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)
| 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 | $10 non-maintenance/$20 maintenance |
| Formulary Brand | 30% max $250 |
| Non-Formulary Brand | 40% max $350 |
| Prescription Drugs (Mail) | |
| Generic | $20 |
| Formulary Brand | 30% max $500 |
| Non-Formulary Brand | 40% max $700 |