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Active Choice PPO Silver

2024 | 個人及家庭計劃
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計劃福利表

主要成本和特點 網路內 不在網路中
年度醫療扣除額 Column ID value for provided table ID not found!
年度藥物扣除額 Column ID value for provided table ID not found!
終身累積保障限額 Column ID value for provided table ID not found!
計劃類型 Column ID value for provided table ID not found!
專業的服務 網路內 不在網路中
家庭計劃 (諮詢及避孕服務) Column ID value for provided table ID not found! Column ID value for provided table ID not found!
主診醫生治療受傷或疾病 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
懷孕前/懷孕期間檢查 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
主診醫生治療受傷或疾病 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
專科醫生門診 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
針灸 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
物理治療 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
職業治療 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
過敏門診 (測試及治療) Column ID value for provided table ID not found! Column ID value for provided table ID not found!
其他醫療門診 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
測試 網路內 不在網路中
化驗測試 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
X-光 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
造影（CT電腦斷層掃描/PET正電子發射斷層掃描，MRI磁力共振） Column ID value for provided table ID not found! Column ID value for provided table ID not found!
門診服務 網路內 不在網路中
手術 - 設施費用（如流動手術中心） Column ID value for provided table ID not found! Column ID value for provided table ID not found!
醫生/外科手術費用 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
門診 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
終止懷孕 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
住院服務 網路內 不在網路中
設施費用（如病房） Column ID value for provided table ID not found! Column ID value for provided table ID not found!
醫生/外科醫生費用 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
分娩及所有住院服務 (醫院服務) Column ID value for provided table ID not found! Column ID value for provided table ID not found!
分娩及所有住院服務 (專業服務) Column ID value for provided table ID not found! Column ID value for provided table ID not found!
緊急健康保險 網路內 不在網路中
急症室服務 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
急症室醫生服務費用 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
急診護理 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
救護車服務 網路內 不在網路中
醫療交通服務（包括緊急及非緊急） Column ID value for provided table ID not found! Column ID value for provided table ID not found!
處方藥承保範圍 網路內 不在網路中
1等級非商標藥物（30 日藥物供應） Column ID value for provided table ID not found! Column ID value for provided table ID not found!
1等級非商標藥物（90 日藥物供應）東華醫院藥房或郵寄服務 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
2等級首選商標藥物（30 日藥物供應） Column ID value for provided table ID not found! Column ID value for provided table ID not found!
2等級首選商標藥物（90 日藥物供應）東華醫院藥房或郵寄服務 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
3等級非首選商標藥物（30 日藥物供應） Column ID value for provided table ID not found! Column ID value for provided table ID not found!
3等級非首選商標藥物（90 日藥物供應）東華醫院藥房或郵寄服務 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
4等級特殊藥物（30 日藥物供應） Column ID value for provided table ID not found! Column ID value for provided table ID not found!
4等級非首選商標藥物（90 日藥物供應）東華醫院藥房或郵寄服務 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
醫療用品和設備 網路內 不在網路中
醫療用品 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
假肢裝置 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
耐用醫療器材 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
心理健康服務 網路內 不在網路中
精神健康/行為健康科門診 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
精神健康/行為健康其它門診項目及服務 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
精神健康/行為健康住院設施費用 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
精神健康/行為健康住院專業費用 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
化學品依賴性服務 網路內 不在網路中
濫用藥物門診 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
濫用藥物其他門診設施及服務 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
濫用藥物住院服務設施 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
濫用藥物住院服務專業服務費用 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
家庭健康服務 網路內 不在網路中
家居健康護理 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
血透析/洗腎服務 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
康復性(門診)服務 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
適應訓練(門診)服務 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
專業護理院 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
寧養服務 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
寧養前諮詢 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
住院臨時護理 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
不孕症 網路內 不在網路中
不育影像檢查 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
不育藥物 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
不育化驗測試 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
不育專科門診 Column ID value for provided table ID not found! Column ID value for provided table ID not found!
人工授精（AI） Column ID value for provided table ID not found! Column ID value for provided table ID not found!
配子輸卵管內移植（GIFT） Column ID value for provided table ID not found! Column ID value for provided table ID not found!

牙科福利表

主要成本和特點 兒科
網路內 不在網路中
成人
網路內 不在網路中
每月保費 $0 (已納入計劃) $18.05 每位會員每月 (選修的)
牙科檢查
$0 自付費 不受保障
$0 自付費 不受保障
⼝腔檢查
$0 自付費 不受保障
$0 自付費 不受保障
預防 - 清洗
$0 自付費 不受保障
$0 自付費 不受保障
預防 - X光
$0 自付費 不受保障
$0 自付費 不受保障
⽛⿒密封劑
$0 自付費 不受保障
$0 自付費 不受保障
局部氟化物應用
$0 自付費 不受保障
$0 自付費 不受保障
間隙保持器 - 固定式
$0 自付費 不受保障
$0 自付費 不受保障
汞合⾦ - 單⾯
$25 不受保障
$0 自付費 不受保障
根管 - ⺽⿒
$300 不受保障
$245 不受保障
每 1/4 ⼝腔的⿒齦切除
$150 不受保障
$165 不受保障
拔⽛ - 單顆⽛⿒暴露⽛根 或
$65 不受保障
$18 不受保障
拔⽛ - 全⾻化
$160 不受保障
$80 不受保障
瓷製金屬冠
$300 不受保障
$485 不受保障
醫療所需的畸⿒矯正
$1,000 不受保障
$2,900 不受保障

視力福利表

主要成本和特點 兒童眼科保障概要 (VSP) 成人視力計劃 (VSP Plan C)
每月保費 $0 (已納入計劃) $3.54 每位會員每月 (選修的)
考試共付額 $0 , 每 12 个月 $0 , 每 12 个月
視網膜篩檢 高達 $39 , 每 12 个月 高達 $39 , 每 12 个月
處方眼鏡 $0 , 每 12 个月 $25, 每 12 个月 ($130 镜框补贴 , 超出补贴金额的部分可享八折优惠)
隱形眼鏡（代替眼鏡） $0 , 每 12 个月 最高 $60 , 每 12 个月
防紫外线 $0 , 每 12 个月 $0 , 每 12 个月
標準漸進鏡片 $0 , 每 12 个月 $55 , 每 12 个月
優質漸進鏡片 $0 , 每 12 个月 $95-$105 . 每 12 个月
客製化漸進鏡片 $0 , 每 12 个月 $150-$15 , 每 12 个月
雷射視力矯正 平均为正常价格的八五折；仅签约机构才提供折扣。 平均为正常价格的八五折或促销价格的九五折；仅签约机构才提供折扣

常見問題列表

投保加州是否提供 Active Choice PPO Silver 個人及家庭計劃？

不是。此計劃不會在投保加州交易市場上提供。

月費是如何計算的？

  • 每位家庭成員的月費是根據年齡及居住他區計算。
  • 只㈲前三名年齡最大的 21 歲以下子女會被計算入投保費用，額外的投保子女則免費。
  • 所有21歲或以上的子女的月費是根據年齡計算。

下表按年齡和居住縣列出了該計劃的每月費率。

Age San Francisco County San Mateo County
0-14$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
15$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
16$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
17$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
18$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
19$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
20$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
21$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
22$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
23$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
24$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
25$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
26$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
27$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
28$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
29$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
30$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
31$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
32$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
33$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
34$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
35$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
36$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
37$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
38$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
39$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
40$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
41$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
42$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
43$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
44$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
45$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
46$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
47$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
48$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
49$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
50$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
51$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
52$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
53$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
54$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
55$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
56$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
57$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
58$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
59$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
60$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
61$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
62$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
63$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
64+$Column ID value for provided table ID not found!$Column ID value for provided table ID not found!
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