Compare health plan details
Check out what’s covered — and the benefit amounts — with each different plan.
Choice Plan Choose a different plan | |||
|---|---|---|---|
Network coverage Does this plan cover both network and out-of-network providers? | No — covers network doctors and facilities only | No — covers network doctors and facilities only | No — covers network doctors and facilities only |
Primary Care Provider Is a Primary Care Provider (PCP) required with this plan? | No — this plan does not require a PCP | Yes — this plan requires you to choose a PCP | Yes — this plan requires you to choose a PCP |
Savings account option Does this plan offer a savings or reimbursement account that can be used toward health expenses? | No | No | No |
Choice Plan Choose a different plan | |||
|---|---|---|---|
Search for providers Find out if your doctor, clinic or facility is in the network |
Choice Plan Choose a different plan | |||
|---|---|---|---|
Deductible amounts | |||
Individual | |||
Network | $0 | $0 | $0 |
Out-of-network | Not Applicable | Not Applicable | $500 |
Family | |||
Network | $0 | $0 | $0 |
Out-of-network | Not Applicable | Not Applicable | $500 |
Out-of-pocket limits | |||
Individual | |||
Network | $2,500 | $2,500 | $2,500 |
Out-of-network | Not Applicable | Not Applicable | $3,000 |
Family | |||
Network | $5,000 | $5,000 | $5,000 |
Out-of-network | Not Applicable | Not Applicable | $6,000 |
Choice Plan Choose a different plan | |||
|---|---|---|---|
Doctors and specialists | |||
Primary care visit (illness or injury) | |||
Network | $20 and 0% | $20 and 0% | $20 and 0% |
Out-of-network | Not Applicable | Not Applicable | $0 and 30% after deductible |
Specialist visit | |||
Network | $40 and 0% | $40 copay with referral and 0% | $40 copay with referral and 0% |
Out-of-network | Not Applicable | Not Applicable | $0 and 30% |
Virtual, urgent and emergency care | |||
24/7 Virtual Visit (online doctor) | |||
Network | $0 and 0% | $0 and 0% | $0 and 0% |
Out-of-network | Not Applicable | Not Applicable | $0 and 30% after deductible |
Emergency room | |||
Network | $200 and 0% | $200 and 0% | $200 and 0% |
Out-of-network | Not Applicable | Not Applicable | $200 and 0% |
Choice Plan Choose a different plan | |||
|---|---|---|---|
Prescription drugs | |||
Retail - up to 31 day supply | |||
Tier level 1 | $20 | $20 | $20 |
Tier level 2 | $50 | $50 | $50 |
Tier level 3 | $70 | $70 | $70 |
Home delivery - up to 90 day supply | |||
Tier level 1 | $40 | $100 | Not Applicable |
Tier level 2 | $100 | $140 | Not Applicable |
Tier level 3 | $140 | $140 | Not Applicable |
Important information | Tier level 1: $ - generic. | ||