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Makina - NDTMACo-Pay’s Preventive and Wellness: $0 Physician Service: Primary Care $30, Specialty $50 Urgent Care & ER: $50, $250 Lab Service $50 Telemedicine: $0

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Page 1: Makina - NDTMACo-Pay’s Preventive and Wellness: $0 Physician Service: Primary Care $30, Specialty $50 Urgent Care & ER: $50, $250 Lab Service $50 Telemedicine: $0
Page 2: Makina - NDTMACo-Pay’s Preventive and Wellness: $0 Physician Service: Primary Care $30, Specialty $50 Urgent Care & ER: $50, $250 Lab Service $50 Telemedicine: $0
Page 3: Makina - NDTMACo-Pay’s Preventive and Wellness: $0 Physician Service: Primary Care $30, Specialty $50 Urgent Care & ER: $50, $250 Lab Service $50 Telemedicine: $0
Page 4: Makina - NDTMACo-Pay’s Preventive and Wellness: $0 Physician Service: Primary Care $30, Specialty $50 Urgent Care & ER: $50, $250 Lab Service $50 Telemedicine: $0
Page 5: Makina - NDTMACo-Pay’s Preventive and Wellness: $0 Physician Service: Primary Care $30, Specialty $50 Urgent Care & ER: $50, $250 Lab Service $50 Telemedicine: $0

Co-Pay’sPreventive and Wellness: $0

Physician Service: Primary Care $30, Specialty $50

Urgent Care & ER: $50, $250

Lab Service $50

Telemedicine: $0

SOB

Deductible

$1,000 Individual$2,500 Family

$3,000 Max-Individual$5,000 Max-Family

80/20 Co-Insurance

SOB

Rx

Preventive Meds $0

Generic Meds $10

Name Brand & Specialty Meds @ Discounted Rate

SOB

Page 9: Makina - NDTMACo-Pay’s Preventive and Wellness: $0 Physician Service: Primary Care $30, Specialty $50 Urgent Care & ER: $50, $250 Lab Service $50 Telemedicine: $0
Page 10: Makina - NDTMACo-Pay’s Preventive and Wellness: $0 Physician Service: Primary Care $30, Specialty $50 Urgent Care & ER: $50, $250 Lab Service $50 Telemedicine: $0