What does ARHealthNetworks cover?

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-coverage for ARHealthNetworks
  • $100 annual deductible (does not apply to office visits & Rx)
  • After deductible, 15% co-coverage 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 immediately

Detailed Information

Service Coverage Limits Prior Authorization Deductible Co-Insurance
Allergy Testing and Treatment Not Covered N/A N/A N/A
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 Not Covered N/A N/A N/A
Dental Care Not Covered N/A N/A N/A
Durable Medical Equipment Included as a Part of Inpatient or Outpatient Services or as the result of a Physician Visit No Notice Required Applied 15% of Allowed Charges
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 Not Covered N/A N/A N/A
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

All services must be delivered by a NovaSys Health network provider. Emergency Services must be delivered within the NovaSys Health Network. The above list is not inclusive of all services. Please refer to the benefit plan document for a complete listing of covered and excluded services.

The ARHealthNetworks Service Plan Document



    
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