Tonik has a $5000 calender-year deductible. You have to satisfy the deductible first before Anthem will pay for the majority of all covered medical service.
There are 6 areas under Anthem Tonik
of Colorado where you are not required to pay the deductible before receiving covered services.
1) Office visits. You just pay $20 for the first 4 visits with no deductible required. Specialist such as OBGYN and Dermatologist count as a office visit while dental visits do not (See below for dental info). If you go to the doctor more than 4 times in one year, your 5th and subsequent visits will require that you pay the doctors negotiated rate for a visit. This fee will go towards satisfying your deductible.
2) Emergency room visits: You just pay $100 copay with no deductible required.
3) Generic Drugs: You just pay $10 copay with no deductible required.
4) Ambulance Services: $100 copayment per day for ground and/or
air ambulance services, not subject to deductible.
5) Preventive Dental: No copay or deductible required. This includes initial dental x-rays, check-ups, teeth cleaning. If you have a cavity then you pay $25 dollars and Anthem Blue Cross pays 80% of the filling and you pay 20%
6) Vision: Vision does not require a copay or deductible. Tonik will pay $50 for routine eye exam, regular glasses, or contact lenses. Want more? Tonik will also cover up to $100 for your basic frames and lenses or $80 for the contacts.
Remember the copays above do not go toward your deductible.
For all other benefits, such as labwork, xrays, inpatient and outpatient operations, you are required to first pay towards your deductible before Tonik contributes to covered services. Once your annual deductible is met, you are not required to pay anything more for covered services and Tonik responsible for all covered medical services fees for the rest of the calendar year
Feel free to search our FAQs for more information.