Here’s a look at what you pay to receive medical care.
What You Pay for Medical Care
| HealthSaver | PPO1 | PPO2 | |
|---|---|---|---|
| Deductible | |||
| Individual | |||
| In-Network | $1,900 | $500 | $1,000 |
| Out-of-Network | $3,800 | ||
| Family | |||
| In-Network | $3,800 | $1,000 | $2,000 |
| Out-of-Network | $7,600 | ||
| Preventive Care (eligible routine services, including wellness-related lab tests and cancer screenings) | |||
| In-Network | No cost to you (if billed for an office visit, see office visits below) | No cost to you (if billed for an office visit, see office visits below) | No cost to you (if billed for an office visit, see office visits below) |
| Out-of-Network | 40% after deductible | 20% (no deductible) | 20% (no deductible) |
| MDLIVE (virtual medical and behavioral health office visits) | |||
| In-Network | 20% after deductible | $25 copayment | $35 copayment |
| Out-of-Network | Not applicable | Not applicable | Not applicable |
| Primary Care Physician Office Visit | |||
| In-Network | 20% after deductible | $25 copayment | $35 copayment |
| Out-of-Network | 40% after deductible | 40% after deductible | 40% after deductible |
| Specialist Office Visit | |||
| In-Network | 20% after deductible | $40 copayment | $50 copayment |
| Out-of-Network | 40% after deductible | 40% after deductible | 40% after deductible |
| Hospital Stay (precertification required for out-of-network stays) | |||
| In-Network | 20% after deductible | 20% after $250 copayment plus deductible | 20% after $250 copayment plus deductible |
| Out-of-Network | 40% after deductible | 40% after $250 copayment plus deductible | 40% after $250 copayment plus deductible |
| Outpatient Surgery | |||
| In-Network | 20% after deductible | 20% after deductible | 20% after deductible |
| Out-of-Network | 40% after deductible | 40% after deductible | 40% after deductible |
| Diagnostic Tests (lab, X-ray and imaging, such as an MRI or CAT scan) | |||
| In-Network | 20% after deductible | 20% after deductible | 20% after deductible |
| Out-of-Network | 40% after deductible | 40% after deductible | 40% after deductible |
| Chiropractic Care (up to 20 visits per year per person) | |||
| In-Network | 20% after deductible | 20% after deductible | 20% after deductible |
| Out-of-Network | 40% after deductible | 40% after deductible | 40% after deductible |
| Physical, Occupational and Speech Therapy (up to a combined maximum of 60 visits per year per person) |
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| In-Network | 20% after deductible | 20% after deductible | 20% after deductible |
| Out-of-Network | 40% after deductible | 40% after deductible | 40% after deductible |
| Fertility and Surrogacy Benefits | |||
| In-Network | 20% after deductible | 20% after deductible | 20% after deductible |
| Out-of-Network | 40% after deductible | 40% after deductible | 40% after deductible |
| Emergency Room (ER) | |||
| In-Network | 20% after deductible | 20% after $150 copayment plus deductible | 20% after $150 copayment plus deductible |
| Out-of-Network | 20% after deductible | 20% after $150 copayment plus deductible | 20% after $150 copayment plus deductible |
| Annual Out-of-Pocket Maximum | |||
| Individual | |||
| In-Network | $4,900 | $2,500 | $4,100 |
| Out-of-Network | $9,800 | $4,800 | $7,500 |
| Family | |||
| In-Network | $9,800 | $5,000 | $8,200 |
| Out-of-Network | $19,600 | $9,600 | $15,000 |
Travel Expenses
Eligible travel expenses are covered for any eligible in-network covered service (medical and behavioral health) that isn’t available within 100 miles of your home address.
- HealthSaver: You must first meet the deductible. Then, you will be reimbursed for 100% of the billed amount of eligible expenses, up to the applicable maximum.
- PPO1 and PPO2: You will be reimbursed for 100% of the billed amount of eligible expenses.
Covering Family? Know How the Family Deductible Works
All three plans have separate individual and family deductibles. The individual deductibles work the same, but the family deductibles work differently.
- HealthSaver: If you have family coverage, there is no individual deductible. The entire family deductible must be met before expenses are paid for any covered family member. However, if you enroll in any level of family coverage, the in-network family out-of-pocket maximum is $9,800, but no individual will pay more than $4,900.
- PPO1 and PPO2: If a family member meets the individual deductible, the plan will start to pay benefits for that family member — even if the family deductible hasn’t been met. Once the family deductible is met, the plan will pay benefits for all covered family members.
What You Pay for Coverage
Now that you know what you will pay for services, see what you will pay to have medical coverage.