Medical

Medical coverage offers healthcare protection for you and your family. Preventive Care – like physical exams, flu shots, and screenings – is always covered 100% when you use in-network providers.You may visit any medical provider you choose, but in-network providers offer the highest level of benefits and lower out-of-pocket costs. Network providers charge members reduced, contracted fees instead of their typical fees. Providers outside the plan’s network set their own rates, so you may be responsible for the difference if a provider’s fees are above the Reasonable and Customary (R&C) limits. 

Medical Plan Glossary

Out-of-Pocket Maximum

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.

Annual Deductible

The amount you pay each year for eligible in-network and out-of-network charges before the plan begins to pay.

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.

Medical Plan Comparison

 Plan 1Plan 2
 In-NetworkIn-NetworkOut-of-Network
 You Pay
Calendar Year Deductible
Individual$XXXX%$XXXX%
Family$XXXX%$XXXX%
Calendar Year Out-of-Pocket Maximum (Includes Deductible)
Individual$XXXX%$XXXX%
Family$XXXX%$XXXX%
Coinsurance / Copays
Preventive Care$XXXX%$XXXX%
Primary Care Physician$XXXX%$XXXX%
Specialist$XXXX%$XXXX%
Urgent Care$XXXX%$XXXX%
Emergency Room$XXXX%$XXXX%
Retail Rx (up to 30-day supply)
Generic$XXXX%$XXXX%
Brand Preferred$XXXX%$XXXX%
Brand Non-Preferred$XXXX%$XXXX%
Mail Order Rx (up to 90-day supply)
Generic$XXXX%$XXXX%
Brand Preferred$XXXX%$XXXX%
* After Deductible