Equilibrio
Who is eligible for this plan?
Universal is a plan for government employees, retirees without Medicare A and B coverage, and their direct and optional dependents, who during the established enrollment period join or renew their coverage.
Am I eligible for this plan?
- $12 copay for General Practitioner office visits.
- $20 copay for Specialist office visits.
- Teleconsulta Program 24/7.
- $0 copay for preventive services required by Federal Law, including services for children, women and adults.
- One pair of eyeglasses from the Preferred collection or contact lenses up to a maximum of $150 per policy year, through Ivision International participating providers.
- 40% coinsurance Oral chemotherapy.
- 40% coinsurance for respiratory therapies.
- Up to $1,000,000 per year, per member for Organ and Tissue transplant services through Major Medical coverage, subject to 20% coinsurance.
- Dental coverage for exams, cleanings, extractions, endodontics and more.
Coverage of this plan
- Hospital services
- Medical-surgical services during hospitalization
- Medical-ambulatory services
- Specialized Diagnostic Tests
- Maternity
- Services in the United States
- Pharmacy
- Dental services
- Additional benefits
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Documents Size Brochure
Promotional brochure that provides information about some of the covered benefits, such as, physicians visits, hospitalizations and the copays and/or coinsurances applicable to the services, pharmacy benefits and more.
28.7 MB Download Drug List or Formulary
Your pharmacy coverage uses a Drug List or a Formulary that offers a wide selection of treatment options.
2.3 MB Download Provider Directory
List of the Network's participating providers.
3.3 MB Download Enrollment Form
Form for new enrollment or renewal of the health plan. Instructions to complete the form are included.
886 KB Download Summary of Benefits
The Summary of Benefits and Coverage is a document created by the National Association of Insurance Commissioners (NAIC) that helps consumers understand, compare and make better choices about their health coverage.
532 KB Download Ivision Provider Directory
Ivision International's participating providers list.
73 KB Download *Documents Not available in English
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