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

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Distinct Overview

PHCS Network, MDLIVE Telehealth,
& Arrive Rx

ADULT AND CHILDREN WELLNESS SERVICES

No Visit Fee. Eligible at 100% up to a maximum of $500.00 annually for wellness services per membership year, per member.

PRIMARY CARE PHYSICIAN, SPECIALIST, OR URGENT CARE VISITS

$25 Visit Fee for all eligible outpatient office visits at a primary care physician, specialist, or urgent care facility.
Membership shares up to a maximum of $100 per eligible office visit.
Office visits at a hospital or in an emergency room are ineligible for sharing by the membership.

MAXIMUM OFFICE VISITS – FOUR (4) per membership year, per member.

PHCS Network, MDLIVE Telehealth, & Arrive Rx

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.

Programs

  • *First Health and PHCS Network, MDLIVE Telehealth & ArriveRx
  • *Based on state availability
  • Adult and Child
    Wellness Services
  • No Visit Fee. Eligible at 100% up to a maximum of $500 annually for wellness services per member, per membership year.
  • Primary Care Physician, Specialist, or Urgent Care Visits
  • $40 Visit Fee for all eligible outpatient office visits with a primary care 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

Explore Distinct

  • *First Health and PHCS Network, MDLIVE Telehealth & ArriveRx
  • *Based on state availability
  • Adult and Child
    Wellness Services
  • No Visit Fee. Eligible at 100% up to a maximum of $2,000 annually for wellness services per member, per membership year.
  • Primary Care Physician, Specialist, or Urgent Care Visits
  • $40 Visit Fee for all eligible outpatient office visits with a primary care physician, specialist, or urgent care provider.
  • Membership shares up to a maximum of $400 per eligible office visit.
  • MAXIMUM OFFICE VISITS – EIGHT (8) per member, per membership year.

Explore Diverse

  • *First Health and PHCS Network, MDLIVE Telehealth & ArriveRx
  • *Based on state availability
  • Adult and Child
    Wellness Services
  • No Visit Fee. Eligible at 100% up to a maximum of $2,000 annually for wellness services per member, per membership year.
  • Primary Care Physician, Specialist, or Urgent Care Visits
  • $40 Visit Fee for all eligible outpatient office visits with a primary care physician, specialist, or urgent care provider.
  • Membership shares up to a maximum of $400 per eligible office visit.
  • MAXIMUM OFFICE VISITS – TWELVE (12) per member, per membership year.

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