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Plan Information

What you need to know during Open Season

Our find a doctor tool will allow you to easily look up your healthcare providers to make sure they are still in-network.

Are my prescriptions still covered? Our prescription tool will allow you to look up all your current medications and their costs. Questions? We are here to help 24/7 – call our advocacy service at 833-960-4025 TTY: 711 for answers to all of your questions.

2024 Plan Documents:

Take a closer look at your plan (in-network coverage only)

Benefits Overview
2024 Plan Design What You Will Pay
Annual Deductible (Ind/Fam) $2,000 / $4,000
Out-of-Pocket Maximum (Ind/Fam) $7,000 / $14,000
Employee Coinsurance 30%
Primary Care Office Visits $30
Specialist Care Office Visits $60
Inpatient Hospital Deductible + 30% coins
Emergency Room Emergent: $300 + 30% coinsurance;
Non-emergency: $600 subject to deductible & coinsurance
Urgent Care $50
Routine Lab & X-Ray 30% after deductible
Prescription Drugs (Retail)
Generic $20
Formulary Brand 30% max $250
Non-Formulary Brand 40% max $350
Prescription Drugs (Mail)
Generic $25
Formulary Brand 30% max $500
Non-Formulary Brand 40% max $700