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Flex | Flex Rx PPO
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Monthly Premium1
Flex: $0*
Flex Rx: $39.40
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In-Network
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Out-of-Network
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Primary Care Physician
$0
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Primary Care Physician
$40
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Doctor on Demand
$0
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Doctor on Demand
$0
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Specialist Copayment
$40
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Specialist Copayment
30%
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Routine Annual Physical Exam Copayment
$0
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Routine Annual Physical Exam Copayment
30%
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Urgent Care Copayment
$60 worldwide coverage
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Urgent Care Copayment
$60 worldwide coverage
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Emergency Room Copayment1
$90 worldwide coverage
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Emergency Room Copayment1
$90 worldwide coverage
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Ambulance
$255
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Ambulance
$255
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Outpatient Surgery
$250-$325
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Outpatient Surgery
30%
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Physical Therapy
$40
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Physical Therapy
$60
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Inpatient Hospitalization
Days 1-6: $310 per day
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Inpatient Hospitalization
30%
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Dental reimbursement for all dental services:
Routine Cleaning/Restorative/Dentures (not for whitening)
$450 reimbursement
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Vision: Annual Routine Eye Exam
$20
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Vision: Annual Routine Eye Exam
30%
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Frames/Lenses (per year)
$175 reimbursement
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Hearing Care Solutions Hearing Aid Benefit
$599 or $899
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Over-the-counter Benefit
$25 / quarter
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Over-the-counter Benefit
Not available
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Senior Fit Included
Yes
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CDPHP Life Points® Rewards
Earn up to $125
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Lab Services
$0 or $5
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Lab Services
30%
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X-rays
$35
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X-rays
$40
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Advanced Imaging Studies (CT, MRI, etc.)
$135
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Advanced Imaging Studies (CT, MRI, etc.)
30%
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OOP Max
$6,100
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OOP Max (Combined)
$10,000
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Plan Documents
Evidence of Coverage (EOC), Summary of Benefits (SOB), and 2023 Inflation Reduction Act Part B Changes
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