Employee Only
|
Employee Only
$415
|
Employee Only
$150
|
Employee + Spouse
|
|
|
Employee + Child(ren)
|
Employee + Child(ren)
$850
|
Employee + Child(ren)
$270
|
Employee + Family
|
|
|
Minimum Employer Contribution
|
Minimum Employer Contribution
50% of Employee Only44
|
Minimum Employer Contribution
100% of Employee Only44
|
Minimum Employee Participation
|
Minimum Employee Participation
50% of Eligible Employees
|
Minimum Employee Participation
50% of Eligible Employees
|
(or add a doctor prior to visit)
|
(or add a doctor prior to visit)
|
(or add a doctor prior to visit)
|
ACA Compliance
Satisfies Penalty A (MEC) & Penalty B (MVP)
|
ACA Compliance
Satisfies Penalty A (MEC) & Penalty B (MVP)
|
ACA Compliance
Satisfies Penalty A (MEC)
Penalty A Only
|
Routine Care
$0 copay with Appointment Preparation/Pre-authorization
$50 copayemployee responsibility22 without Appointment Preparation/Pre-authorization
- Virtual Primary Care (24/7/365)
- In-Office Primary
- Urgent Care
- Annual Adult Physical11 & Well Child11
- 12 FREE Chiropractic Visit per year
- X-rays
|
Routine Care
$0 copay with Appointment Preparation/Pre-authorization
$50 copayemployee responsibility22 without Appointment Preparation/Pre-authorization
- Virtual Primary Care (24/7/365)
- In-Office Primary
- Urgent Care
- Annual Adult Physical11 & Well Child11
- 12 FREE Chiropractic Visit per year
- X-rays
|
Routine Care
$0 copay with Appointment Preparation/Pre-authorization
$50 copayemployee responsibility22 without Appointment Preparation/Pre-authorization
- Virtual Primary Care (24/7/365)
- In-Office Primary
- Urgent Care
- Annual Adult Physical11 & Well Child11
- 12 FREE Chiropractic Visit per year
- X-rays
|
|
|
|
$0 copay Mental Health & Tele-Counseling
No Coverage without Appointment Preparation/Pre-authorization
|
$0 copay Mental Health & Tele-Counseling
No Coverage without Appointment Preparation/Pre-authorization
|
$0 copay Mental Health & Tele-Counseling
No Coverage without Appointment Preparation/Pre-authorization
|
Rx and Immunizations (Copays $10, $25, $50, $100)
View Rx Formulary
Copays may vary depending on pharmacy location, quantity, and dosage.
|
Rx and Immunizations (Copays $10, $25, $50, $100)
View Rx Formulary
Copays may vary depending on pharmacy location, quantity, and dosage.
|
|
$50 copayemployee responsibility Specialist Consults & Care
No Coverage without Appointment Preparation/Pre-authorization
|
$50 copayemployee responsibility Specialist Consults & Care
No Coverage without Appointment Preparation/Pre-authorization
|
Specialist Consults & Care
Care Navigation Only
- Appointment preparation,
- coordination, navigation,
- alternative funding management,
- and pre-negotiations
|
$50 copayemployee responsibility MRI, PET, CT Scans, Ultrasound and other imaging
No Coverage without Appointment Preparation/Pre-authorization
|
$50 copayemployee responsibility MRI, PET, CT Scans, Ultrasound and other imaging
No Coverage without Appointment Preparation/Pre-authorization
|
MRI, PET, CT Scans, Ultrasound and other imaging
Care Navigation Only
- Appointment preparation,
- coordination, navigation,
- alternative funding management,
- and pre-negotiations
|
Hospital Care - Inpatient & Outpatient
Individual - (non-embedded) plan year
- $2,000 deductibleinitial employee responsibility 20% coinsurancethen 20%
- $4,000 out-of-pocket max^^
Family - (non-embedded) plan year
- $4,000 deductibleinitial employee responsibility 20% coinsurancethen 20%
- $6,000 out-of-pocket max^^
Emergency Room
- $500 copay + 20% coinsurance + 20% employee responsibility
- Pre-authorization REQUIRED for ALL NON-EMERGENCY Care
|
Hospital Care - Inpatient & Outpatient
Individual - (non-embedded) plan year
- $2,000 deductibleinitial employee responsibility 20% coinsurancethen 20%
- $4,000 out-of-pocket max^^
Family - (non-embedded) plan year
- $4,000 deductibleinitial employee responsibility 20% coinsurancethen 20%
- $6,000 out-of-pocket max^^
Emergency Room
- $500 copay + 20% coinsurance + 20% employee responsibility
- Pre-authorization REQUIRED for ALL NON-EMERGENCY Care
|
Hospital Care - Inpatient & Outpatient
Care Navigation Only
- Appointment preparation,
- coordination, navigation,
- alternative funding management,
- and pre-negotiations
|
Excluded Services33
Pre-existing conditions, oOrgan transplants, dialysis, skilled nursing, advanced psychiatric care and specialty & non-formulary medications
|
Excluded Services33
Pre-existing conditions, oOrgan transplants, dialysis, skilled nursing, advanced psychiatric care and specialty & non-formulary medications
Care Navigation Only
Appointment preparation, coordination, navigation, alternative funding management, and pre-negotiations
|
Excluded Services33
Pre-existing conditions, oOrgan transplants, dialysis, skilled nursing, advanced psychiatric care and specialty & non-formulary medications
Care Navigation Only
- Appointment preparation,
- coordination, navigation,
- alternative funding management,
- and pre-negotiations
|
Employee Only |
Employee Only
$415
|
Employee Only
$150
|
Employee + Spouse |
|
|
Employee + Child(ren) |
Employee + Child(ren)
$850
|
Employee + Child(ren)
$270
|
Employee + Family |
|
|
Minimum Employer Contribution
|
Minimum Employer Contribution
50% of Employee Only44
|
Minimum Employer Contribution
100% of Employee Only44
|
Minimum Employee Participation
|
Minimum Employee Participation
50% of Eligible Employees
|
Minimum Employee Participation
50% of Eligible Employees
|
|
|
|
|
EverydayCARE® Hospitalization
|
|