Core CHOICE

Core CHOICE

About the Plan
The Farm Bureau Health Plans Core CHOICE plan for families or individuals is a health plan that offers peace of mind coverage and includes dental and vision benefits. With this plan you get a choice of two different deductible amounts.

Farm Bureau Health Plans uses UnitedHealthcare Choice Plus Network. Please keep in mind that in-network payments are based on negotiated fees. If an out-of-network provider is used, the member’s liability will increase significantly.
 
Resources
Provider Network
Schedule of Benefits

  In-Network Out-of-Network

CALENDAR YEAR DEDUCTIBLE (CYD)
(Unless otherwise indicated, all benefits are subject to CYD)

$1,500 per member
$3,000 per member
(Per member, per calendar year)

OUT-OF-POCKET MAXIMUM (OOP)

(Once the OOP maximum is met, benefits are provided at 100% for a member for the remainder of the calendar year. This applies to in-network provider services only. Copayments do not apply to OOP and must still be paid after OOP is met)

For $1,500 CYD:

$7,500 for individual coverage

$15,000 for family coverage

For $3,000 CYD:

$15,000 for individual coverage

$25,000 for family coverage

Unlimited
LIFETIME BENEFIT MAXIMUM Unlimited

  In-Network Out-of-Network

OFFICE VISIT

(Not subject to CYD)

For $1,500 CYD:

$25 copayment* per visit

For $3,000 CYD:

$35 copayment* per visit

CYD/Coinsurance

COINSURANCE

(Based on the maximum allowable charge)

0% for covered preventative services
(Plan pays 100%)

20% for all other covered services
(Plan pays 80%)

40%
(Plan pays 60%)

PREVENTATIVE CARE BENEFITS In-Network Out-of-Network

(NO WAITING PERIOD)

(Plan pays 100%)

(Plan pays 60%)

Preventative health exam1

0%

40%

Annual well woman exam2

0%

40%

Routine colonoscopy3

0%

40%

Annual routine PSA4

0%

40%

Routine physical exam

0%

40%

EMERGENCY ROOM
Not resulting in admission

$75 deductible per visit
(in addition to CYD)

PRESCRIPTION DRUG COVERAGE
$7,500 calendar year maximum per member

  • Generic | Farm Bureau Health Plans will reimburse 100% of the maximum allowable charge, after CYD, when purchased at an in-network pharmacy and 60% of the maximum allowable charge, after CYD for out-of-network pharmacy
  • Brand Name | Farm Bureau Health Plans will reimburse 75% of the maximum allowable charge, after CYD, when purchased at an in-network pharmacy and 60% of the maximum allowable charge, after CYD for out-of-network pharmacy
  • Home delivery service is also available

DENTAL

Routine dental services, including two exams, x-rays and fillings per calendar year

  • Subject to a six month waiting period
  • There is a copayment per visit and a $500 calendar year maximum per member per calendar year
  • Pediatric Only – Two routine oral health risk assessments and one topical fluoride application are covered at 100% per calendar year

VISION

Pediatric Only - Routine vision benefits including eye exams, eyeglasses and contact lenses

  • Eye exams are covered at 100% once every calendar year, no dollar limit
  • Eyeglass frames, eyeglass lenses or contact lenses are covered once every calendar year with a $100 limit per member

Members Age 19 and Above - Routine vision benefits including eye exams, eyeglasses and contact lenses

  • Subject to a six month waiting period
  • Eye exams are covered once every calendar year with a $40 limit per member
  • Eyeglasses or contact lenses are covered once every calendar year with a limit of $100 per member
FOOTNOTES

1. Preventative health exam for adults and children and related services as outlined below and performed by the physician during the preventative health exam or referred by the physician as appropriate, including:
2. Annual well woman exam
  • Routine well woman preventative exam office visit includes: 
    • Cervical cancer screening
    • Screening mammography at age 40 and older, with one baseline mammogram between the ages of 35 and 39 
    • Other USPSTF screenings with an A or B rating 
    • Pap smears 
    • Bone density measurement screening

3. Colorectal cancer screening for members age 50 and older

4. Prostate cancer screening for men age 50 and older 

Maternity Benefits will be provided after a member’s coverage on a family contract has been in effect for nine consecutive months. Individual coverage has NO maternity benefits except for complications of pregnancy.

 

Benefits will not be provided for any pre-existing condition until a member has completed a waiting period of at least six months for all contracts and nine months for maternity on family contracts. A pre-existing condition is defined in the contract as “An illness, injury, pregnancy or any other medical condition which existed at any time preceding the effective date of coverage under this contract for which medical advice or treatment was recommended by, or received from, a provider of health care services; or symptoms existed which would cause an ordinarily prudent person to seek diagnosis, care or treatment.” The pre-existing condition waiting period will not apply to members under the age of 19 enrolled as dependents in a family coverage.

Additional waiting periods may apply as indicated in the contract.

 

*A copayment will be applied to each office visit for the covered services performed in the office and provided and billed by a physician who is an in-network provider. The remaining charges for covered services rendered during the office visit will be paid at 100% of the maximum allowable charge. If a physician who is an out-of-network provider is utilized for covered services, benefits will be determined on the basis of the out-of-network coinsurance percentage after deductible is met.

Copayments do not apply to the following services: advanced radiological imaging, allergy testing and injections, biopsy interpretation, bone density testing, cardiac diagnostic testing, chemotherapy services, chiropractic services, dental services except preventative and restorative for all members, diagnostic services sent out, durable medical equipment, growth hormone injections, IV therapy, Lupron injections, mammography, maternity services, nerve conduction studies, neuropsychological or neurological tests, nuclear cardiology, nuclear medicine, orthotics, preventative services as indicated in contract, prosthetics, provider administered specialty pharmacy products, sleep studies, surgery performed in a physician’s office and related surgical supplies, Synagis injections, therapeutic/rehabilitative services, ultrasounds and vision services.

These services are subject to the terms and conditions of the contract and deductibles and coinsurance will apply except where otherwise indicated. Copayments will not be applied toward deductibles or out-of-pocket maximums.

 

Ready to Enroll?

Farm Bureau Health Plans is proud to offer quality coverage at an affordable cost.

Medicare Supplements Insured by TRH Health Insurance Company, Columbia, TN.
TRHH-POST-POLA-FL14-174; TRHH-POST-POLB-FL14-175; TRHH-POST-POLC-FL14-176; TRHH-POST-POLD-FL14-177; 
TRHH-POST-POLF-FL14-178; TRHH-POST-POLG-FL14-179; TRHH-POST-POLM-FL14-180; TRHH-POST-POLAN-FL14-181
Not connected with or endorsed by the U.S. or state government. This is a solicitation of insurance. A representative of TRH Health Insurance Company may contact you. Benefits not provided for expenses incurred while coverage under the policy is not in force, expenses payable by Medicare, non- Medicare eligible expenses or any Medicare deductible or copayment/coinsurance or other expenses not covered under the policy.

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