

Deductible $600
Coinsurance 20%
Maximum Out-Of-Pocket Cost
(MOOP)
$4,000

Cost (Family)

Deductible $1,200
Coinsurance 20%
Maximum Out-Of-Pocket Cost
(MOOP)
$8,000

 

Covered Benefits (Individual and Family)

Preventive Care No deductible or cost sharing applies to preventive care visits or services as defined in section 2713 of the ACA
Primary Care Physician $25 copay
Specialist $40 copay

PT/OT/ST: Rehabilitative & Habilitative Services

$30 copay
Urgent Care $60 copay
Emergency Room $150 copay
Ambulance $150 copay
Surgeon, Anesthesiologist $100 copay
Outpatient facility $100 copay
Inpatient Facility /
Skilled Nursing Facility
$1,000 per admission

Prescription Drugs (Individual and Family)

Generic $10 copay
Brand Name (formulary) $35 copay
Brand Name (not in formulary) $70 copay

The benefit information provided above is a brief summary, not a comprehensive description of benefits.

For more information please click here.