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Wellness & Preventative Care

Aspire

250  500  1000

Aspire offers you access to everyday non-emergency/non-chronic medical needs such as wellness and preventative care, including primary care physician, specialist, or urgent care visits.

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Overview

PHCS Network, MDLIVE Telehealth & Paramount Rx

  ASPIRE WELLNESS & PREVENTATIVE SERVICES  

No Visit Fee. Eligible at a 100% for wellness and preventative services for PHCS providers only.

See Wellness & Preventative Overview for complete list of all eligible services.

  PRIMARY CARE PHYSICIAN, SPECIALIST or URGENT CARE VISITS  

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Primary Care Physician/Urgent Care

$25 Visit Fee

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Specialist

$50 Visit Fee

$25 Visit Fee (Primary Care Physician/Urgent Care) $50 Visit Fee (Specialist) for all eligible injury or illness outpatient office visits at a primary care physician, specialist or at an urgent care.

 

Membership shares up to a maximum of a $150 per office visit for eligible medical services. 

 

MAXIMUM OFFICE VISITS PER MEMBERSHIP YEAR of 2 or 3 visits, per member, based on the Aspire 250-500-1000 you have selected.

 

Aspire 250 ∙ 500 ∙ 1000

Aspire
  1. There is 12-month pre-existing condition limitation for all inpatient hospital and emergency room features.

  2. The hospital admission features for defined condition has a 30-day waiting period. No features are eligible for any defined condition where the date of diagnosis is during 30-day waiting period.

  3. The daily hospital admission features is eligible for either heart attack or heart disease during a membership year, but not both.

  4. Daily features for eligible surgery are scheduled and vary based on the specific surgical procedure performed.

  5. Daily features for eligible anesthesia vary and are equal to 20% of the applicable surgery feature.

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  1. Network Provider: PHCS -The Aspire 250-500-1000 provides these preventative services only through a PHCS provider.

  2. Office Visit Fees: Your doctor may provide a preventative service, such as a cholesterol screening test, as part of an office visit. Please note, that you may have to pay some costs of the office visit, if the preventative service is not the primary purpose of the visit, or if your doctor bills you for preventative services separately from the office visit.

  3. Talk to your health care provider to know which eligible preventative services are right for you based on your age, gender, and health status.

 

Summary of Eligible Wellness & Preventative Services

The list below summarizes all eligible wellness and preventative services. Services not listed under wellness and preventative are not eligible for sharing by the membership. All eligible wellness and preventative services are shared at 100% by the membership with no visit fee for PHCS providers only.

Eligible Services for Adults

ANNUAL PREVENTATIVE CARE VISIT

  • History

  • Physical Exam

  • Measurements (Height, Weight &

  • Body Mass Index)

GENERAL HEALTH SCREENINGS

  • Blood Pressure

  • Cholesterol Screening based on Age and Individual

  • Risk Factors

  • Depression Screening

  • Diabetes Screening for Adults with High Blood

  • Pressure

  • Obesity Screening

  • HPV Screening

  • Screening for Sexually Transmitted Infections (STIs)

  • HIV Screening

  • Cervical Dysplasia Screening

IMMUNIZATIONS

  • Diphtheria, Tetanus, Pertussis

  • Hepatitis A & B

  • Human Papillomavirus (HPV)

  • Influenza (Flu)

  • Measles, Mumps, Rubella

  • Meningococcal

  • Pneumococcal (Pneumonia)

  • Varicella (Chickenpox)

  • Zoster

HEALTH COUNSELING

  • Alcohol Misuse

  • Healthy Diet

  • Obesity

  • Prevention of Sexually Transmitted

  • Infections (STIs)

  • Tobacco Use

  • Use of Aspirin to Prevent Cardiovascular Disease

  • Use of Folic Acid

Men Only
  • Abdominal Aortic Aneurysm Screening

Women Only

WELL WOMAN VISITS

  • Screening Mammography

  • Cervical Cancer Screening including Pap Smear

  • Osteoporosis Screening

  • Genetic Counseling and Evaluation for BRCA Testing where family history is associated with an Increased Risk

  • Human Papillomavirus (HPV) DNA Test

  • Chemoprevention of Breast Cancer

  • Domestic Violence Counseling

  • Contraception

  • Generic Prescription Contraceptives Approved by FDA and eligible under the plan.

  • Branded Prescription Contraceptives Approved by FDA and eligible under the plan ($50 MRA per prescription)

  • Over-the-Counter Contraceptives Approved by the FDA (i.e. Foam, Sponge, Female Condoms) when prescribed by a physician

PREGNANT WOMAN

  • Alcohol Misuse Screening and Counseling

  • Anemia Screening

  • Bacteriuria Screening

  • Blood Test screening for RH Incompatibility

  • Gestational Diabetes Screening

  • Hepatitis B Screening

  • Screening for Sexually Transmitted Infections (STIs), including Chlamydia, Gonorrhea and Syphilis

  • Tobacco Cessation Counseling

  • Varicella (Chickenpox)

  • Zoster

BREASTFEEDING WOMAN

  • Breastfeeding specialist/nurse practitioner with state recognized certification who is in provider network

  • Breastfeeding support and counseling by a trained in-network provider while you are pregnant and/or after you've given birth

  • Manual Breast Pump

Please see the limitations under Medical (Preventative Care Only) below that pertains to the Summary of Eligible Wellness & Preventative Services.

Eligible Services for Children & Adolescents

WELL CHILD EXAMS

  • History

  • Physical Exam

  • Measurements (Height, Weight & Body Mass Index)

  • Vision Acuity Test

  • Developmental & Behavioral Assessments

  • Oral Health Assessment

  • Anticipatory Guidance

SCREENINGS

  • Hearing Loss, Hypothyroidism, Sickle Cell Disease

  • Phenylketonuria (PKU) in Newborns

  • Hematocrit or Hemoglobin Screening

  • Obesity Screening

  • Lead Screening

  • Dyslipidemia Screening for Children at Higher Risk of Lipid Disorder

  • Tuberculin Testing

  • Depression Screening

  • HIV Screening

  • Cervical Dysplasia Screening

IMMUNIZATIONS

  • Diphtheria, Tetanus, Pertussis

  • Hemophilus Influenza Type B

  • Hepatitis A & B

  • Human Papillomavirus (HPV)

  • Influenza (Flu)

  • Measles, Mumps, Rubella

  • Meningococcal

  • Pneumococcal (Pneumonia)

  • Inactivated Poliovirus

  • Rotavirus

  • Varicella (Chickenpox)

PREVENTATIVE TREATMENTS

  • Gonorrhea Preventative Medication for Eyes of All Newborns

 
 
 
 

Medical (Preventative Care Only) Limitations

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Medical (Preventative Care Only) Ineligible Services:

  1. Injury or self-inflicted bodily harm

  2. Sickness or disease

  3. Preventative health services not included under ACA

  4. Preventative health services rendered outside of the United States

  5. Preventative health services that are performed by a person who is related to the member as a spouse, parent, child, brother or sister, whether the relationship exists by virtue of 'blood' or 'in law.'

 
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MDLIVE

®

The MDLIVE® program utilizes a network of state licensed primary treating physicians, providing cross coverage consultations 24 hours a day, 7 days a week, and 365 days a year at no cost to the member.

The network physicians diagnose routine, non-emergency, medical problems via telephone or video consult, as well as recommend treatment and prescribe medication, when necessary.

MDLIVE® Uses

  • Fevers/Coughs/Sore Throats

  • Nasal Congestion

  • Acute Cystitis (Bladder Infections)

  • Diabetes

  • Allergies

  • Urinary Tract Infections (Adult Females 18+)

  • Pharyngitis

  • Sinusitis

  • Weight Control

  • Anxiety

  • High Blood Pressure

  • Constipation

  • Diarrhea

  • Ear Problems

  • Insect Bites

  • Rash

  • Pink Eye

  • Vomiting

  • Respiratory Problems

  • Prescription Refill (short-term only)

Our Advantages

  • No age limits for all household family members

  • No medical restrictions

  • No limit consultations per family

  • Doctors available nationwide

  • Doctors will return your call within 10-15 minutes

  • Consult by phone or video

  • No language barriers choose, your language preference

  • Choose the gender of your Doctor

  • Schedule your appointment by phone or via the web

  • Doctor On Call – 24 hour service; consult with the next available Doctor.

 

PARAMOUNT Rx

Pharmacy discounts ranging from 10% to 75%. You never have to skip taking your medications again!

Our pharmacy program boasts the largest pharmacy discount network in the country with well over 54,000 participating pharmacies including just about every major pharmacy chain from CVS to Walgreens. Our pharmacies are contracted to deliver some of the largest discounts in the industry. Unlike most discount plans, your prescription plan provides discounts on most FDA–approved prescription drugs. There are no limited drug lists, gimmicks, or excuses.

  • Unlimited use

  • Immediate activation

  • No enrollment requirements or restrictions

  • No forms to fill out

  • Generic substitution when allowed by prescribing physician

  • 24–hour help desk for pharmacies

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