APEX Management Group’s Advantage Plan

Covers all mandated Preventive Benefits required by PPACA
Note: This list will be updated from time to time and a current list of covered preventive services is available by visiting Healthcare.gov/center/regulations/prevention.html
Medical benefits – Must utilize PHCS participating provider or facility
21 Preventive Services for Adults100% Coverage for mandated 21 preventive services
28 Preventive Services for Women100% Coverage for mandated 28 preventive services
31 Preventive Services for Children100% Coverage for mandated preventive 31 preventative services
Telemedicine: Teledoc$0 Copay, Unlimited use per covered family member
Primary Care Office Visit$20 Copay, (Max 3 visits per calendar year)
Specialists Office Visit$50 Copay, (Max 3 visits per calendar year)
Urgent Care$50 Copay, (Max 3 visits per calendar year)
Diagnostic X-Ray, Lab$50 Copay by date of service, (Max 5 visits per calendar year)
*CT Scan or MRI $200 Copay, (Max 1 CT scan or MRI per calendar year)
* 3 D MRI’s or Contrast Services for MRI’s and ST Scans are not covered, pre-authorization required prior to scans.
Prescription Drug Benefits – Citizens Rx Click HERE for Drug Coverage Tier Information
Tier 1 – Low Cost Generics$1 Copay
Tier 2 – Generics10% Coinsurance
Tier 3 – Preferred Brands20% Coinsurance
Tier 4 – Non-Preferred Brands40% Coinsurance
Tier 5 – Generic and Preferred Specialty10% Coinsurance (Plan pays 90% up to a maximum of $150 per Rx
Tier 6 – Non-Preferred Specialty20% Coinsurance (Plan pays 80% up to a maximum of $250 per Rx
TELADOC1-800-TELADOC (835-2362)
Citizens Rx1-877-532-7912
PHCS Multiplan1-800-950-7040