AMG/Liberty HealthShare Plan
Medical Services |
AMG (100% Covered) |
Liberty Healthshare Plan Shared Amount* |
Plus other Benefits (Discounted Benefits) |
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Age | 0-65 |
Hospital ChargesInpatient or Outpatient hospital treatment or surgery for a medically diagnosed condition. Specialist ServicesPhysician services for an Illness or Injury related to each medical incident. Emergency RoomEmergency room services for stabilization or initiation of treatment of a medical emergency condition provided on an outpatient basis at a Hospital, Clinic or Urgent Care Facility, including when Hospital Admission occurs within 23 hours of emergency room treatment. Prescription DrugsPrescriptions 45 days before and after each related medical incident. Chiropractic TreatmentUp to 12 visits per membership year for treatment of skeletal or musculoskeletal disease or injury. Physical TherapyUp to 20 visits per membership year for physical therapy by a licensed physical therapist. Home Health CareSkilled care services at home for up to 30 days by a Home Health Care Agency for each related medical incident provided such home care reduces the expected medical expense and replaces hospital or nursing home services. AmbulanceEmergency land or air ambulance transportation to the nearest medical facility capable of providing the medically necessary care to avoid seriously jeopardizing the Sharing Member’s life or health. Naturopathic and/or Alternative treatments |
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Co-pay | 0 | ||||
Medical Care | |||||
Annual Physical exams | |||||
Routine Office visits | |||||
Urgent Care during office hours | |||||
EKG | |||||
Urinalysis | |||||
Blood Sugar | |||||
Fecal occult blood test | |||||
PPD (skin test for tuberculosis) (One per year) | |||||
Weight Loss Management | |||||
Ear Irrigation for wax | |||||
Nebulizer Treatment with oxygen concentrator | |||||
Flu vaccine (One per year) | |||||
Pulmonary Function Test (Spirometry) | |||||
Vitamin B-12 and Allergy shot (steroid) | |||||
Vascular studies (Venous,Carotid, Peripheral duplex scans) | |||||
Allergy testing through blood test (paid seprately to the lab) | |||||
Tetanus vaccine (after injury) | |||||
Office Based surgeries | |||||
Shaving of skin lesions | |||||
Mole removal – skin biopsy | |||||
Skin Tag removal | |||||
Warts (genital, sole, hand) | |||||
I & D of abscess | |||||
Wound care with debridement | |||||
Partial or full nail removal for fungus ingrown toe nail | |||||
Fine needle aspiration (Thyroid, Breast) | |||||
Application of cast for minor non-dispalced fractures | |||||
Repair of laceration | |||||
Excision of benign skin lesions | |||||
Joint injections (steroid) | |||||
Facet joint injections | |||||
Application of splint | |||||
Tendon injections (steroid) | |||||
Trigger point injections | |||||
Gynecological Care | |||||
Gyn exam | |||||
Pap smear (One per year) | |||||
Family Planning | |||||
Pediatrics | |||||
Pediatric visits | |||||
Audiometry | |||||
Imaging | |||||
X-rays
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(Three per year) |
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Sonograms
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(Two per year) |
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Mammogram Screening (One per year) | |||||
Physical Therapy (Manhattan Only) | (10 Visits Per Year) |
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Lab Test (blood, urine, stool) | (Two per year) |
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Second opinions | |||||
Discount prescription card | |||||
Referral for discounted CT scan and MRI | |||||
Referral for discounted colonoscopy and upper endoscopy | *After unshared amount is met | ||||