Compare Essential Plans
There are several Essential Plans to fit your needs. All groups are eligible for Simple Plans and Basic Plans. Some groups may not be eligible for Edge Plans, Care 1 Plans, Plus Plans, or Premier Plans. Eligibility will be determined during a review of a group's claims experience data or employee health applications.
The premium equivalent is the shared monthly cost for the employer and employee.
| In-Network | Simple | Basic | Edge | Care 1 | Plus | Premier |
|---|---|---|---|---|---|---|
| Deductible (Single/Family) | None | None | None | None | None | None |
| Out-of-Pocket Limit (Single/Family) | None | None | None | None | None | None |
| Annual Physical* | Covered in Full | Covered in Full | Covered in Full | Covered in Full | Covered in Full | Covered in Full |
| Primary Care Office Visits | Not covered | $20 Copayment per visit. Limited to 6 visits per benefit year. | $30 Copayment | $30 Copayment | $30 Copayment | $30 Copayment |
| Specialist Care Office Visits | Not covered | Not covered | $50 Copayment | $50 Copayment | $50 Copayment | $50 Copayment |
| Physician Services in a Facility (Hospital, Outpatient Surgery) | Not covered | Not covered | $150 Copayment, then 0% Coinsurance. Limited to $500 per year. | $150 Copayment, then 0% Coinsurance. Limited to $500 per year. | $150 Copayment, then 0% Coinsurance. Limited to $750 per year. | $150 Copayment, then 0% Coinsurance. Limited to $1,000 per year. |
| Emergency Room Services | Not covered | Not covered | $250 Copayment, then 0% Coinsurance. Limited to $1,000 per year. | $250 Copayment, then 0% Coinsurance. Limited to $1,500 per year. | $250 Copayment, then 0% Coinsurance. Limited to $1,500 per year. | $250 Copayment, then 0% Coinsurance. Limited to $2,000 per year. |
| Inpatient Room and Care | Not covered | Not covered | Covered in Full. Limited to $150 per day benefit, limited to 30 days per year. | $1,000 Copayment per admission, then 0% Coinsurance. Limited to $500 per day benefit, limited to 30 days per year. | $1,000 Copayment per admission, then 0% Coinsurance. Limited to $1,000 per day benefit, limited to 30 days per year. | $1,000 Copayment per admission, then 0% Coinsurance. Limited to $1,500 per day benefit, limited to 30 days per year. |
| Non-Preventive Prescription Services (Prescription Drugs: Pharmacy Retail - up to a 30-Day Supply) | Not covered | Not covered | Not covered | $20 Copayment (Generic only up to $250 per prescription) | $20 Copayment (Generic only up to $250 per prescription) | $20 Copayment (Generic only up to $250 per prescription) |
| Preventive Prescription Services (Prescription Drugs, Pharmacy Retail – up to a 30-Day Supply) | Generic - Covered in full | Generic - Covered in full | Generic - Covered in full | Generic - Covered in full | Generic - Covered in full | Generic - Covered in full |
| Schedule of Benefits | Schedule of Benefits | Schedule of Benefits | Schedule of Benefits | Schedule of Benefits | Schedule of Benefits |