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Benefit Schedules: High Deductible Plans | Copay Plans | HSA Plans
Arizona Medical Insurance > Golden Rule Insurance Company > High Deductible Plan Benefits
Lower Premiums
With high deductible plans, you’re keeping more of your money and taking responsibility for covering minor or routine health care expenses — if they come up. The higher the deductible, the lower your premiums.
Saver 80SM is our lowest premium plan. This plan provides coverage for hospital confinements, surgical procedures in or out of the hospital, and the more costly outpatient expenses, such as CAT scans and MRIs.
Simple to Use
Golden Rule’s top-selling high deductible plan — Plan 100® — pays 100% of covered expenses once you meet your calendar-year deductible. Your benefits are not complicated with multiple copays or coinsurance.
Comprehensive Coverage
- You choose $3 million or $5 million lifetime maximum benefit per covered person.
- Plan 100® and Plan 80SM include preventive care and childhood immunizations with no waiting period (first-dollar coverage available).
- Add optional benefits to increase coverage (see optional benefits for details).
Plan 100® |
Plan 80SM |
Saver 80SM |
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| Design Basics | |||||||||
| Calendar-Year Deductible Choices (maximum 2 per family, per calendar year) |
You pay: $1,500, $2,500 $3,500, or $5,000 |
You pay: $1,500, $2,500 $3,500, or $5,000 |
You pay: $500, $1,000, $1,500, $2,500, $3,500, or $5,000 |
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| Coinsurance After Deductible (per covered person, per calendar year) |
You pay: Nothing We pay: 100% |
You pay: 20% to $3,000 We pay: 80% to $12,000 then 100% |
You pay: 20% to $3,000 We pay: 80% to $12,000 then 100% |
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| Lifetime Maximum Benefit (per covered person) |
$3 million ($5 million available) |
$3 million ($5 million available) |
$3 million ($5 million available) |
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| Initial Rate Guarantee (subject to benefit and address changes) |
12 months |
12 months |
12 months |
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We pay the percentages below AFTER you pay the deductible unless otherwise indicated. |
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| Preventive Care Benefits | |||||||||
| Doctor Office Visit (X-ray and lab performed in the doctor's office or a network facility) |
History and exam: 100% X-ray and lab: 100% |
History and exam: 80% X-ray and lab: 80% |
Not Covered |
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| Child Immunizations (age 0-18) |
Vaccine: 100% |
Vaccine: 80% |
Not Covered |
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| Preventive Mammogram, Pap Smear, PSA Testing | Testing: 100% |
Testing: 80% |
Testing: 80% |
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| Outpatient Expense Benefits | |||||||||
| Doctor Office Visit Fees — Illness & Injury | 100% |
80% |
Not Covered |
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| Outpatient X-ray and Lab (X-ray and lab performed in the doctor's office or a network facility) |
100% |
80% |
80% if performed within 14 days of surgery or confinement |
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| Outpatient Prescription Drugs | 100% Preferred Price Card Included |
80% Preferred Price Card Included |
Not Covered — Discount Card Included |
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| Surgeon, Assistant Surgeon, and Facility Fees | 100% |
80% |
80% |
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| Hemodialysis, Radiation, Chemotherapy, and Organ Transplant Drugs | 100% |
80% |
80% |
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| Cat Scans, MRIs | 100% |
80% |
80% |
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| Emergency Room Fees | Illness: 100%, additional $100 Copay if not admitted Injury: 100% |
Illness: 80%, additional $100 Copay if not admitted Injury: 80% |
Illness & Injury: 80%, additional $500 Copay if not admitted |
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| Other Covered Outpatient Expenses | 100% |
80% |
See Covered Expenses for details |
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| Inpatient Expense Benefits | |||||||||
| Room and Board, Intensive Care Unit, Operating Room, Recovery Room, and Professional Fees of Doctors, Surgeons, Nurses | 100% |
80% |
80% |
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| Other Covered Inpatient Services | 100% |
80% |
80% |
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| Dental and Vision Discounts — Programs Are Not Insurance | Discounts through FACT membership provided by Health Allies — save up to 50% on dental and vision. | ||||||||
| Optional Benefits — For a complete list, see Optional Benefits. |
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| This chart only summarizes standard covered expenses, exclusions, and limitations of each plan. To be considered for reimbursement, expenses must qualify as covered expenses. Expenses are also subject to reasonable and customary limits unless you use a network. We recommend review of the more detailed plan information under Covered Expenses, Provisions That Apply To All Plans. | |||||||||
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