Diverse
ADULT AND CHILD WELLNESS SERVICES
No Visit Fee. Eligible at 100% up to a maximum of $2,000 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 – EIGHT (8) PER MEMBER, PER MEMBERSHIP YEAR.
*First Health and *PHCS Networks, Drexi, Healthee & MDLIVE Telehealth.
*Based on state availability and members can use any in or out of network provider with no reduction in sharing limits.
Diverse
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 Diverse 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, care, services, treatment or diagnosis was received, any
prescription was written, taken, or there were signs and/or symptoms present with or without treatment, during the 24-month period preceding the member’s effective date will be
ineligible for member-to-member sharing. The pre-existing waiting period of 12 month’s from member’s effective date 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, inpatient accidental injury, or eligible ER acute illness.
