Medical Insurance Overview

Cost per pay period per coverage level:

Employee Only: $25.00 (Without Wellness: $63.00)

Employee + Spouse: $266.50 (Without Wellness: $273)

Employee + Child(ren): $137.50 (Without Wellness: $144) 

Employee + Family: $382.00 (Without Wellness: $388.50)

Deductible and Out-of-Pocket Maximum:

Deductible: $1,250 Individual and $3,750 Family

Out-of-Pocket-Maximum $4,890 Individual and $14,670 Family

Office Visits:

PCP: $20 Copay

Specialist: $30 Copay

Preventative Services: $20 Copay 

(Colonoscopy/Mammogram $0)

Hospital Related Cost

Hospital Inpatient: 20% after deductible has been met.

Hospital Outpatient: 20% after deductible has been met.

Emergency Room Visit: $200 Copay Then Subject to Co-Insurance after Deductible is Met.

Urgent Care Visit: $30 Copay

Prescription Drugs

Retail 31 Day or Mail Order 90 Day Supply

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$10 Copay- Tier 1

$30 Copay- Tier 2

$45 Copay- Tier 3

25% up to $100 Max- Tier 4