Compare Plans

Not all coverage is the right coverage.

Your healthcare coverage is important to us. Age, family status, medical conditions, hobbies, lifestyle and a myriad of other factors will help you determine if you need a lot or a very little amount of health coverage. This summary will help you understand your plan and its coverage.

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Summary of Medical Benefits

$3,300 HSA Plan

In-Network

Out-of-Network

Deductible

Individual

Individual Under Family

Family

 

$3,300

$3,300

$6,600

 

$5,200

$5,200

$10,400

Out-of-Pocket Maximum

Individual

Individual Under Family

Family

 

$3,300

$3,300

$6,600

 

$8,200

$8,200

$16,400

Preventive Care Services

No Charge

20%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

0%*

0%*

0%*

 

20%*

20%*

20%*

Urgent Care Services

0%*

20%*

Complex Imaging: MRI/CT/PET Scans

0%*

20%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

0%*

0%*

 

20%*

20%*

Outpatient Procedures

Facility Fee

Physician Fee

 

0%*

0%*

 

20%*

20%*

Emergency Room **

Emergency Medical Transportation **

0%*

0%*

0%*

0%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

0%*

0%*

 

20%*

20%*

Teladoc Benefits

General Consultations

Dermatology

 

$55 Copay

$85 Copay

 

$55 Copay

$85 Copay

NOTE: * Coinsurance After Deductible

**Services covered at in-network benefit level when the diagnosis is an Emergency Medical Condition.

Please refer to your Summary Plan Description for actual coverage, limitation, and exclusion provisions

 

 

 

 

 

 

$6,000 HSA Plan

In-Network

Out-of-Network

Deductible

Individual

Individual Under Family

Family

 

$6,000

$6,000

$12,000

 

$8,250

$8,250

$16,500

Out-of-Pocket Maximum

Individual

Individual Under Family

Family

 

$6,000

$6,000

$12,000

 

$10,000

$10,000

$20,000

Preventive Care Services

No Charge

20%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

0%*

0%*

0%*

 

20%*

20%*

20%*

Urgent Care Services

0%*

20%*

Complex Imaging: MRI/CT/PET Scans

0%*

20%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

0%*

0%*

 

20%*

20%*

Outpatient Procedures

Facility Fee

Physician Fee

 

0%*

0%*

 

20%*

20%*

Emergency Room **

Emergency Medical Transportation **

0%*

0%*

0%*

0%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

0%*

0%*

 

20%*

20%*

Teladoc Benefits

General Consultations

Dermatology

 

$55 Copay

$85 Copay

 

$55 Copay

$85 Copay

NOTE: * Coinsurance After Deductible

**Services covered at in-network benefit level when the diagnosis is an Emergency Medical Condition.

Please refer to your Summary Plan Description for actual coverage, limitation, and exclusion provisions

 

 

 

 

 

 

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