Available to residents of Washoe County and Carson City.
The Essential Plan offers residents of Washoe County and Carson City access to our widest provider network, with a $0 monthly premium. Essential Plan members are can select a community provider as their Primary Care Provider while still enjoying priority access to Renown Health providers and facilities.
|PRIMARY CARE VISIT||$0 per visit (preferred PCP) $10 per visit (non preferred PCP)|
|SPECIALIST VISIT||$50 per visit|
|ROUTINE LAB SERVICES||$0 per visit|
|URGENTLY NEEDED CARE||$35 / $65 per visit ($0 Teladoc)|
|OVER-THE-COUNTER BENEFIT||$25 Quarter|
|DENTAL COVERAGE||Preventative Included|
|Doctors & Hospitals||Amount You Will Pay|
|Maximum Out-of-Pocket||$3,300 per year|
|Primary Care Office Visit||$0 per visit (preferred PCP) $10 per visit (non preferred PCP)|
|Specialist Office Visits||$50 per visit|
|Urgently Needed Care||$35 / $65 per visit ($0 Teladoc)|
|Routine Lab Services||$0 per visit|
|Diagnostic Tests (X-ray, CT, MRI)||$70 / $100 / $135 per visit|
|Emergency Room Care||$125 per visit|
|Ambulance Services||$325 per trip|
|Inpatient Hospital||Preferred: $300 / 5 days per period Non-Preferred: $440 / 5 days per period|
|Outpatient Hospital Services||Preferred: $300 per visit Non-Preferred: $440 per visit|
|Prescription Coverage||Amount You Will Pay for Preferred Medications|
|Coverage in the Gap||Preferred $2.50 (Tier 6) Non-preferred $8.50 (Tier 6)|
|Rx Deductible||No deductible|
|Preferred Generic (Tier 1)||Preferred $5 Non-Preferred $11|
|Non-Preferred Generic (Tier 2)||Preferred $12 Non-preferred $20|
|Preferred Brand (Tier 3)||Preferred $41 Non-preferred $47 Senior Savings $35|
|Non-Preferred Brand (Tier 4)||Preferred $94 Non-preferred $100|
|Specialty Drugs (Tier 5)||33% coinsurance|
|Select Drug (Tier 6)||Preferred $2.50 Non-preferred $8.50|
|90-day Retail / 90-day Mail Order||2.5 times 30-day / 2 times 30 day|
See all the new 2023 benefits in the Healthy Me 2023 Benefits Brochure – includes OTC Catalog and Dental Directory
Essential Plan members can choose to see any community provider including priority access to Renown Health providers and facilities.
Senior Care Plus members have two options when accessing virtual care: Renown Health virtual visits (for urgent, primary and specialty care) and Teladoc (for urgent care and dermatology).
The Essential Plan is the right option for you if your primary care physician is not a Renown provider. The Essential Plan includes the entire Senior Care Plus network of doctors and specialists, including priority access to Renown Health facilities. The Essential Plan has been enhanced in 2023 with an updated hearing benefit from NationsHearing® that includes a $0 hearing exam and a generous hearing aid benefit. NationsOTC® provides a $25 quarterly Over-the-Counter benefit with free two-day shipping. The plan also has a Preventive Dental benefit from Liberty Dental. The prescription drug coverage included in the Essential Plan is extensive, and includes select insulins at the $35 Senior Savings Program cost. Personal Assistants, who can help schedule appointments and navigate the healthcare system are included when you select a Renown Primary Care Provider (PCP). Above is a partial list of benefits and should not be construed as a complete list. Please refer to the Evidence of Coverage in the plan documents section above for a complete list of benefits. Out-Of-Network Providers: If you use an out-of-network provider, your share of the costs for your covered services may be higher. Out-of-network providers are under no obligation to treat members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost sharing that applies to out-of-network services.