Dynamic

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 – TWELVE (12) PER MEMBER, PER MEMBERSHIP YEAR.

*First Health and *PHCS Networks, MDLIVE Telehealth & ArriveRx
*based on state availability

Explore Dynamic

Dynamic Overview

Adult and ChildWellness 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. Office visits at a hospital or in an emergency room are ineligible for sharing by the membership.

Membership shares up to a maximum of $200, $300 or $400 per office visit.

MAXIMUM OFFICE VISITS OF SIX (6), EIGHT (8), TEN (10) PER MEMBERSHIP YEAR, per member, based on the Capstone 1-2-3 program option selected.

Member Responsibility Amount (MRA): Must be satisfied per member, per membership year not to exceed three family members in a family membership.

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.

EXPLORE DYNAMIC 

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