其他資訊
| 會員保費 | $0 |
|---|---|
| B 部分保費預付折扣 | $105 (San Diego, San Bernardino, & Riverside Counties), $110 (Los Angeles & Orange Counties) |
| 自付額 | $0 |
| 自付費用上限 | $2,900 |
| Inpatient Hospital Stay** | $0 copay for days 6-90, $100 copay for days 1-5 |
| 門診住院 | 每次就診的共付額為 $75 |
| 醫生看診 | 每次就診的定額手續費為 $0 |
| 專科醫生看診 | 每次就診的定額手續費為 $5 |
| 急救照護 | $125 copay per visit |
| 緊急照護 | 每次就診的定額手續費為 $0 |
| 實驗室 | X 光 | 定額手續費 $0 |
| 助聽器承保 | 助聽器 | $0 Copay, $600 per ear, per year |
| 牙科承保 | $200 per quarter, with rollover ($800 annually) |
| 例行視力與眼鏡用品承保 | $0 copay, $200 annually |
| Transportation (Non-Emergency)* | $0 Copay for 16 one-way trips per year, 30 mile radius |
| 彈性健康及福祉津貼 | $50 per quarter, no rollover ($200 annually) |
| 針灸 | $0 copay, $1,000 Max Allowance (unlimited visits) |
| 中醫保健治療 | 每年最多 12 次服務，定額手續費為 $0 |
| 全球緊急承保範圍 | Up to $55,000 annual limit |
| 處方藥物承保（D 部分） | Included |
| Prescription Drug Deductible (Part D)* | $0 |
