Visit LimitedVisit LimitHDHPHSA-Eligible
VL 1750
$1,750 individual deductible · HSA-eligible · annual visit allowances
Schedule of benefits
What members pay on VL 1750.
Deductibles & Limits
- Deductible — Individual
- $1,750
- Deductible — Family
- $3,500
- OOP Max — Individual
- $8,500
- OOP Max — Family
- $17,000
Care & Visits
- Telemedicine (OurLiveDoc)
- $0 Copay
- PCP / Specialist (10 visits/yr combined)
- $50 (after deductible)
- Urgent Care (10 visits/yr combined)
- $50 (after deductible)
- ER (2 accident + 2 sickness/yr)
- $250 (after deductible)
- Labs (3/yr)
- $25 (after deductible)
- X-Rays (3/yr)
- $50 (after deductible)
- Advanced Imaging (3/yr)
- $200 (after deductible)
Hospital & Surgery
- Inpatient (2 ICU + 2 non-ICU/yr)
- $1,000/admission (after ded.)
- Outpatient Surgery (3/yr)
- $250/surgery (after ded.)
Pharmacy
- Generics (Retail & Mail)
- $0 Copay
- Preferred Brand / Non-Preferred
- PAP Available
What brokers should know
Annual visit allowances apply: 10 combined PCP/specialist/urgent care visits, 4 hospital admissions, 3 surgeries, 3 labs/X-rays/imaging, 4 ER visits. Best fit for younger or healthier groups. Services beyond limits are not covered under this plan.
FCHP & PHCS networks available
All plans underwritten by Benefit Re Insurance, Inc. (NAIC #17459). FCHP and PHCS national networks — over 800,000 providers. Plans effective July 1, 2026. Premiums quoted on request.
Quote VL 1750 for your group.
Premiums quoted on request — brokers can pre-qualify a group in 60 seconds with the Savings Estimator.