Summary of Benefits and Coverage:
What it Covers and Costs

Vytra | Vytra with Rx

Benefits Summary: Vytra
Medical Care Your In-Network Cost
PCP office visit $5 copay
Specialist office visit $5 copay
Diagnostic lab/X-ray $0
Routine physical exam $5 copay
Well child care $0
Outpatient mental health $5 copay
Urgent care $5 copay
Ambulatory surgery $0
Ambulance $0
Inpatient care $0
Anesthesia $0
Emergency room $25 copay (waived if admitted)
Durable medical equipment $0

Additional Riders

You can add the following through a payroll deduction:

Prescription drugs (for generic and brand drugs from network retail drug stores and home delivery service)