1000 VL Plan Summary | First Choice Health Plan

Annual Deductible (Ind / Family)

$1,000 / $2,000

Out-of-Pocket Max (Ind / Family)

$10,600 / $21,200

Network

In-network only (except true emergencies)

Benefit	What You Pay
Primary Care & Specialist Visits	$50 copay after deductible (10 visits/plan year combined)
Urgent Care	$50 copay after deductible (within the same 10-visit limit)
Telemedicine (MYMDNOW)	$0 copay
Preventive Care	$0 copay / $0 deductible
Emergency Room	$1,000 copay after deductible (limited to 2 accident + 2 illness visits/year)
Inpatient Hospital Care	$2,500 copay/admission after deductible (limited to 3 ICU + 2 non-ICU stays/year, 10-day max each)

Prescription Drug Benefits

Drug Tier	What You Pay
Preventive Medicine Rx — Generic	$0 copay
Generic Drugs — Urgent Care	$0 copay
Generic Drugs — Maintenance	$0 copay
Brand & Specialty Drugs	Not covered (patient assistance programs may be available)

This plan has annual visit, admission, and surgery limits by design to keep premiums low. Organ transplant and dialysis are not covered.

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This page summarizes the key benefits only. For the complete Summary of Benefits, exclusions, and plan documentation, return to your plan overview page and schedule time with the benefits advisor affiliated with your association.

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