Navigator VBP

VBP HDHP

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

VBP HDHP Plans offer the same features as Navigator VBP but with a lower premium equivalent and higher deductible. Coverage and costs vary by plan.

Tier 1In-Network	3000 Plan	5000 Plan
Deductible (Single / Family)	$3,000 / $6,000	$5,000 / $10,000
Out-of-Pocket Limit (Single / Family)	$7,050 / $14,100	$7,050 / $14,100
Tier 2Out-of-Network	3000 Plan	5000 Plan
Deductible (Single / Family)	$6,000 / $12,000	$10,000 / $20,000
Out-of-Pocket Limit (Single / Family)	$8,000 / $16,000	$13,200 / $26,400
	Schedule of Benefits	Schedule of Benefits

Medical and pharmacy plans

Physician & Ancillary Services	In-Network	Out-of-Network
Primary Care Office Visit	20% Coinsurance ^*	50% Coinsurance ^**
Specialist Office Visit	20% Coinsurance ^*	50% Coinsurance ^**
Other Services (Performed in Office)	20% Coinsurance ^*	50% Coinsurance ^**
Physician Services (Performed in a Facility)	20% Coinsurance ^*	50% Coinsurance ^**
Urgent Care Visit	20% Coinsurance ^*	50% Coinsurance ^**
Maternity Physician Services	20% Coinsurance ^*	50% Coinsurance ^**
Lab Services (Non-Hospital)	20% Coinsurance ^*	50% Coinsurance ^**
Rehab & Therapy (Non-Hospital)	20% Coinsurance ^*	50% Coinsurance ^**
Alternative Care (Chiropractic, Acupuncture, Massage Therapy)	20% Coinsurance ^*	50% Coinsurance ^**
Facility-Based Services
Emergency Services Hospital ER (Facility Charge Only)	20% Coinsurance (Network not applicable) ^***	20% Coinsurance (Network not applicable) ^***
Ambulance – Emergent (Ground Only)	20% Coinsurance (Network not applicable) ^***	20% Coinsurance (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	20% Coinsurance (Network not applicable) ^{† *** ††}	20% Coinsurance (Network not applicable) ^{† *** ††}
Inpatient Hospitalizations	20% Coinsurance (Network not applicable) ^{† *** ††}	20% Coinsurance (Network not applicable) ^{† *** ††}
Transplant Procedures	20% Coinsurance (Network not applicable) ^{*** ††}	20% Coinsurance (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)	20% Coinsurance ^*	Not Covered
Specialty Drugs	20% Coinsurance ^*	Not Covered

^* After Annual Deductible.
^** After Annual Deductible plus amounts that exceed the Maximum Allowed Charge.
^*** After Annual Deductible plus amounts that exceed the Maximum Allowable 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

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Navigator VBP

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VBP

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.

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