ARHealthNetworks provides coverage for those services you need and use the most. Unlike traditional health benefit coverage, ARHealthNetworks includes a limited package of benefits, including:

Every 12 months, ARHealthNetworks will cover the following:

• 7 Inpatient Days Per Year
• 2 Major Outpatient Services Per Year, including emergency room and major services performed in the office.
• 6 Physician Office Visits Per Year
• Two Prescriptions Per Month
• Maximum Annual Benefit of $100,000
• Renewable each 12 months

Deductible and Co-Insurance for ARHealthNetworks:

• $100 annual deductible (does not apply to office visits & Rx)
• After deductible, 15% co-insurance will be required
• $1,000 maximum out of pocket annually, including deductible
• NovaSys Health providers must be used for benefits to be paid (including ER)
• Ongoing discounts apply after benefits are exhausted

Pharmacy Benefits for ARHealthNetworks:

• Two monthly prescriptions
• Subject to Co-Pay (but not deductible)
• $5 Generic
• $15 Brand Formulary
• $30 Brand Non-Formulary
• Program administered by Express Scripts
• Wide choice of pharmacies (no mail order)

Additional Features for ARHealthNetworks:

• No medical underwriting
• No one can be turned down for coverage for existing medical issues
• No waiting period for initial enrollment
• Benefits begin on the first day the insurance becomes effective, usually the first of the month after the member signs their forms.

Service	Coverage Limits	Prior Authorization	Deductible	Co-Insurance
Allergy Testing and Treatment	Once Visit Counts as One of a Maximum of 6 Physician Services Annually	No Notice Required	None	15% of Allowed Charges
Ambulance (emergency only)	Not Covered	N/A	N/A	N/A
Ambulatory Surgical Center	One Visit Counts as One of a Maximum of 2 Outpatient Services Annually	Notice Required	Applied	15% of Allowed Charges
Chiropractor	Once Visit Counts as One of a Maximum of 6 Physician Services Annually	No Notice Required	None	15% of Allowed Charges
Dental Care	Not Covered	N/A	N/A	N/A
Emergency Room Services	One Visit Counts as One of a Maximum of 2 Outpatient Services Annually	Notice Required	Applied	15% of Allowed Charges
Home Health	Not Covered	N/A	N/A	N/A
Immunizations	Covered as a Part of Physician Services Visit	No Notice Required	None	15% of Allowed Charges
Inpatient Hospital	Covered up to seven days anually	Notice Required	Applied	15% of Allowed Charges
Inpatient Mental or Behavioral Health Hospital	Covered up to seven days anually	Notice Required	Applied	15% of Allowed Charges
Laboratory And Xray	Included as part of a covered Physician Services Visit or Outpatient or Inpatient Services Only	No Notice Required	None	15% of Allowed Charges
Medical Supplies	Included as part of a covered Inpatient or Outpatient Services or as the result of a Physician Visit	No Notice Required	Applied	15% of Allowed Charges
Nurse Midwife	One Visit Counts as One of a Maximum of 6 Physician Services Annually. Midwives must work under the direction of a participating plan physician.	No Notice Required	None	15% of Allowed Charges
Outpatient Mental and Behavioral Health	One Visit Counts as One of a Maximum of 2 Outpatient Services Annually	Notice Required	Applied	15% of Allowed Charges
Physical Therapy	One Visit Counts as One of a Maximum of 6 Physician Services Annually	No Notice Required	None	15% of Allowed Charges
Physician Services	One Visit Counts as One of a Maximum of 6 Physician Services Annually	No Notice Required	None	15% of Allowed Charges
Podiatry	Once Visit Counts as One of a Maximum of 6 Physician Services Annually	No Notice Required	None	15% of Allowed Charges
Prescription Drugs	Maximum of Two Prescriptions per Month Per Year. Mail order prescriptions are not covered.	No Notice Required	None	Copays $5 Generic/$15 Brand Preferred/$30 Non Brand Non-Preferred
Preventative Health Screenings	Covered as a Part of Physician Services Visit or Outpatient Services	No Notice Required	None	15% of Allowed Charges
Speech Therapy	One Visit Counts as One of a Maximum of 6 Physician Services Annually	No Notice Required	None	15% of Allowed Charges
Vision Care	Glasses and Contacts are Not Covered. Vision Services related to Medical Issues that are non-corrective in nature are covered	No Notice Required	None	15% of Allowed Charges