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La Nueva Frontera Plan Option
A unique plan design for employees who choose to receive their primary benefits in Mexico.
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BENEFITS |
Mexico |
California |
Lifetime Maximum Coverage Amount |
$5,000,000 |
Calendar Year Maximum |
None |
$100,000 |
Calendar Year Deductible (individual/family) |
None |
$1,000 |
Max Out of Pocket |
Copays+ $ over Benefit Limits |
$3500 + copays, deductible and $ over Benefit Limits |
Doctor's Office Visit |
Primary Care Physician |
$5 copay |
$10 copay
4 max per year combined with Specialty |
Specialty Care Physician |
$5 copay |
$20 copay
4 max per year combined with Primary |
X-Ray |
100%
$1000 max/calendar year |
80%
$400 max/calendar year |
Lab Fees |
100%
$750 max/calendar year |
80%
$400 max/calendar year |
Inpatient Physical Therapy & Rehab |
$5 copay
$1000 max/calendar year |
Inpatient ONLY - Limit 4 visits per calendar year - combined with Primary & Specialty visits |
Emergency Care |
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$100 copay,
then 80%
(deductible applies)
copay waived if hospitalized
Must be life threatening or urgent only. |
Hospital |
Room and Board |
100% |
80% |
In Hospital Xray & Lab |
100% |
80% |
Hospital Extras |
100% |
80% |
Intensive Care |
100% |
80% |
Cardiovascular Disorder |
100% |
80% |
Immune System Disorder |
100% |
80% |
Hearing & Eye Exam
1 per calendar year |
$5 copay |
Not covered |
Durable Medical Equipment Coverage: |
100%
$500 max/calendar year |
Not covered |
Prescription Drugs: |
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None |
None |
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$5 |
$5 |
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$5 |
Not covered |
last updated: 7.31.07sje
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