H1416_009_2023_IL_EOC_HMAPD_106158E_C OMB Approval 0938-1051 (Expires: February 29, 2024) IL3IMREOC06158E_0009 H1416009000 January 1 – December 31, 2023H1416, Plan 009 Outpatient hospital observation services In-Network $125 copay for outpatient observation services when you enter observation status through an emergency room. $250 copay for outpatient observation services when you enter observation status through an outpatient facility. * Out-of-Network 40% coinsurance * Ambulatory surgical ...Wellcare Assist (HMO) 3 out of 5 stars* for plan year 2024. Wellcare Assist (HMO) is a HMO Medicare Advantage (Medicare Part C) plan offered by WellCare Health Plans, Inc. Plan ID: H1416-042-000. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $21.70 Monthly Premium. Wellcare No Premium (HMO-POS) Wellcare No Premium (HMO-POS) is a Medicare Advantage (Part C) Plan by Wellcare. This page features plan details for 2024 Wellcare No Premium (HMO-POS) H1416 – 009 – 0 available in Select counties in IL. IMPORTANT: This page has been updated with plan and premium data for 2024. The Wellcare No Premium (HMO-POS) (H1416 - 009) currently has 10,223 members. There are 276 members enrolled in this plan in Kankakee, Illinois, and 10,190 members in Illinois. The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 3.5 stars. The detail CMS plan carrier ratings are as follows: H1416_009_H1416_048_2023_IL_ANOC_HMAPD_105433E_M. 3 Wellcare No Premium (HMO-POS) Annual Notice of Changes for 2023 OMB Approval 0938-1051 (Expires: February 29, 2024) H1416-009: Wellcare Assist Compass (HMO) 2024: H1416-023: Wellcare No Premium Value (HMO-POS) 2024: H1416-082: Wellcare No Premium Essential Value (HMO) 2024: H5779-009: Zing Health View payer . Plan Name Effective Year Benefit Package; Zing Select Care IL (HMO) 2024: H7330-001: Zing Essential Wellness Diabetes & Heart IL …Wellcare No Premium (HMO-POS) Wellcare No Premium (HMO-POS) is a Medicare Advantage (Part C) Plan by Wellcare. This page features plan details for 2024 Wellcare No Premium (HMO-POS) H1416 – 009 – 0 available in Select counties in IL. IMPORTANT: This page has been updated with plan and premium data for 2024.Companies that offer Illinois Insurance Company Medicare Advantage with Part D. Aetna Better Health Premier Plan. Aetna Medicare. Blue Cross Community MMAI. Blue Cross and Blue Shield of IL, NM ... H9730:005-0 Wellcare No Premium Essential (HMO-POS) H9730:007-0 Wellcare Giveback (HMO) H9730:009-0 Wellcare No Premium (HMO) H9730:010-0 Wellcare Assist (HMO) Compare the 172 Medicare Advantage plans available from Wellcare through Alight Retiree Health Solutions. 2021 WellCare Value (HMO-POS) - H1416-009-0 in IL Plan Benefits Details Summary of Benefits January 1, 2020 - December 31, 2020 WellCare Advance (HMO-POS) H1416053000 IL WellCare Choice (HMO-POS) H1416024000 IL Out-of-Network: 20% per day for days 1 to 90. Urgent Care. Copayment for Urgent Care $35.00. Copayment for Medicare Covered Urgent Care waived if you are admitted to hospital within 24 hours. Worldwide Coverage: Copayment for Worldwide Urgent Coverage $120.00. Maximum Plan Benefit of $50,000. Emergency Room Visit.Copayment for Worldwide Urgent Coverage $100.00. Maximum Plan Benefit of $50,000. Emergency Room Visit. Copayment for Emergency Care $100.00. Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital within 24 hours. Worldwide Coverage: Copayment for Worldwide Emergency Coverage $100.00.Get 2024 Medicare Advantage Part C/Part D Health and Prescription plan benefit details for any plan in any state, including premiums, deductibles, Rx cost-sharing and health benefits/cost-sharing. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLCGet 2024 Medicare Advantage Part C/Part D Health and Prescription plan benefit details for any plan in any state, including premiums, deductibles, Rx cost-sharing and health benefits/cost-sharing. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLCHarmony Health Plan of Illinois Inc., H1416 Dual (Medicare Subset Zero Cost Sharing) Special Needs Plan Model of Care Score: 98.75% 3-Year Approval January 1, 2012 – December 31, 2014 Target Population The target population for WellCare’s specific product is called Access $0 Cost Share andThe testicles are suspended in the scrotal sac. The testicles are suspended in the scrotal sac. Updated by: Kelly L. Stratton, MD, FACS, Associate Professor, Department of Urology,...Dental, Vision & Hearing Plans. More. AA. Log In. Create Account. View the coverage and benefits provided in the Wellcare No Premium (HMO-POS) plan from Wellcare. Alight …H1416_009_H1416_048_2023_IL_ANOC_HMAPD_105433E_M. 3 Wellcare No Premium (HMO-POS) Annual Notice of Changes for 2023 OMB Approval 0938-1051 (Expires: February 29, 2024)2019 WellCare Value (HMO-POS) - H1416-009-0 in IL Plan Benefits DetailsOut-of-Network: 20% per day for days 1 to 90. Urgent Care. Copayment for Urgent Care $35.00. Copayment for Medicare Covered Urgent Care waived if you are admitted to hospital within 24 hours. Worldwide Coverage: Copayment for Worldwide Urgent Coverage $120.00. Maximum Plan Benefit of $50,000. Emergency Room Visit.The Evidence of Coverage (EOC) provides a complete list of all coverage and services. It is important to review plan coverage, costs, and benefits before you enroll. Visit …H1416, Plan 065 Wellcare No Premium (HMO) H1416, Plan 071 Wellcare Assist (HMO) H1416, Plan 068 Maximum Out-of-Pocket Responsibility (does not include prescription drugs) $6,700 annually This is the most you will pay in copays and coinsurance for Part A and B services for the year. $5,900 annually This is the most you will pay in …The Wellcare No Premium (HMO-POS) (H1416 - 009) currently has 10,223 members. There are 276 members enrolled in this plan in Kankakee, Illinois, and 10,190 members in Illinois. The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 3.5 stars. The detail CMS plan carrier ratings are as follows:Harmony Health Plan of Illinois Inc., H1416 Dual (Medicare Subset Zero Cost Sharing) Special Needs Plan Model of Care Score: 98.75% 3-Year Approval January 1, 2012 – December 31, 2014 Target Population The target population for WellCare’s specific product is called Access $0 Cost Share andYour next extreme sport obsession is in Chile and it includes lots of sand. Join our newsletter for exclusive features, tips, giveaways! Follow us on social media. We use cookies f...Get 2023 Medicare Advantage Part C/Part D Health and Prescription plan benefit details for any plan in any state, including premiums, deductibles, Rx cost-sharing and health benefits/cost-sharing. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLC2018 WellCare Value (HMO-POS) - H1416-009-0 in IL Plan Benefits Details2014 WellCare Value (HMO-POS) - H1416-009-0 in IL Plan Benefits DetailsH1416_009_2023_IL_EOC_HMAPD_106158E_C OMB Approval 0938-1051 (Expires: February 29, 2024) IL3IMREOC06158E_0009 H1416009000 January 1 – December 31, 2023Here's the inside scoop on how much hotels get paid when you redeem points for award nights. The answer might surprise you. Most major hotel chains don’t actually own most of their... Copayment for Worldwide Urgent Coverage $120.00. Maximum Plan Benefit of $50,000. Emergency Room Visit. Copayment for Emergency Care $120.00. Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital within 24 hours. Worldwide Coverage: Copayment for Worldwide Emergency Coverage $120.00. Oct 10, 2023 · Our nurses will give you answers to your medical questions and help you decide whether to see your doctor or go to the emergency room. Nurses are available 24 hours a day, seven days a week at 1-800-581-9952. (TTY users dial .) Wellcare No Premium (HMO-POS) is offered exclusively to enrollees eligible for Medicare. Mental health inpatient care. In-Network: Psychiatric Hospital Services: $325.00 per day for days 1 to 4. $0.00 per day for days 5 to 90. Prior Authorization Required for Psychiatric Hospital Services. Mental health outpatient care. POS (Out-of-Network): Outpatient Mental Health Services: H1416_009_H1416_048_2023_IL_ANOC_HMAPD_105433E_M. 3 Wellcare No Premium (HMO-POS) Annual Notice of Changes for 2023 OMB Approval 0938-1051 (Expires: February 29, 2024) Doctor Specialty Visit: Copayment for Physician Specialist Office Visit $45.00. Prior Authorization Required for Doctor Specialty Visit. Inpatient hospital care. In-Network: Acute Hospital Services: $475.00 per day for days 1 to 4. $0.00 per day for days 5 …H1416, Plan 009 Outpatient hospital observation services In-Network $125 copay for outpatient observation services when you enter observation status through an emergency room. $250 copay for outpatient observation services when you enter observation status through an outpatient facility. * Out-of-Network 40% coinsurance * Ambulatory surgical ...H1416, Plan 009 Wellcare No Premium Value (HMO-POS) H1416, Plan 082 Outpatient Hospital coverage Outpatient hospital services In-Network $0 copay for diagnostic colonoscopy. $250 copay for all other outpatient services. * Out-of-Network 40% coinsurance for surgical and non-surgical services (includes diagnostic colonoscopy) * In …2019 WellCare Value (HMO-POS) - H1416-009-0 in IL Plan Benefits DetailsGet 2023 Medicare Advantage Part C/Part D Health and Prescription plan benefit details for any plan in any state, including premiums, deductibles, Rx cost-sharing and health benefits/cost-sharing. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLC2020 WellCare Value (HMO-POS) - H1416-009-0 in IL Plan Benefits DetailsH1416_009_2024_IL_EOC_HMAPD_127141E_C OMB Approval 0938-1051 (Expires: February 29, 2024) IL4IMREOC27141E_0009 REV H1416009000 January 1 – December …H9730:005-0 Wellcare No Premium Essential (HMO-POS) H9730:007-0 Wellcare Giveback (HMO) H9730:009-0 Wellcare No Premium (HMO) H9730:010-0 Wellcare Assist (HMO) Compare the 172 Medicare Advantage plans available from Wellcare through Alight Retiree Health Solutions.Get 2024 Medicare Advantage Part C/Part D Health and Prescription plan benefit details for any plan in any state, including premiums, deductibles, Rx cost-sharing and health benefits/cost-sharing. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLC2.5 out of 5 stars. Wellcare No Premium (HMO-POS) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Wellcare Health Plans, Inc. Plan ID: H1416-009. Have …2019 WellCare Value (HMO-POS) - H1416-009-0 in IL Plan Benefits DetailsShop for Plans. Find Medicare Plans. Learn AboutH1416 - 071 - 0 Click to see other plans: Member Services: 1-833-444-9088 TTY users 711 — This plan information is for research purposes only. — Click here to see plans for the current plan year: Medicare Contact Information: Please go to Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to get information on all of your options. Copayment for Urgent Care $35.00. Copayment for Medicare Covered Urgent Care waived if you are admitted to hospital within 24 hours. Worldwide Coverage: Copayment for Worldwide Urgent Coverage $100.00. Maximum Plan Benefit of $50,000. Emergency room visit. Emergency Care: Copayment for Emergency Care $100.00. 2020 WellCare Value (HMO-POS) - H1416-009-0 in IL Plan Benefits DetailsH1416_009_2023_IL_EOC_HMAPD_106158E_C OMB Approval 0938-1051 (Expires: February 29, 2024) IL3IMREOC06158E_0009 H1416009000 January 1 – December 31, 2023Get 2024 Medicare Advantage Part C/Part D Health and Prescription plan benefit details for any plan in any state, including premiums, deductibles, Rx cost-sharing and health benefits/cost-sharing. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLCH1416_009_H1416_048_2023_IL_ANOC_HMAPD_105433E_M. 3 Wellcare No Premium (HMO-POS) Annual Notice of Changes for 2023 OMB Approval 0938-1051 (Expires: February 29, 2024)2019 WellCare Value (HMO-POS) - H1416-009-0 in IL Plan Benefits DetailsCopayment for Worldwide Urgent Coverage $120.00. Maximum Plan Benefit of $50,000. Emergency Room Visit. Copayment for Emergency Care $120.00. Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital within 24 hours. Worldwide Coverage: Copayment for Worldwide Emergency Coverage $120.00.H3146 - 009 January 1, 2021 - December 31, 2021 H3146-009 1_A Y0001_H3146_009_NP56_SB21_M Aetna Medicare Assure Plan (HMO D-SNP) | H3146-009 | $0 Aetna Medicare Assure Plan (HMO D-SNP) is a Dual Eligible Special Needs Plan (D-SNP) for Medicare beneficiaries who are also eligible for Medicaid. This is a Medicare …Read these CRM statistics to grasp why this tool is so popular and learn about its benefits, challenges, and best-ranked features. Sales | Statistics REVIEWED BY: Jess Pingrey Jess...Copayment for Urgent Care $35.00. Copayment for Medicare Covered Urgent Care waived if you are admitted to hospital within 24 hours. Worldwide Coverage: Copayment for Worldwide Urgent Coverage $95.00. Maximum Plan Benefit of $50,000. Emergency room visit. Emergency Care: Copayment for Emergency Care $95.00.Get 2024 Medicare Advantage Part C/Part D Health and Prescription plan benefit details for any plan in any state, including premiums, deductibles, Rx cost-sharing and health benefits/cost-sharing. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLCCopayment for Urgent Care $35.00. Copayment for Medicare Covered Urgent Care waived if you are admitted to hospital within 24 hours. Worldwide Coverage: Copayment for Worldwide Urgent Coverage $100.00. Maximum Plan Benefit of $50,000. Emergency room visit. Emergency Care: Copayment for Emergency Care $100.00.Get 2024 Medicare Advantage Part C/Part D Health and Prescription plan benefit details for any plan in any state, including premiums, deductibles, Rx cost-sharing and health benefits/cost-sharing. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLCGet 2022 Medicare Advantage Part C/Part D Health and Prescription plan benefit details for any plan in any state, including premiums, deductibles, Rx cost-sharing and health benefits/cost-sharing. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLC2021 WellCare Value (HMO-POS) - H1416-009-0 in IL Plan Benefits DetailsThe testicles are suspended in the scrotal sac. The testicles are suspended in the scrotal sac. Updated by: Kelly L. Stratton, MD, FACS, Associate Professor, Department of Urology,...H1416, Plan 065 Wellcare No Premium (HMO) H1416, Plan 071 Wellcare Assist (HMO) H1416, Plan 068 Inpatient Hospital coverage For each admission, you pay: • $475 copay per day for days 1 through 4 • $0 copay per day for days 5 through 90 • $0 copay per day for days 91 and beyond * For each admission, you pay: • $300 copay per day for days 1Summary of Benefits - Home | WellcareH1416_009_2023_IL_ANOC_HMAPD_105422E_M. 3 Wellcare No Premium (HMO-POS) Annual Notice of Changes for 2023 OMB Approval 0938-1051 (Expires: February 29, 2024) Annual Notice of Changes for 2023 Table of ContentsWellcare Patriot Giveback H1416-061 (HMO-POS) Tennessee. Medicare. Health. Wellcare Patriot Giveback (HMO-POS) H1416-061. Wellcare | Local HMO. Why Trust U.S. News. 344. Insurance Companies Evaluated.H4537-003. Wellcare Low Premium Open (PPO) 2024. H6348-007. Wellcare Mutual of Omaha Low Premium Open (PPO) 2024. H7518-004. Wellcare Mutual of Omaha No Premium Open (PPO) 2024.Out-of-Network: 20% per day for days 1 to 90. Urgent Care. Copayment for Urgent Care $35.00. Copayment for Medicare Covered Urgent Care waived if you are admitted to hospital within 24 hours. Worldwide Coverage: Copayment for Worldwide Urgent Coverage $120.00. Maximum Plan Benefit of $50,000. Emergency Room Visit. Initial Coverage Phase. After you pay your deductible, if applicable, up to the initial coverage limit of $5,030. Prescription Drug Tier Name. Standard Retail. Cost-Sharing 30 days. Standard ... 2020 WellCare Value (HMO-POS) - H1416-009-0 in IL Star Rating DetailsGet 2023 Medicare Advantage Part C/Part D Health and Prescription plan benefit details for any plan in any state, including premiums, deductibles, Rx cost-sharing and health benefits/cost-sharing. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLC H1416, Plan 009 Wellcare Assist Compass (HMO) H1416, Plan 023 Wellcare Plus (HMO) H1416, Plan 048 Maximum out-of-Pocket Responsibility (does not include prescription drugs) $3,450 in-network annually $3,450 combined in and out-of-network annually This is the most you will pay in copays and coinsurance for Part A and B services for the year. H1416 | 009 Wellcare Assist Compass (HMO) H1416 | 023 Wellcare Plus (HMO) H1416 | 048 H1416_WCM_78652E_M ©Wellcare 2022 IL2IMRSOB78652E_0106. 2 Your Summary of BenefitsH1416_009_2023_IL_EOC_HMAPD_106158E_C OMB Approval 0938-1051 (Expires: February 29, 2024) IL3IMREOC06158E_0009 H1416009000 January 1 – December 31, 2023H1416, Plan 079 Wellcare No Premium (HMO-POS) H1416, Plan 077 Wellcare Assist (HMO) H1416, Plan 042 Maximum Out-of-Pocket Responsibility (does not include … Initial Coverage Phase. After you pay your deductible, if applicable, up to the initial coverage limit of $5,030. Prescription Drug Tier Name. Standard Retail. Cost-Sharing 30 days. Standard ...
H3822-007. Blue Cross Community MMAI (Medicare-Medicaid Plan) 2024. H0927-001. Blue Cross Medicare Advantage Choice Plus (PPO) 2024. H8634-003. Medicare Plus Blue PPO Employer CY (PPO) 2024.. Dyani eaton obituary
H1416_009_2024_IL_EOC_HMAPD_127141E_C OMB Approval 0938-1051 (Expires: February 29, 2024) IL4IMREOC27141E_0009 REV H1416009000 January 1 – December 31, 2024 5 Wellcare No Premium (HMO-POS) Annual Notice of Changes for 2024. OMB Approval 0938-1051 (Expires: February 29, 2024) Cost 2023 (this year) 2024 (next year) Inpatient hospital stays For covered admissions, per admission: In-Network: $275 copay per day, for days 1 to 8 and a $0 copay per day, for days 9 to 90 for each covered hospital stay.2021 Medicare Advantage Plan Benefit Details for the WellCare Value (HMO-POS) - H1416-009-0. This is archive material for research purposes. Please see PDPFinder.com or … Wellcare No Premium (HMO-POS) is a HMO-POS Medicare Advantage plan offered by WellCare Health Plans, Inc. It has a monthly plan premium of $0.00 and covers prescription drugs, vision, dental, hearing, and other health care services. It has a maximum plan benefit of $50,000 and a primary care doctor visit copayment of $0.00. When you stay by July 18, targeted cardholders enjoy $60 off a $300 or more select purchase at Hyatt Regency hotels. Update: Some offers mentioned below are no longer available. Vi...H1416, Plan 009 Outpatient hospital observation services In-Network $125 copay for outpatient observation services when you enter observation status through an …Mental health inpatient care. In-Network: Psychiatric Hospital Services: $325.00 per day for days 1 to 4. $0.00 per day for days 5 to 90. Prior Authorization Required for Psychiatric Hospital Services. Mental health outpatient care. POS (Out-of-Network): Outpatient Mental Health Services:Wellcare No Premium (HMO-POS) is a Medicare Advantage (Part C) Plan by Wellcare. This page features plan details for 2024 Wellcare No Premium (HMO-POS) H1416 – 009 – 0 … 2021 Medicare Advantage Plan Benefit Details for the WellCare Value (HMO-POS) - H1416-009-0. This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans. Get 2022 Medicare Advantage Part C/Part D Health and Prescription plan benefit details for any plan in any state, including premiums, deductibles, Rx cost-sharing and health benefits/cost-sharing. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLCH1416_009_2023_IL_EOC_HMAPD_106158E_C OMB Approval 0938-1051 (Expires: February 29, 2024) IL3IMREOC06158E_0009 H1416009000 January 1 – December 31, 2023Get 2024 Medicare Advantage Part C/Part D Health and Prescription plan benefit details for any plan in any state, including premiums, deductibles, Rx cost-sharing and health benefits/cost-sharing. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLCIn-Network: Copayment for Medicare-Covered Podiatry Services $50.00. Prior Authorization Required for Podiatry Services. Prior authorization required. Skilled Nursing Facility Care. In-Network: Skilled Nursing Facility Services: $0.00 per day for days 1 to 20. $203.00 per day for days 21 to 60.3 out of 5 stars* for plan year 2024. Wellcare No Premium (HMO-POS) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by WellCare Health Plans, Inc. Plan ID: H1416-077-000. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium.3 out of 5 stars* for plan year 2024. Wellcare Dual Liberty (HMO D-SNP) is a HMO D-SNP Medicare Advantage (Medicare Part C) plan offered by WellCare Health Plans, Inc. Plan ID: H1416-044-000. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium.Get 2022 Medicare Advantage Part C/Part D Health and Prescription plan benefit details for any plan in any state, including premiums, deductibles, Rx cost-sharing and health benefits/cost-sharing. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLC2018 WellCare Value (HMO-POS) - H1416-009-0 in IL Plan Benefits DetailsMental health inpatient care. In-Network: Psychiatric Hospital Services: $325.00 per day for days 1 to 4. $0.00 per day for days 5 to 90. Prior Authorization Required for Psychiatric Hospital Services. Mental health outpatient care. POS (Out-of-Network): Outpatient Mental Health Services:Selecting new or replacement windows can be overwhelming with all the styles, materials, and features to choose from. Read on for tips on how to choose windows for your home. Exper... Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital within 24 hours. Worldwide Coverage: Copayment for Worldwide Emergency Coverage $135.00. Maximum Plan Benefit of $50,000. Ambulance transportation. In-Network: Ground Ambulance: Copayment for Ground Ambulance Services $225.00. .