Use our online Approved Drug List to search by drug name, see what drugs your plan covers and check what your copayment will be.
Value plan | Standard plan | High plan | |
|---|---|---|---|
Deductible Your medical-only deductible is the amount you pay before the health plan starts to pay for certain services. Some services have a copayment before you meet your deductible. | $1,500 single $3,000 family | $350 single | $0 single |
Primary care visits This is the amount you can expect to pay at your primary care doctor, before and after you meet your deductible. | $10 copayment | $15 copayment | $10 copayment |
Virtual care Virtual care is great option when you have a non-life-threatening condition but can't wait for a doctor's appointment. The best part? We cover in-network virtual care in full which means you won't pay anything out-of-pocket to receive care. | Covered in full | Covered in full | Covered in full |
Specialist visits | $35 copayment Deductible applies | $45 copayment | $35 copayment |
Urgent care visit | $75 copayment Deductible applies | $75 copayment | $75 copayment |
Allergy testing, serum & injections Covered in full means you will pay nothing out-of-pocket for these services when you receive care. | Covered in full | Covered in full | Covered in full |
Outpatient services Coinsurance is your portion of the cost for the medical service. The standard and value plan coinsurance applies after you meet your deductible. | 10% coinsurance | 20% coinsurance | Covered in full |
Inpatient and outpatient labs & X-ray services Coinsurance is your portion of the cost for the medical service. The standard and value plan coinsurance applies after you meet your deductible. | 10% coinsurance | 20% coinsurance | 10% coinsurance |
Emergency room Copayment waived if admitted. | $200 copayment Deductible applies. | $200 copayment Deductible applies. | $200 copayment |
Ambulance services | $150 copayment Deductible applies. | $150 copayment Deductible applies. | $150 copayment |
Prior deductible carryover | No | Yes | Not applicable |
Prescription drugs
Value plan | Standard plan | High plan | |
|---|---|---|---|
Generic | $20 copayment | $20 copayment | $15 copayment |
Preferred brand | $60 copayment | $60 copayment | $50 copayment |
Non-preferred brand | $90 copayment | $90 copayment | $80 copayment |
Preferred specialty | 20% coinsurance ($200 limit for 31-day supply) | 20% coinsurance ($200 limit for 31-day supply) | 20% coinsurance ($150 limit for 31-day supply) |
Non-preferred specialty | 20% coinsurance ($400 limit for 31-day supply) | 20% coinsurance ($400 limit for 31-day supply) | 20% coinsurance ($300 limit for 31-day supply) |