data/coverage_doc.txt

Plan Name: Elevate Health PPO 2025
Type: Preferred Provider Organization (PPO)

Summary:
The Elevate Health PPO Plan offers flexibility in choosing healthcare providers. Members can visit any doctor or specialist without a referral, but in-network providers offer lower out-of-pocket costs.

Key Benefits:
- Annual deductible: $1,500 individual / $3,000 family
- Out-of-pocket maximum: $6,000 individual / $12,000 family
- Primary care visits: $25 copay in-network
- Specialist visits: $50 copay in-network
- Emergency room: $250 copay
- Generic prescriptions: $10 copay
- Brand name prescriptions: $40 copay

Wellness Programs:
- Free annual physical exams
- Telehealth services with no copay
- Mental health counseling (up to 10 visits/year covered)

Covered Services:
- Preventive care (100% in-network)
- Maternity and newborn care
- Surgery and hospitalization
- Lab tests and X-rays

Exclusions:
- Cosmetic procedures
- Fertility treatments
- Long-term custodial care

Plan Name: CoreCare HMO 2025
Type: Health Maintenance Organization (HMO)

Summary:
CoreCare HMO Plan requires members to choose a Primary Care Physician (PCP) and get referrals for specialist care. This plan offers coordinated care at lower premiums.

Key Benefits:
- Annual deductible: $500 individual / $1,000 family
- Out-of-pocket maximum: $4,000 individual / $8,000 family
- Primary care visits: $15 copay
- Specialist visits: $30 copay (with referral)
- Emergency room: $200 copay
- Generic prescriptions: $5 copay
- Brand name prescriptions: $25 copay

Covered Services:
- Preventive and routine care
- Prenatal and maternity services
- Behavioral health support
- Diagnostic imaging and lab services

Exclusions:
- Out-of-network care (except emergencies)
- Cosmetic procedures
- Alternative therapies (e.g., acupuncture)

Contact Information:
For questions about coverage, contact Member Services at 1-800-555-1234.