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Alternative Plan Deductible - $0 PCP - $25 Copay Specialist - $50 Copay

Alternative Plan Deductible - $0 PCP - $25 Copay Specialist - $50 Copay Lab & Xray - $0 Copay Specialty Scans - $250 per scan Inpatient Hospital - $250 per day with $750 max per admission Outpatient Hospital - $250 Copay Emergency - $150 Copay Out-of-pocket

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Alternative Plan Deductible - $0 PCP - $25 Copay Specialist - $50 Copay

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  1. Alternative Plan • Deductible - $0 • PCP - $25 Copay • Specialist - $50 Copay • Lab & Xray - $0 Copay • Specialty Scans - $250 per scan • Inpatient Hospital - $250 per day with $750 max per admission • Outpatient Hospital - $250 Copay • Emergency - $150 Copay • Out-of-pocket maximum - Subscriber $3000 - Family $5000 Featuring Preventive Care at No Charge !

  2. Pharmacy Benefit Tier One: Generics $10 Tier Two: Brand Name $50 Tier Three: Non-Formulary $75 Includes a 30 – day Supply Pharmacy Benefit Manager: Express Script 1.866.274.1612 GlobalHealth Formulary available at www.globalhealth.com

  3. Seventh Plan Year withState of Oklahoma Service Area has grown from 6 counties to over 63 ! Check for your zip code Membership has more than quadrupled in 6 years Providers can be found on our website on the Provider Look up feature

  4. New for 2011 No copayment for Preventive Care No copayment forWell Child Visits New website Healthcare doesn’t have to be expensive…just good! Be good with GlobalHealth.

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