Medical

Here’s a summary of services for the two limited medical plan options underwritten by Nationwide Life Insurance Company: Standard or Premium. The plans include the AWP Value Rx, First Health Network and Teladoc, which are provided by separate vendors. All benefits pay on a calendar year basis per person, unless stated otherwise. These plans do not qualify as minimum essential coverage under the Affordable Care Act (ACA).

Limited Medical Benefits	Standard Plan	Preferred Plan
Physician's Office	$50 per day; 6 days per year	$90 per day; 6 days per year
Out-patient Diagnostic Lab	$50 per testing day; 3 days per year	$75 per testing day; 3 days per year
Out-patient Diagnostic X-Ray	$50 per testing day; 3 days per year	$125 per testing day; 3 days per year
Out-patient Diagnostic Advanced Studies	$100 per testing day; 3 days per year	$200 per testing day; 3 days per year
Preventive Care	$50 per day; 1 day per year	$100 per day; 1 day per year
Emergency Room Sickness	$100 per day; 2 days per year	$100 per day; 2 days per year
Surgical Indemnity Benefit - Daily In-patient Surgical - Daily Out-patient Surgical - Daily Out-patient Minor - Out-patient Benefit Maximum	N/A	$500 per day, 1 day per year $250 per day $50 per day 1 day per year
Anesthesia	N/A	30% of Surgucal Benefit
Hospital Admission	N/A	$300 lump sum per confinement
Daily In-Hospital Indemnity Intensive Care Until Substance Abuse Mental Illness Skilled Bursing (In-patient)	$100 per day; 500 day lifetime max $200 per day; 30 days per year $50 per day; 30 days per year $50 per day; 30 days per year $50 per day; 60 days per stay	$300 per day; 500 days lifetime max $600 per day; 30 days per year $150 per day; 30 days per year $150 per day; 30 days per year $150 per day; 60 days per stay
*Accident Medical Expense	$5,000 maximum benefit per injury	$5,000 maximum benefit per injury
*Accident Death & Dismemberment	$15,000 Employee $7,500 Spouse / $3,00 Child	$15,000 Employee $7,500 Spouse / $3,00 Child
*Teladoc	No cost access to doctors by phone or online	No cost access to doctors by phone or online
*Prescription Drugs	AWP Value Rx Discount Card	AWP Value Rx Discount Card
*First Health Network	Physician and Hospital	Physician and Hospital

^* Benefits are not underwritten by Nationwide Life Insurance Company.

• Virtual medical with Teladoc

  Teladoc is great for those times when you can't get to the doctor, like in the middle of the night, on the weekends or while traveling. It's a video chat service that gives you super convenient access to a doctor right from your computer, phone or tablet. When you log on or call, you'll talk with a board certified, state licensed doctor. You'll pay $0 per visit. And if you need a prescription, your Teladoc doctor can write one for you.

  The doctors treat non-emergency conditions, like bronchitis, allergies, ear infections, the flu and a lot more. Learn more and sign up by visiting Teladoc or call 1-800-Teladoc (835-2362).

• Your prescription drug benefits

  The AWP Value Rx program is designed to provide substantial savings on your prescription drug expenses. This plan will help you identify affordable generic and brand name drugs by therapeutic class.

  • Select generic and brand name drugs available for $10, $20, $50 or less

  • Generic and brand name drugs for which a discounted price has been negotiated

  • Over 58,000 participating pharmacies nationwide

  • No maximum annual benefit, deductibles or claims forms

  • To view drug prices or locate a pharmacy, visit AWPValueRx.com

• Network benefits

  Members have access to the First Health Network, which provides savings on Physician and Hospital services. By visiting a First Health provider, you can reduce your out-of-pocket expenses.

  • Over 490,000 provider locations across the country

  • Network providers submit claims for you to simplify the claim process

  • To locate a provider, visit First Health