Elite Health USA

Elite Health USA is a copay-based plan designed for generally healthy individuals who want affordable access to routine doctor visits, prescriptions, and basic urgent and emergency care. It works best for people who rarely need hospitalization or complex procedures, since many advanced services are not covered. This plan includes telemedicine at no cost and a broad formulary for common generic medications.

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Monthly premiums

Member: $438.38/mo
Member & Spouse: $695.64/mo
Member & Children: $712.17/mo
Member & Family: $1,002.13/mo

Elite Health USA is a Minimum Essential Coverage (MEC) plan that focuses on everyday healthcare needs — things like primary care visits, specialist appointments, lab work, urgent care, and prescriptions. You'll pay a $50 copay to see your primary care doctor and $100 to see a specialist. Urgent care visits cost $200, and lab work runs $60 to $100 per visit depending on the test or service. Importantly, lab work and radiology are not covered when performed at a hospital — you'll need to use a free-standing or outpatient facility for those services. Telemedicine is included at no cost, and preventive care and wellness visits are also covered at no charge. The plan has a $2,500 individual deductible ($5,000 for a family) that applies to some services. Emergency room visits require a $500 copay plus 50% coinsurance after the deductible, and are limited to one visit per calendar year. Hospital room and board is similarly limited — covered up to 3 days per year at a $500 copay plus 50% coinsurance, covering room and board only. There is no out-of-pocket maximum listed for this plan, which means your costs are not capped — a significant consideration if you face a serious illness or injury. Prescription coverage is provided through the VaultRx Plus formulary. Preventive generic medications (Tier 1) are covered at $0. Other medications are covered based on tier: Tier 2 at $15 or less, Tier 3 at $30 or less, Tier 4 at $60 or less, and Tier 5 for drugs over $60. However, prescription benefits for Tiers 2 through 5 are subject to a combined monthly maximum of $250 per individual and $500 per family — once you hit that cap, you'll pay 100% out of pocket for the rest of the month. There are important gaps to be aware of before enrolling. This plan does not cover outpatient surgery, inpatient surgery or surgical professional fees, ambulance transport, maternity professional services, home health care, rehabilitation, chemotherapy or radiation, chemical dependency treatment, or durable medical equipment. It is best suited for individuals who are generally healthy, primarily need routine and preventive care, and are comfortable with the risk of significant out-of-pocket costs if a serious medical event occurs. Anyone with ongoing complex health needs, expected surgery, or a pregnancy should carefully evaluate whether this plan provides sufficient coverage.

Benefits

Deductible
$2,500 / $5,000
Copay
$50 / $100 / $200
PCP / Specialist / Urgent Care
Coinsurance
50% after deductible
Doctor Visits
PCP/Unlimited, Specialist/May be subject to limitations
Rx Coverage
$0 / ≤$15 / ≤$30 / ≤$40
T1 Preventive / T2 Generic / T3 Preferred / T4 Non-Preferred
Hospitalization
$500 copay
3 days/yr
ER
$500 copay
1 visit/yr
Lab Work
$60-$100 copay per visit depending on test/service. NOT covered at a hospital.
Imaging
$500 copay
CT/MRI/MRA/PET · basic radiology $60–$100 range

Elite Health USA

Monthly premiums

Benefits

Plan documents

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