Navigator VBP

VBP

Navigator Value-Based Pricing (VBP) Plans use negotiated pricing to reduce the cost of benefits up to 40% when compared to traditional PPO networks.

Unlike traditional PPO health plans that limit hospital access, VBP allows patients the ability to select any hospital or facility they choose by connecting with a Care Advocate. Coverage and costs vary by plan.

Tier 1In-Network	1000 Plan	2000 Plan	3000 Plan	5000 Plan
Deductible (Single / Family)	$1,000 / $3,000	$2,000 / $6,000	$3,000 / $6,000	$5,000 / $10,000
Out-of-Pocket Limit (Single / Family)	$8,700 / $17,400	$8,700 / $17,400	$8,700 / $17,400	$8,700 / $17,400
Tier 2Out-of-Network	1000 Plan	2000 Plan	3000 Plan	5000 Plan
Deductible (Single / Family)	$2,000 / $6,000	$4,000 / $12,000	$6,000 / $12,000	$10,000 / $20,000
Out-of-Pocket Limit (Single / Family)	$17,400 / $34,800	$17,400 / $34,800	$17,400 / $34,800	$17,400 / $34,800
	Schedule of Benefits	Schedule of Benefits	Schedule of Benefits	Schedule of Benefits

Medical and pharmacy plans

The benefit coinsurances and copayments listed here are for Navigator VBP 1000. Please see the full Plan Summaries for Navigator VBP 2000, 3000, and 5000.

Physician & Ancillary Services	In-Network	Out-of-Network
Primary Care Office Visit	$35 Copay (Per Visit)	40% Coinsurance ^**
Specialist Office Visit	$35 Copay (Per Visit)	40% Coinsurance ^**
Other Services (Performed in Office)	20% Coinsurance ^*	40% Coinsurance ^**
Physician Services (Performed in a Facility)	20% Coinsurance ^*	40% Coinsurance ^**
Urgent Care Visit	$75 Copay (Per Visit)	40% Coinsurance ^**
Maternity Physician Services	20% Coinsurance ^*	40% Coinsurance ^**
Lab Services (Non-Hospital)	Covered in Full	40% Coinsurance ^**
Rehab & Therapy (Non-Hospital)	$35 Copay (Per Visit)	40% Coinsurance ^**
Alternative Care (Chiropractic, Acupuncture, Massage Therapy)	$35 Copay (Per Visit)	40% Coinsurance ^**
Facility-Based Services
Emergency Services Hospital ER (Facility Charge Only)	$150 Copayment (Network not applicable) ^***	$150 Copayment (Network not applicable) ^***
Ambulance – Emergent (Ground Only)	$200 Copayment (Network not applicable) ^†	$200 Copayment (Network not applicable) ^†
Radiology (Hospital Outpatient)	20% Coinsurance (Network not applicable) ^{‡ †† ‡‡}	20% Coinsurance (Network not applicable) ^{‡ †† ‡‡}
Dialysis & Supplies	20% Coinsurance (Network not applicable) ^{†† ‡‡}	20% Coinsurance (Network not applicable) ^{†† ‡‡}
Outpatient Services (Cardiac, Pulmonary, PT, OT, ST)	20% Coinsurance (Network not applicable) ^{‡ †† ‡‡}	20% Coinsurance (Network not applicable) ^{‡ †† ‡‡}
Outpatient Surgeries	$150 Copayment (Network not applicable) ^{‡ *** ‡‡}	$150 Copayment (Network not applicable) ^{‡ *** ‡‡}
Inpatient Hospitalizations	$450 Copayment (Network not applicable) ^{‡ † ‡‡}	$450 Copayment (Network not applicable) ^{‡ † ‡‡}
Transplant Procedures	$450 Copayment (Network not applicable) ^{† ‡‡}	$450 Copayment (Network not applicable) ^{† ‡‡}
Prescription Drug Benefits	In-Network	Out-of-Network
Preventive Prescription Services (Prescription Drugs, Pharmacy Retail – up to a 30-Day Supply)	Generic - $0 Copayment	Not Covered
Non-Preventive Prescription Services (Prescription Drugs, Pharmacy Retail – up to a 30-Day Supply)	Generic - $10 Copay Preferred Brand - $20 Copay	Not Covered
Specialty Drugs	50% Coinsurance	Not Covered

^* After Annual Deductible.
^** After Annual Deductible plus amounts that exceed the Maximum Allowed Charge.
^*** Plus amounts that exceed the Maximum Allowable Charge (waived if admitted to Inpatient status)
^† Plus amounts that exceed the Maximum Allowable Charge.
^†† After Annual Deductible plus amounts that exceed the Maximum Allowed Charge. In-Network Annual Deductible and Annual Out-of-Pocket Maximum applies. Amounts in excess of the Maximum Allowable Charge DO NOT apply to the Annual Deductible NOR the Annual Out-of-Pocket Maximum.
^‡ In certain cases, when the member works with a Care Advocate and chooses to be redirected, member cost sharing may be waived.
^‡‡ Prior authorization required. If prior authorization is not obtained, benefits could be reduced by 25%.

Care Advocates

The cost of care at hospitals and facilities can be expensive for both members and employers. Care Advocates can negotiate lower costs on your behalf, often with a $0 copay.

Read real-life stories

View Navigator VBP HDHP Plans

VBP

VBP HDHP

Value-Based Pricing, High-Deductible Health Plans (VBP HDHP) offer the same features as Navigator VBP but with a lower premium equivalent and higher deductible.

View VBP HDHP Plans

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