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What is included?

ACA Essential Health Benefits
The Affordable Care Act (ACA) requires that all Essential Health Benefits (EHB) be covered to ensure that everyone in the individual and small group health insurance markets has access to the same comprehensive coverage that includes the services they need.  The Nova Pathfinder HealthCare plan meets all of these requirements. 

The Nova Pathfinder Essential Health EHB coverages include: 

  • Ambulatory patient services (outpatient care you get without being admitted to a hospital) 
  • Emergency services 
  • Hospitalization (like surgery and overnight stays) 
  • Pregnancy, maternity, and newborn care (both before and after birth) 
  • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy) 
  • Prescription drugs 
  • Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills) 
  • Laboratory services 
  • Preventive and wellness visits and chronic disease management 
  • Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits) 

We also include the following coverage: 

  • Birth control coverage 
  • Breastfeeding coverage 

Additional covered services as benefits: 

  • Dental coverage 
  • Vision coverage 
  • Gym Membership Reimbursement 

Coverage Limits

Deductible $5000 Single  $10,000 Couple/Family 
HSA (Health Savings Account)Available Yes   
Annual Wellness Exam Covered$300 per individual per year is covered toward an Annual Wellness Visit.  Your yearly wellness visits will cover basic labs and screenings for preventive care (must be coded as preventative care) and be reimbursed up to the $300 benefit amount.  (You may be able to use a Chiropractor for your Annual Wellness Visit.) Any amount over the $300 benefit and any diagnostic testing will be applied to the Member’s deductible.   *Members must be active on the plan for three months to qualify.   
Open Preferred Provider Network   Yes  
Holistic and Naturopathic Providers      Yes  
24/7 General Medicine Teladoc MembershipAs a member, you have access to “Healthiest You’ by Teledoc, providing 24/7 Telehealth services anywhere in the United States, any time you need it.   *Please note that while Teladoc is provided as part of your membership, you must opt-in for the benefit. You may opt-in at any time during your membership. We encourage you to do this as soon as you sign up. 
Traditional/Biological Dental Care$1,000 per individual per year is covered for Dental Care. Any cost after the benefit of $1000 is the Member’s responsibility.  *Members must be active on the plan for three months to qualify.   
Vision CoverageOur members receive up to $350, per individual, per year, toward Vision Care. Any cost after the benefit of $350 is the Member’s responsibility. *Members must be active on the plan for three months to qualify. 
Wellness Treatments & Services:$2,000.00 Single* 
$4,000.00 Couple/Family* 

Acupuncture, Massage Therapy, Naturopathic, Homeopathy, Supplements & Essentials Oils*  
Chiropractor  12 visits or $1,200.00 per person on the policy  
Physical Therapy    12 visits or $2,200.00 per person on the policy 
Gym Memberships and Health Clubs Our members are eligible to be reimbursed for an annual gym membership and select health clubs, up to $200 maximum for an Individual plan, $300 for an Individual+1 $400 maximum for a Family Plan.  Please remit your gym membership invoice for your annual reimbursement. You can only submit your receipts once a year to be reimbursed up to your maximum yearly benefit, regardless of the membership’s annual cost. *Please note that your invoice must be a verifiable statement or receipt from the facility.   
Personal Care Advocate Yes 
Membership AdvisorYes  
* See reimbursement policy on how to submit requests for reimbursement and product type restrictions. 

Monthly Rates & Fees
Nova Pathfinder HealthCare member benefits start with a one-time membership and enrollment fee of $250 for each plan. The enrollment fee for Group Plans will be $350. Our enrollment fees are tax-deductible. *See the table below for our monthly rates.

More than Traditional Healthcare, current health, habits, age, and your selected plan (Individual/Individual+1 or Economic Family Unit) will ultimately determine your monthly cost. The following prices are estimates; your exact cost will be determined following the completion of a standard health questionnaire.

AgesIndividualIndividuals + 1
(Economic Unit,
or Partners)
Family )Economic Unit,
or Partners)
Up to 34 Years Old$280.50 – $428.22$ 460.70 – $ 668.11$ 681.70 – $ 919.45
Ages 35 – 44$432.51 – $479.65$674.79 – $748.34$ 928.64 – $1,015.64
Ages 45 – 54$491.22 – $612.32$766.40 – $955.33$1,040.16 – $1,296.57
Ages 55 – 64$630.69 – $797.43$983.99 – $1,244.14$1,322.50 – $1,596.42
65 and up for
Non-MediCare Clients
$897.43 – $2,347.43$1,334.14 – $2,794.14$1,696.42 – $4,146.42
Non-Medicare subscribers are usually subscribers who cannot qualify for Medicare. (NMQ)
*Family coverage includes up to 4 individuals; the rate is increased by $280 per additional dependent per month after that. Take care of your health by taking full advantage of your holistic coverage plan with Nova Pathfinder