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Allstate Essentials PPO $25000 Deductible Short Term Medical Plan
For those seeking a higher deductible option with meaningful protection, the Essentials PPO $25,000 plan offers coverage you can count on. With benefits extending up to $250,000 per coverage period, you’ll have financial protection for major events like hospital stays, urgent care, diagnostics, and office visits. Child immunizations are included from day one, helping families with important preventive care. While this plan does not provide coverage for prescription drugs, free annual physicals, or preexisting conditions, it does offer nationwide access through the Aetna Open Choice® PPO network. That means more choices, more flexibility, and trusted care wherever you are. With its simple structure, this plan functions like a traditional health policy — giving you peace of mind that your healthcare needs will be supported, no matter where life takes you. You can enhance your coverage with optional Recuro Health benefits, offering $0-copay virtual urgent care, behavioral health, and prescription medications. See the health questions to see if you qualify at https://www.utahavenue.com/single-post/private-health-plan-qualifications
Carrier
Allstate
2026
Plan Year
Individual and Family Deductible
An individual deductible and family deductible are key components of a private health insurance plan. The individual deductible represents the amount a single policyholder must pay out of pocket for covered medical expenses before their insurance begins to cover costs. In contrast, a family deductible encompasses the cumulative medical expenses incurred by all covered family members before the insurance kicks in for the rest of the members within the family. Once these deductibles are met, the insurance plan typically covers a percentage of the remaining medical expenses. Maximum out-of-pocket limits are the cap on the total amount a policyholder or family is required to pay in a given year for covered medical services, including deductibles and co-payments. Once this annual limit is reached, the insurance company usually covers all additional eligible expenses, providing financial protection against catastrophic healthcare costs. These components help individuals and families manage healthcare expenses while ensuring they have a safety net against excessive medical bills.
Deductible
$25,000
$75,000
Individual
Family
Maximum Out of Pocket
$32,500
Individual
Family deductible plus $7,500 per member
Family
Coinsurance After Deductible
40% after deductible
Doctor Visits
Doctor visit costs refer to the expenses you are responsible for paying directly to your healthcare provider during each visit to a doctor's office. In many private health insurance plans, individuals are required to cover the entire cost of their doctor visits until they meet their deductible, which is the predetermined amount they must pay out of pocket before their insurance starts sharing the expenses. However, even when you're responsible for the full price, if you choose an in-network healthcare provider, you often benefit from a negotiated rate that is typically lower than what you'd pay if you were uninsured or used an out-of-network provider. This negotiated rate extends to any diagnostic tests or procedures performed during the visit, helping to make healthcare more affordable while encouraging individuals to seek care from within their plan's network.
Doctor Office Visit
40% after deductible
Mental Health Visits
$0 copay with optional Recuro Health benefit
Preventative Care
Applies to Deductible/Coinsurance
Labor & Delivery
Not Covered
Emergency and Urgently Needed Services
Emergency and urgently needed services in the context of health insurance refer to medical care that is required immediately due to a life-threatening situation or when delaying care could result in serious harm. Emergency services encompass situations like severe injuries, heart attacks, or sudden illnesses that demand immediate attention. Urgently needed services involve medical conditions that require prompt care to avoid complications, even though they might not be immediately life-threatening. Health insurance plans typically cover these services, even if the provider is out of network, ensuring that individuals receive essential care regardless of the circumstances.
Urgent Care Visit
$50 access fee and coinsurance
Emergency Room Visit
$250 access fee, deductible & coinsurance
Ground Ambulance
See full summary of benefits
Coverage Period Maximum
The coverage period maximum is a critical concept in health insurance, representing the utmost limit that a health insurance company will pay for an individual's covered medical services within a specific plan term. This maximum is established to protect both the policyholder and the insurer. Once this limit is reached, the policyholder becomes responsible for all additional medical expenses, unless they renew or enroll in a new insurance plan. Understanding the coverage period maximum is essential for individuals to plan their healthcare expenses effectively, as exceeding this limit can result in substantial out-of-pocket costs. It underscores the importance of selecting a health insurance plan that aligns with one's healthcare needs and financial capacity to ensure comprehensive coverage and peace of mind.
Coverage Maximum
$250,000
Prescription Coverage
Prescription benefits are a crucial aspect of healthcare coverage, as they determine the extent to which health insurance plans will help pay for necessary medications. Many private health insurance plans do not include prescription drug coverage in their standard offerings as a way to keep premiums more affordable. However, policyholders can choose to enhance their coverage by paying a higher premium to include prescription benefits, ensuring access to vital medications while managing healthcare costs. This option allows individuals to customize their health insurance plans to their specific needs and financial situation, making it particularly valuable for those who rely on regular medications to maintain their health.
Preferred Generic Rx
$0 copay with optional Recuro Health benefit
Extra Benefits for Children
Many health insurance plans offer extra benefits for kids under 18 to ensure their well-being. These benefits often include coverage for pediatric services such as well-child visits, immunizations, vision and dental care, and preventive screenings. Additionally, some plans might provide access to specialized pediatric care and therapies, ensuring that children receive comprehensive healthcare tailored to their developmental needs. It's important to review your insurance policy to understand the specific extra benefits available for kids and their coverage details.
Children's Immunizations
First dollar benefits
Full Summary of Benefits and Helpful Links
Official documents, such as your insurance policy or Summary of Benefits and Coverage (SBC), outline the details of your coverage, including deductibles, copayments, and covered services. Provider links, often available through your insurance company's website, offer directories of in-network healthcare professionals and facilities, helping you find the right doctors and hospitals that are covered by your plan. Utilizing these resources can empower you to make informed healthcare decisions and effectively navigate your insurance coverage.
Helpful Links
Schedule a consultation with a local health insurance agent
We're here to assist you with your health insurance needs, whether you'd prefer to meet in person, virtually, or over the phone. Our team can guide you through health insurance options both on and off the Marketplace, as well as Medicare Advantage and supplements, dental, vision, life, and accident plans. Thank you for trusting us as your advocate. Best of all, our services are always at no cost to you!
Please note that the costs and copays mentioned are subject to change based on the terms set by your health insurance provider. Utah Avenue Insurance strives to provide accurate information, but we cannot guarantee the exact costs or benefits outlined in your specific plan. It is important to review your policy details directly with your insurance company. Utah Avenue Insurance is not liable for any discrepancies or changes in coverage, copays, or other plan details.