Medical
Medical coverage provides healthcare protection for you and your family. You can visit any provider, but in-network doctors offer the highest level of benefits and lower out-of-pocket costs by charging reduced, contracted rates. Out-of-network providers set their own fees, so you may be responsible for charges above the Reasonable and Customary (R&C) limits. Preventive care—such as physical exams, flu shots, and screenings—is covered at 100% when you use in-network providers. The main differences between plan options are how much you pay per paycheck and what you pay when you receive care.
Each plan has different:
- Annual deductible amounts – the amount you pay each year for eligible in-network and out-of-network charges before the plan begins to pay.
- Out-of-pocket maximums– the most you will pay each year for eligible network services and/or prescriptions. After you reach your out-of-pocket maximum, the plan picks up the full cost of covered medical care for the remainder of the year.
- Copays – A copay is a fixed amount you pay for a health care service. Copays do not count toward your deductible but do count toward your annual out-of-pocket maximum.
- Coinsurance – Once you’ve met your deductible, you and the plan share the cost of care, which is called coinsurance. For example, you pay 20% for services and the plan will pay 80% of the cost until you have reached your out-of-pocket maximum.
HDHP 1800
Benefit Highlights
In-Network
Deductible (Individual/Family)
$1,800/$3,600
Out-of-Pocket Max (Individual/Family)
$4,000/$6,550
Preventive Care
$0
Primary Care Visit
20%*
Specialist Visit
20%*
Urgent Care
20%*
Emergency Room
Facility Fee: $100/visit + 20%*
Physician Fee: 20%*
Retail Rx (Up to 30-Day Supply)
Generic
$10
Preferred Brand
$25
Non-Preferred Brand
$40
Specialty
30%* up to $200
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20
Preferred Brand
$50
Non-Preferred Brand
$80
Specialty
30%* up to $400
*After deductible
Out-of-Network
Deductible (Individual/Family)
$1,800/$3,600
Out-of-Pocket Max (Individual/Family)
$8,000/$16,000
Preventive Care
Not covered
Primary Care Visit
40%*
Specialist Visit
40%*
Urgent Care
40%*
Emergency Room
Facility Fee: $100/visit + 20%*
Physician Fee: 20%*
Retail Rx (Up to 30-Day Supply)
Generic
25%* + $10
Preferred Brand
25%* + $25
Non-Preferred Brand
25%* + $40
Specialty
30%* up to $200 + 25% of purchase price
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Plan Cost
Employee Only: $XX
Employee and Spouse: $XX
Employee and Child(ren): $XX
Employee and Family: $XX
PPO 750
Benefit Highlights
In-Network
Deductible (Individual/Family)
$750/$1,500
Out-of-Pocket Max (Individual/Family)
$3,500/$7,000
Preventive Care
$0
Primary Care Visit
$25
Specialist Visit
$40
Urgent Care
$25
Emergency Room
Facility Fee: $200/visit
Physician Fee: 20%*
Retail Rx (Up to 30-Day Supply)
Generic
$10
Preferred Brand
$35
Non-Preferred Brand
$60
Specialty
30%* up to $150
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20
Preferred Brand
$70
Non-Preferred Brand
$120
Specialty
30%* up to $300
*After deductible
Out-of-Network
Deductible (Individual/Family)
$750/$1,500
Out-of-Pocket Max (Individual/Family)
$5,500/$11,000
Preventive Care
Not covered
Primary Care Visit
40%*
Specialist Visit
40%*
Urgent Care
40%*
Emergency Room
Facility Fee: $200/visit
Physician Fee: 20%*
Retail Rx (Up to 30-Day Supply)
Generic
25%* + $10
Preferred Brand
25%* + $35
Non-Preferred Brand
25%* + $60
Specialty
30%* up to $150 + 25% of purchase price
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Plan Cost
Employee Only: $XX
Employee and Spouse: $XX
Employee and Child(ren): $XX
Employee and Family: $XX