Distinct
ADULT AND CHILD WELLNESS SERVICES
No Visit Fee. Eligible at 100% up to a maximum of $500 for wellness services per member, per membership year.
OFFICE VISITS
Physician, Specialist, or Urgent Care Visits
$40 Visit Fee for all eligible outpatient office visits with physician, specialist, or urgent care provider.
Membership shares up to a maximum of $400 per eligible office visit.
MAXIMUM OFFICE VISITS – FOUR (4) PER MEMBER, PER MEMBERSHIP YEAR.
*First Health and PHCS Network, MDLIVE Telehealth & ArriveRx *based on state availability
Distinct
Member Responsibility Amount (MRA): Must be satisfied per member, per membership year not to exceed three family members in a family membership.
*Additional Member Responsibility Amount (AMRA): After a Distinct family satisfies their AMRA of $15,000, no further AMRAs will be assessed to the family for the remainder of the membership year. This does not include amounts applied to the member’s MRA.
Pre-existing Waiting Period: Any medical needs resulting from a disease or physical condition for which medical advice, treatment or diagnosis was received and/or a prescription was prescribed, during the 12-month period preceding the member’s effective date are ineligible for member-to-member sharing. The pre-existing waiting period does not apply to services or treatment billed as an office visit or urgent care visit.
90-Day Waiting Period: Certain medical needs are ineligible for member-to-member sharing for 90 days from the member’s effective date. The 90-day waiting period does not apply to services or treatment billed as an office visit or urgent care visit.
