Overview
VitalCare includes the broadest range of healthcare services available among the plan options.
In addition to preventive care, virtual care, and prescription benefits, VitalCare includes primary care visits, specialist visits, urgent care, laboratory services, and X-rays with defined copays.
This means many common healthcare services can be accessed with a known out-of-pocket cost at the time of care.
What's Included With VitalCare?
VitalCare includes:
Preventive Care
Primary Care Visits
Specialist Visits
Urgent Care Visits
Laboratory Services & X-Rays
Prescription Drug Coverage
Virtual Urgent Care
Virtual Behavioral Health
Preventive Care Coverage
Preventive care services are covered when received from participating providers. These services are designed to help identify health concerns early and support overall wellness.
Examples include:
- Annual wellness visits
- Preventive screenings
- Immunizations and vaccines
- Well-woman visits
- Well-child visits
- Recommended cancer screenings
Preventive care is included in all available plans.
Primary Care Visits
VitalCare includes visits with a primary care physician.
Your Cost
$25 Copay Per Visit
Primary care physicians can help with:
- Routine healthcare needs
- Minor illnesses
- Preventive care follow-up
- Prescription management
- Ongoing health concerns
Specialist Visits
VitalCare includes access to specialist care.
Your Cost
$25 Copay Per Visit
Examples of specialists include:
- Cardiologists
- Dermatologists
- Orthopedic specialists
- Gastroenterologists
- Pulmonologists
- Endocrinologists
Unlike FlexCare, which provides a network discount for specialist visits, VitalCare provides a defined copay, making costs easier to predict before receiving care.
Urgent Care Visits
VitalCare includes coverage for in-person urgent care visits.
Your Cost
$50 Copay Per Visit
Urgent care may be appropriate for:
- Flu symptoms
- Ear infections
- Minor injuries
- Sprains
- Minor burns
- Stitches
- Non-emergency illnesses
Laboratory Services and X-Rays
VitalCare includes laboratory services and standard X-rays.
Your Cost
$50 Copay Per Visit
Examples include:
- Blood tests
- Diagnostic laboratory work
- Standard X-rays
- Routine diagnostic testing
Like specialist visits, VitalCare provides a defined copay rather than a network discount.
Important Note
Advanced imaging such as MRI scans, CT scans, PET scans, and ultrasounds are generally not covered under the plan.
Prescription Drug Coverage
VitalCare includes prescription drug benefits through the PureRx program.
Prescription Copays
| Drug Tier | Member Cost |
|---|---|
| Tier 1 | $15 |
| Tier 2 | $30 |
| Tier 3 | $50 |
| Tier 4 | $75 |
Covered medications are determined by the plan formulary.
Virtual Urgent Care
VitalCare includes unlimited access to virtual urgent care through Recuro.
Your Cost
$0 Copay
Members can connect with licensed healthcare providers through:
- Video visits
- Phone visits
- Secure messaging
Available 24 hours a day, 7 days a week.
Common Conditions Treated
- Colds and flu
- Allergies
- Rashes
- Respiratory infections
- Gastrointestinal issues
- UTIs
When medically appropriate, prescriptions can be sent directly to your pharmacy.
Virtual Behavioral Health
VitalCare includes virtual behavioral health counseling through Recuro.
Your Cost
$0 Copay
Members can schedule appointments with licensed counselors for support with:
- Anxiety
- Depression
- Stress management
- Grief and loss
- Relationship concerns
- Anger management
Psychiatric services may be available at an additional cost.
Services Generally Not Covered
Although VitalCare includes the broadest range of routine healthcare services, some services remain excluded.
Examples generally include:
Hospital Services
- Hospital admissions
- Inpatient care
- Observation stays
Emergency Services
- Emergency room visits
- Ambulance transportation
Major Procedures
- Surgery
- Transplants
Advanced Imaging
- MRI scans
- CT scans
- PET scans
- Ultrasounds
Other Services
- Chiropractic care
- Durable medical equipment
- Home healthcare
- Long-term care
These services are generally not covered under the VitalCare plan.
How To Access Your Benefits
Find A Provider
Use the PHCS network through MultiPlan to locate participating providers.
Access Virtual Care
Virtual Urgent Care and Virtual Behavioral Health services can be accessed through:
- The HealthWallet mobile app
- Recuro Health
Fill Prescriptions
Present your ID card at participating pharmacies to access your prescription benefits.
Quick Summary
Included
✓ Preventive care
✓ Primary care visits ($25 copay)
✓ Specialist visits ($25 copay)
✓ Urgent care visits ($50 copay)
✓ Laboratory services ($50 copay)
✓ X-rays ($50 copay)
✓ Prescription drug coverage
✓ Virtual urgent care ($0 copay)
✓ Virtual behavioral health ($0 copay)
Generally Not Included
✗ Hospital services
✗ Emergency room visits
✗ Ambulance services
✗ Surgery
✗ MRI scans
✗ CT scans
✗ PET scans
VitalCare includes access to the widest range of routine healthcare services available among the plan options, with defined copays for many commonly used healthcare services.