Classic Choice

About the Plan

Classic Choice is for those who are looking for a health plan with preventative health, dental and vision benefits. Get the trifecta—health, dental and vision—under one health plan. Available for individuals only.

Farm Bureau Health Plans uses UnitedHealthcare Choice Plus Network. Please keep in mind that in-network payments are based on negotiated fees. If an out-of-network provider is used, the member’s liability will increase significantly.

Resources

Provider Network 

Schedule of Benefits

  In-Network Out-of-Network

CALENDAR YEAR DEDUCTIBLE (CYD)
Unless otherwise indicated, all benefits are subject to CYD.

Option 1: $3,000

Option 2: $6,000

OUT-OF-POCKET MAXIMUM (OOP)
Once the OOP maximum is met, benefits are provided at 100% for a member for the remainder of the calendar year. This applies to in-network provider services only. Copayments do not apply to OOP and must still be paid after OOP is met.

Option 1
$10,000 

Option 2
$20,000 
Unlimited

LIFETIME BENEFIT MAXIMUM

Unlimited
  In-Network Out-of-Network

OFFICE VISIT
Not subject to CYD or OOP

$40 copayment per visit

CYD/Coinsurance

TELADOC

$0 copayment per visit

No coverage

COINSURANCE
Based on the maximum allowable charges for eligible benefits.

Plan pays: 80%

Your responsibility: 20%

Plan pays: 60%

Your responsibility: 40%

PREVENTATIVE CARE BENEFITS

In-Network Out-of-Network

NO WAITING PERIOD

Plan pays 100%

Plan pays 60%

Preventative Health Exam1

0%

40%

Annual Well Woman Exam2

0%

40%

Routine Colonoscopy3

0%

40%

Annual Routine PSA4

0%

40%

EMERGENCY ROOM
Not resulting in admission

$75 deductible per visit

(in addition to CYD and Coinsurance)

PRESCRIPTION DRUG COVERAGE

Unlimited Calendar Year Maximum Per Member

Generic 30 day supply

Plan pays all but copayment

Your responsibility: $4 copayment5

Plan pays 60%

Your responsibility: 40%

Brand

 

Plan pays: 80%

Your responsibility: 20%

Plan pays 60%

Your responsibility: 40%

DENTAL - No waiting periods

Pediatric (Under Age 19)

  • Preventative services paid at 100%
  • Other eligible dental services subject to CYD and coinsurance
  • Limited orthodontic care

Age 19 and Over

  • $40 copay for preventative and restorative services
  • Maximum benefit per calendar year is $500

VISION - No waiting periods

Pediatric (Under Age 19)

  • Eye exams are covered at 100% once every calendar year
  • Eyeglass frames, eyeglass lenses or contact lenses are covered once every Calendar Year at 100% up to a maximum of $100 per Member, not subject to Deductible and Coinsurance.

Age 19 and Over

  • Eye exams are covered once every calendar year with a limit of $40
  • Eyeglass frames, eyeglass lenses or contact lenses are covered once every Calendar Year at 100% up to a maximum of $100 per Member, not subject to Deductible and Coinsurance.

FOOTNOTES

1 Preventative health exam for adults and children and related services as outlined below and performed by the physician during the preventative health exam or referred by the physician as appropriate, including:

2 Annual Well Woman Exam

  • Routine well woman preventative exam office visit
  • Cervical cancer screening
  • Screening mammography at age 40 and older, with one baseline mammogram between the ages of 35-39
  • Other USPSTF screenings with an A or B rating 
    • Pap smears
    • Bone density measurement screening

3 Colorectal cancer screening for members age 50 and older

4 Prostate cancer screening for men age 50 and older

5 Prescription copayment does not apply toward deductibles or out-of-pocket maximums.

 

Benefits will not be provided for any pre-existing condition until a member has completed a waiting period of at least 6 months. A pre-existing condition is defined in the contract as “An illness, injury, pregnancy or any other medical condition which existed at any time preceding the effective date of coverage under this contract for which: Medical advice or treatment was recommended by, or received from, a provider of health care services; or symptoms existed which would cause an ordinarily prudent person to seek diagnosis, care or treatment.”

A copayment will be applied to each office visit for the covered services performed in the office and provided and billed by a physician who is an in-network provider. The remaining charges for covered services rendered during the office visit will be paid at 100% of the maximum allowable charge. If a physician who is an out-of-network provider is utilized for covered services, benefits will be determined on the basis of a out-of-network coinsurance percentage after deductible is met.

Copayments do not apply to the following services: advanced radiological imaging, allergy testing and injections, biopsy interpretation, bone density testing, cardiac diagnostic testing, chemotherapy services, chiropractic services, complex diagnostic services, dental services except preventative and restorative for all Members age nineteen (19) and over, diagnostic services sent out, durable medical equipment, growth hormone injections, IV therapy, Lupron injections, mammography, maternity services, nerve conduction studies, neuropsychological or neurological tests, nuclear cardiology, nuclear medicine, orthotics, preventative services as indicated in contract, prosthetics, provider administered specialty pharmacy products, sleep studies, surgery performed in a physician’s office and related surgical supplies, Synagis injections, therapeutic/ rehabilitative/ habilitative services, ultrasounds and vision services. These services are subject to the terms and conditions of the contract and deductibles and coinsurance will apply except where otherwise indicated. Copayments will not be applied to the deductibles or out-of-pocket maximums.

Maternity benefits will be eligible after a member’s 6 month pre-existing waiting period is exhausted.