Services + Costs
JRT has 3 benefit tiers.
Vital Care will send your claims to HMA and HMA will process them based on the criteria below. As always, if you have met your max out of pocket amount, the JRT Insurance Plan will cover your services at 100%.
Summary of Services Billed by Benefit Tier
Tier 3 = Buy-up Plan
- Office Visits: No Copay. Paid at 100%. Deductible waived.
- Urgent Care Visit: No Copay. Paid at 100%. Deductible waived.
- Flu Shots/Immunizations: Paid at 100%. Deductible waived.
- COVID-19 Testing/Vaccines: Paid at 100%. Deductible waived.
- X-rays: Paid at 80%. Deductible waived.
- Ultrasounds: Paid at 80%. Deductible waived.
- CT Scans: Paid at 80% after deductible is met.
Tier 2 = Mid Plan
- Office Visits: No Copay. Paid at 100%. Deductible waived.
- Urgent Care Visit: No Copay. Paid at 100%. Deductible waived.
- Flu Shots/Immunizations: Paid at 100%. Deductible waived.
- COVID-19 Testing/Vaccines: Paid at 100%. Deductible waived.
- X-rays: Paid at 70%. Deductible waived.
- Ultrasounds: Paid at 70%. Deductible waived.
- CT Scans: Paid at 70% after deductible is met.
Tier 1 = HDHP Plan
- Office Visits: Paid at 80% after deductible is met.
- Urgent Care Visit: Paid at 80% after deductible is met.
- Flu Shots/Immunizations: Paid at 100%. Deductible waived.
- COVID-19 Testing/Vaccines: Paid at 100%. Deductible waived.
- X-rays: Paid at 80%. Deductible waived.
- Ultrasounds: Paid at 80%. Deductible waived.
- CT Scans: Paid at 80% after deductible is met.
Services + Costs Summary
Vital
Care
Buy-up
Plan
Mid
Plan
HDHP
Plan
$198.04
$337.28
$415.54
$239.92
$505.19
$149.20
$179.26
$207.67
$178.36
$185.43
$227.12
$181.61
$212.12
$59.40
$101.18
$124.66
$71.98
$151.56
$44.76
$53.78
$62.30
$53.51
$55.63
$68.14
$54.48
$63.64
Meet Deductible then 80%
Meet Deductible then 80%
Meet Deductible then 80%
Meet Deductible then 80%
Meet Deductible then 80%
Meet Deductible then 80%
Meet Deductible then 80%
Meet Deductible then 80%
Meet Deductible then 80%
Meet Deductible then 80%
Meet Deductible then 80%
Meet Deductible then 80%
Meet Deductible then 80%
$39.60
$67.46
$83.11
$47.98
$101.04
$29.84
$35.85
$41.53
$35.67
$37.09
$45.42
$36.32
$42.42
Drainage of skin abscess
Drainage of skin abscess, complicated or multiple
Drainage of pilonidal cyst
Incision and removal of foreign body, subcutaneous tissues; simple
Excision, benign lesion including margins, except skin tag, trunk, arms or legs
Simple repair of superficial wounds to the scalp, neck, axillae, external genitalia, trunk, and/or extremities (including the hands and feet), 2.5 cm or less in size
Superficial wounds to the scalp, neck, axillae, external genitalia, trunk, and/or extremities (including the hands and feet), 2.6 to 7.5 cm in size
Simple repair of superficial wounds to the scalp, neck, axillae, external genitalia, trunk, and/or extremities (including the hands and feet), 7.6 to 12.5 cm in size.
Simple repair of superficial wounds to the face, ears, eyelids, nose, lips, and/or mucous membranes, 2.5 cm or less in size
Simple repair of superficial wounds to the face, ears, eyelids, nose, lips and/or mucous membranes, 2.6 to 5.0 cm in size
Simple repair of superficial wounds to the face, ears, eyelids, nose, lips, and/or mucous membranes, 5.1 to 7.5 cm in size
Destruction of benign lesion, 1-14
Destruction of benign lesion, 15+