euCare Information Sheet

The euCare Review will enable you to see how a new style PPO plan meets your specific medical care needs. The euCare Report will show specific cost benefits in both routine care (office visits and RX needs) as well as major medical care benefits (surgery, hospital and rehab. services and equipment)

Please complete the required information. Vinclair needs all required information in order to complete the computer analysis. A final report showing estimated cost savings will be emailed directly to the email-address you provide us.

*Required information

Current health plan or plan being considered:*

HMO
PPO/POS
No insurance
Person in the plan:*


Subscriber Age:*

Spouse Age:*

Children Age(s):

Subscriber zipcode:*



example: 05, 11

Office visit co-pay:*

RX co-pay:*

Hospital co-pay:*

enter 00 for zero

enter 00 for zero

enter 00 for zero

Annual deductible:*

Max. out-of-pocket (OOP):*

enter 00 for zero

enter 00 for zero

Insurance carrier:

Plan name:

Current Premium:*

enter 00 for zero

Medical Care needs:

Office visits/year:

RX prescrip./year:

Estimated next Hosp. visit:

 
Enter your name:*
Enter your email:*
Enter your telephone:*

 

 

CA residents only

 

 

 

 

 

 

 

 

 

 

 

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