Copay 3500

PHCS / Multiplan Network

The Copay 3500 plan is a major medical PPO plan that uses the nationwide PHCS/Multiplan network, giving you flat copays for everyday doctor visits so you know your costs upfront. It's a solid fit for working adults who want predictable out-of-pocket costs for routine care and are comfortable with a $3,500 deductible before coverage kicks in for hospital and surgical services. This plan also includes a $20,000 Humana life insurance benefit and prescription drug coverage with no separate drug deductible.

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Monthly premiums

member_only: $799.45/mo
child: $1,399.44/mo
spouse: $1,431.81/mo
family: $2,055.61/mo

The Copay 3500 is a major medical PPO plan built around straightforward copays for the care you use most often. Primary care visits cost $40, specialist visits are $75, and urgent care is $90 — all without needing a referral. Telemedicine visits are $0, making it easy to get quick care at no cost. Preventive care such as annual wellness visits and screenings is also covered at no charge when you use an in-network provider. These copays apply right away, before you meet any deductible, so routine care stays affordable from day one. For bigger medical needs — like hospital stays, outpatient surgery, imaging, or emergency room visits — the plan works differently. You'll first need to meet a $3,500 individual deductible for in-network services, after which the plan pays 80% and you pay 20% coinsurance. Your total in-network out-of-pocket maximum is $7,350 per individual, which caps what you can spend in a year. Lab work and X-rays come with a helpful first-dollar benefit: the plan covers 100% of the first $500 combined for outpatient lab, radiology, and scans before your deductible applies. Advanced imaging like CT scans and MRIs carries a $300 copay. Keep in mind that most hospital and surgical services require prior authorization — if you skip this step, your benefits can be reduced by 50%, so it's important to call ahead. Prescription coverage is included with no separate deductible. Preventive generic drugs are $0, non-preventive generics are $20, preferred brand-name drugs are $65, non-preferred brands are $95, and specialty drugs are $200. All prescriptions must be filled at participating pharmacies such as CVS, Walgreens, or Walmart; non-participating pharmacies are not covered. Mental health, behavioral health, and pregnancy are also covered under this plan, giving you broad protection across major life events. As a bonus, the plan includes $20,000 in Humana life insurance for the primary member. This plan is best suited for working adults who want low, predictable costs for routine and preventive care and can manage a moderate deductible if a serious illness or hospital stay occurs. Because this plan requires applicants to be actively working and is not guaranteed issue, it may not be available to everyone. Out-of-network care is significantly more expensive — you'd face a $7,500 deductible and 50% coinsurance — so staying in the PHCS/Multiplan network is key to keeping costs manageable. If you expect frequent specialist visits or plan to have a baby, review the coverage examples carefully to understand how your costs could add up over the year.

Plan details

Deductible (Individual): $3,500
Deductible (Family): $7,000
Out-of-Pocket Max (Individual): $7,350
Out-of-Pocket Max (Family): $14,700
Coinsurance (In-Network): 20%
Primary Care Copay: $40
Specialist Copay: $75
Urgent Care Copay: $90

Benefits

Deductible
$3,500 / $7,000
OON: $7,500 / $15,000
Max Out of Pocket
$7,350 / $14,700
OON: $17,500 / $35,000
Copay
$40 / $75 / $90
PCP / Specialist / Urgent Care
Coinsurance
20% after deductible
Rx Coverage
$0 / $20 / $65 / $95 / $200
Preventive / Generic / Preferred / Non-Preferred / Specialty
Pregnancy
Covered
Mental Health
Covered
Inpatient & outpatient — 20% after deductible
Life Insurance
$20,000 Humana
Primary Member Only
Work Requirement
Must be working

Copay 3500

Monthly premiums

Plan details

Benefits

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