WiseCalc

Health Plan Price Estimator

Compare estimated monthly prices, deductibles, copays and service limits for 14 health coverage options. Estimates are not quotes or enrollment approval.

Estimated monthly prices. Final price, additional fees, state availability and eligibility depend on plan terms.

This age is used to look up the table price. Confirm which household member’s age applies before enrolling.

Estimated monthly price range: $859.99 – $2,000.32

Estimated monthly prices

Copays with annual service limits

No deductible, with copays from day one. Check the visit and hospital-day limits carefully.

Option 1

$997.01 / month

Limits to check

Hospital care is limited to 3 days per year. Maternity, hospice, brand and specialty prescriptions are not covered.

Benefits and cost sharing
Plan structure
Copays with annual service limits
Provider network
Provider network. Check your doctors before choosing.
ERISA sponsorship
Not listed. Confirm with an advisor.
Lifetime benefit maximum
Not listed. Confirm with an advisor.
Out-of-network coverage
Not listed. Confirm with an advisor.
How you pay for care
No deductible. Flat copays from day one, with per-year visit limits.
Deductible — per person
$0
Deductible — family
$0
Out-of-pocket maximum — per person
$7,350
Out-of-pocket maximum — family
$14,700
Plan and member share after deductible
None listed . copays only
Preventive care
Included (outside a hospital)
Telemedicine
$0 copay
Primary care visit
$25 copay 6 visits per year (outside a hospital)
Specialist visit
$50 copay 6 visits per year (outside a hospital)
Urgent care
$50 copay 2 visits per year
Chiropractic
Not listed. Confirm with an advisor.
Laboratory tests
$50 copay 3 visits per year, lab + radiology (outside a hospital)
Radiology (X-ray)
$50 copay 3 visits per year, lab + radiology (outside a hospital)
Advanced imaging (CT / MRI / PET)
$350 copay 1 per year (outside a hospital)
Emergency room
$350 copay 1 visit per year
Ambulance / emergency transport
$250 copay 1 per year (ground only)
Hospital stay
$350 copay per admission 3 days per year
Inpatient surgery
Included in inpatient copay 3 days per year
Outpatient surgery / facility
$350 copay 1 visit per year (outpatient hospital or free-standing facility)
Surgery in a medical office
Not listed. Confirm with an advisor.
Anesthesia / surgeon fees
Included in inpatient / outpatient copay (subject to benefit limit)
Delivery
Not covered
Prenatal / other maternity care
Not covered
Physical / occupational / speech therapy
$50 copay per day 6 visits per year
Home health care
$25 copay 5 visits per year
Skilled nursing facility
Not listed. Confirm with an advisor.
Durable medical equipment
Not listed. Confirm with an advisor.
Infusions / chemotherapy / radiotherapy
Not listed. Confirm with an advisor.
Allergy care
Not listed. Confirm with an advisor.
Hospice
Not covered
Outpatient mental health
Not listed. Confirm with an advisor.
Inpatient mental health
Not listed. Confirm with an advisor.
Preventive generic prescriptions
$0 copay
Generic prescriptions
$10 copay
Preferred-brand prescriptions
Not covered
Other brand prescriptions
Not covered
Specialty prescriptions
Not covered
Prescription conditions
Subject to formulary
Bill negotiation and patient assistance
Not listed. Confirm with an advisor.
Out-of-network deductible — per person / family
Not listed. Confirm with an advisor.
Out-of-network maximum — per person / family
Not listed. Confirm with an advisor.
Out-of-network plan and member share
Not listed. Confirm with an advisor.
Office visits outside the network
Not listed. Confirm with an advisor.
Lab and hospital outside the network
Not listed. Confirm with an advisor.
Emergency room outside the network
Not listed. Confirm with an advisor.
Prescriptions outside the network
Not listed. Confirm with an advisor.

Option 2

$1,455.22 / month

Limits to check

Hospital care is limited to 10 days per year. Maternity has a 12-month waiting period. Specialty and non-preferred brand prescriptions are not covered.

Benefits and cost sharing
Plan structure
Copays with annual service limits
Provider network
Provider network. Check your doctors before choosing.
ERISA sponsorship
Not listed. Confirm with an advisor.
Lifetime benefit maximum
Not listed. Confirm with an advisor.
Out-of-network coverage
Not listed. Confirm with an advisor.
How you pay for care
No deductible. Flat copays from day one, with per-year visit limits.
Deductible — per person
$0
Deductible — family
$0
Out-of-pocket maximum — per person
$5,000
Out-of-pocket maximum — family
$10,000
Plan and member share after deductible
None listed . copays only
Preventive care
Included (outside a hospital)
Telemedicine
$0 copay
Primary care visit
$15 copay 12 visits per year (outside a hospital)
Specialist visit
$25 copay 12 visits per year (outside a hospital)
Urgent care
$35 copay 3 visits per year
Chiropractic
Not listed. Confirm with an advisor.
Laboratory tests
$50 copay 4 visits per year, lab + radiology (outside a hospital)
Radiology (X-ray)
$50 copay 4 visits per year, lab + radiology (outside a hospital)
Advanced imaging (CT / MRI / PET)
$350 copay 3 per year (outside a hospital)
Emergency room
$350 copay 2 visits per year
Ambulance / emergency transport
$250 copay 2 per year (ground only)
Hospital stay
$350 copay per admission 10 days per year
Inpatient surgery
Included in inpatient copay 4 surgeries per year
Outpatient surgery / facility
$350 copay 2 visits per year (outpatient hospital or free-standing facility)
Surgery in a medical office
Not listed. Confirm with an advisor.
Anesthesia / surgeon fees
Included in inpatient / outpatient copay 4 inpatient + 2 outpatient per year
Delivery
$350 copay per admission (treated as inpatient stay) 12-month waiting period
Prenatal / other maternity care
$350 copay (professional services) 12-month waiting period
Physical / occupational / speech therapy
$50 copay per day 12 visits per year
Home health care
$25 copay 20 visits per year
Skilled nursing facility
Not listed. Confirm with an advisor.
Durable medical equipment
Not listed. Confirm with an advisor.
Infusions / chemotherapy / radiotherapy
Not listed. Confirm with an advisor.
Allergy care
Not listed. Confirm with an advisor.
Hospice
Not covered
Outpatient mental health
Not listed. Confirm with an advisor.
Inpatient mental health
Not listed. Confirm with an advisor.
Preventive generic prescriptions
$0 copay
Generic prescriptions
20% charge. Confirm the terms with an advisor.
Preferred-brand prescriptions
20% charge. Confirm the terms with an advisor.
Preferred-brand drug coverage is unclear: a 20% charge is listed, but a footnote excludes brand drugs except the base contraceptive benefit. Confirm with an advisor.
Other brand prescriptions
Not covered
Specialty prescriptions
Not covered
Prescription conditions
Subject to formulary
Bill negotiation and patient assistance
Not listed. Confirm with an advisor.
Out-of-network deductible — per person / family
Not listed. Confirm with an advisor.
Out-of-network maximum — per person / family
Not listed. Confirm with an advisor.
Out-of-network plan and member share
Not listed. Confirm with an advisor.
Office visits outside the network
Not listed. Confirm with an advisor.
Lab and hospital outside the network
Not listed. Confirm with an advisor.
Emergency room outside the network
Not listed. Confirm with an advisor.
Prescriptions outside the network
Not listed. Confirm with an advisor.

Deductible, then copays

Different deductibles, with the same service limits. Office visits share one annual allowance.

Option 3

$999.00 / month

Limits to check

Office visits: 10 combined per year. Hospital: 2 stays per year, up to 10 days each. Elective surgery is not covered. Maternity has a 12-month waiting period.

Benefits and cost sharing
Plan structure
Deductible Value Plan
Provider network
PPO provider network. Check your doctors before choosing.
ERISA sponsorship
Yes
Lifetime benefit maximum
Not listed. Confirm with an advisor.
Out-of-network coverage
Not listed. Confirm with an advisor.
How you pay for care
Deductible first, then flat copays with per-year visit limits. Telemedicine and preventive care are not subject to the deductible.
Deductible — per person
$250
Deductible — family
$500
Out-of-pocket maximum — per person
$9,200
Out-of-pocket maximum — family
$18,400
Plan and member share after deductible
None listed . flat copays after deductible
Preventive care
$0 copay Deductible does not apply
Telemedicine
$0 copay . deductible does not apply Virtual primary care, urgent care, mental health
Primary care visit
$50 copay after deductible 10 visits per year combined (primary care + specialist + urgent care)
Specialist visit
$50 copay after deductible 10 visits per year combined (primary care + specialist + urgent care)
Urgent care
$50 copay after deductible 10 visits per year combined (primary care + specialist + urgent care)
Chiropractic
$50 copay after deductible 12 visits per year
Laboratory tests
$25 copay after deductible 3 per year
3 tests per year are listed. Confirm whether this limit applies to each test type or to all three combined.
Radiology (X-ray)
$50 copay after deductible 3 per year
3 tests per year are listed. Confirm whether this limit applies to each test type or to all three combined.
Advanced imaging (CT / MRI / PET)
$200 copay after deductible 3 per year. prior authorization
3 tests per year are listed. Confirm whether this limit applies to each test type or to all three combined.
Emergency room
$250 copay after deductible 2 per year for accident + 2 per year for sickness
Ambulance / emergency transport
$250 copay after deductible 2 per year
Hospital stay
$1,000 copay after deductible 2 hospitalizations per year, 10-day limit each. prior authorization
Confirm whether the $1,000 hospital copay is charged once per admission or separately for surgery.
Inpatient surgery
$1,000 copay after deductible 2 surgeries per year. elective surgery not covered. prior authorization
Confirm whether the $1,000 hospital copay is charged once per admission or separately for surgery.
Outpatient surgery / facility
$250 copay after deductible 3 surgeries per year (office + outpatient). elective not covered. prior authorization
Surgery in a medical office
$250 copay after deductible Counts toward the 3 surgeries per year. prior authorization
Anesthesia / surgeon fees
Included in the surgery copay (surgeon, anesthesia, related services)
Confirm whether the $1,000 hospital copay is charged once per admission or separately for surgery.
Delivery
$250 copay routine vaginal / $500 copay routine C-section, after deductible 12-month waiting period
Prenatal / other maternity care
Covered 100% (office visits, lab, radiology, prenatal / postnatal care) Genetic testing excluded unless medically necessary. 12-month waiting period
Physical / occupational / speech therapy
$50 copay after deductible 16 visits per year combined (PT, OT, speech, cardiac rehab)
Home health care
$50 copay after deductible 10 days per year
Skilled nursing facility
$50 copay after deductible 10 days per year
Durable medical equipment
$50 copay per item after deductible 5 items per year
Infusions / chemotherapy / radiotherapy
$100 copay after deductible 10 visits per year combined. prior authorization
Allergy care
Shots: $25 copay, 24 visits per year Visits / testing: $50 copay, 2 visits per year (after deductible)
Hospice
Not listed. Confirm with an advisor.
Outpatient mental health
$50 copay after deductible 15 days per year
Inpatient mental health
$250 copay after deductible 15 days per year (within the inpatient hospitalization limit)
Preventive generic prescriptions
$0 copay Covered before the deductible
Generic prescriptions
$0 copay after deductible
Preferred-brand prescriptions
Not listed. Confirm with an advisor.
Other brand prescriptions
Not listed. Confirm with an advisor.
Specialty prescriptions
Not listed. Confirm with an advisor.
Prescription conditions
Only generic prescriptions is listed
Bill negotiation and patient assistance
Included
Out-of-network deductible — per person / family
Not listed. Confirm with an advisor.
Out-of-network maximum — per person / family
Not listed. Confirm with an advisor.
Out-of-network plan and member share
Not listed. Confirm with an advisor.
Office visits outside the network
Not listed. Confirm with an advisor.
Lab and hospital outside the network
Not listed. Confirm with an advisor.
Emergency room outside the network
Not listed. Confirm with an advisor.
Prescriptions outside the network
Not listed. Confirm with an advisor.

Option 4

$969.00 / month

Limits to check

Office visits: 10 combined per year. Hospital: 2 stays per year, up to 10 days each. Elective surgery is not covered. Maternity has a 12-month waiting period.

Benefits and cost sharing
Plan structure
Deductible Value Plan
Provider network
PPO provider network. Check your doctors before choosing.
ERISA sponsorship
Yes
Lifetime benefit maximum
Not listed. Confirm with an advisor.
Out-of-network coverage
Not listed. Confirm with an advisor.
How you pay for care
Deductible first, then flat copays with per-year visit limits. Telemedicine and preventive care are not subject to the deductible.
Deductible — per person
$500
Deductible — family
$1,000
Out-of-pocket maximum — per person
$9,200
Out-of-pocket maximum — family
$18,400
Plan and member share after deductible
None listed . flat copays after deductible
Preventive care
$0 copay Deductible does not apply
Telemedicine
$0 copay . deductible does not apply Virtual primary care, urgent care, mental health
Primary care visit
$50 copay after deductible 10 visits per year combined (primary care + specialist + urgent care)
Specialist visit
$50 copay after deductible 10 visits per year combined (primary care + specialist + urgent care)
Urgent care
$50 copay after deductible 10 visits per year combined (primary care + specialist + urgent care)
Chiropractic
$50 copay after deductible 12 visits per year
Laboratory tests
$25 copay after deductible 3 per year
3 tests per year are listed. Confirm whether this limit applies to each test type or to all three combined.
Radiology (X-ray)
$50 copay after deductible 3 per year
3 tests per year are listed. Confirm whether this limit applies to each test type or to all three combined.
Advanced imaging (CT / MRI / PET)
$200 copay after deductible 3 per year. prior authorization
3 tests per year are listed. Confirm whether this limit applies to each test type or to all three combined.
Emergency room
$250 copay after deductible 2 per year for accident + 2 per year for sickness
Ambulance / emergency transport
$250 copay after deductible 2 per year
Hospital stay
$1,000 copay after deductible 2 hospitalizations per year, 10-day limit each. prior authorization
Confirm whether the $1,000 hospital copay is charged once per admission or separately for surgery.
Inpatient surgery
$1,000 copay after deductible 2 surgeries per year. elective surgery not covered. prior authorization
Confirm whether the $1,000 hospital copay is charged once per admission or separately for surgery.
Outpatient surgery / facility
$250 copay after deductible 3 surgeries per year (office + outpatient). elective not covered. prior authorization
Surgery in a medical office
$250 copay after deductible Counts toward the 3 surgeries per year. prior authorization
Anesthesia / surgeon fees
Included in the surgery copay (surgeon, anesthesia, related services)
Confirm whether the $1,000 hospital copay is charged once per admission or separately for surgery.
Delivery
$250 copay routine vaginal / $500 copay routine C-section, after deductible 12-month waiting period
Prenatal / other maternity care
Covered 100% (office visits, lab, radiology, prenatal / postnatal care) Genetic testing excluded unless medically necessary. 12-month waiting period
Physical / occupational / speech therapy
$50 copay after deductible 16 visits per year combined (PT, OT, speech, cardiac rehab)
Home health care
$50 copay after deductible 10 days per year
Skilled nursing facility
$50 copay after deductible 10 days per year
Durable medical equipment
$50 copay per item after deductible 5 items per year
Infusions / chemotherapy / radiotherapy
$100 copay after deductible 10 visits per year combined. prior authorization
Allergy care
Shots: $25 copay, 24 visits per year Visits / testing: $50 copay, 2 visits per year (after deductible)
Hospice
Not listed. Confirm with an advisor.
Outpatient mental health
$50 copay after deductible 15 days per year
Inpatient mental health
$250 copay after deductible 15 days per year (within the inpatient hospitalization limit)
Preventive generic prescriptions
$0 copay Covered before the deductible
Generic prescriptions
$0 copay after deductible
Preferred-brand prescriptions
Not listed. Confirm with an advisor.
Other brand prescriptions
Not listed. Confirm with an advisor.
Specialty prescriptions
Not listed. Confirm with an advisor.
Prescription conditions
Only generic prescriptions is listed
Bill negotiation and patient assistance
Included
Out-of-network deductible — per person / family
Not listed. Confirm with an advisor.
Out-of-network maximum — per person / family
Not listed. Confirm with an advisor.
Out-of-network plan and member share
Not listed. Confirm with an advisor.
Office visits outside the network
Not listed. Confirm with an advisor.
Lab and hospital outside the network
Not listed. Confirm with an advisor.
Emergency room outside the network
Not listed. Confirm with an advisor.
Prescriptions outside the network
Not listed. Confirm with an advisor.

Option 5

$939.00 / month

Limits to check

Office visits: 10 combined per year. Hospital: 2 stays per year, up to 10 days each. Elective surgery is not covered. Maternity has a 12-month waiting period.

Benefits and cost sharing
Plan structure
Deductible Value Plan
Provider network
PPO provider network. Check your doctors before choosing.
ERISA sponsorship
Yes
Lifetime benefit maximum
Not listed. Confirm with an advisor.
Out-of-network coverage
Not listed. Confirm with an advisor.
How you pay for care
Deductible first, then flat copays with per-year visit limits. Telemedicine and preventive care are not subject to the deductible.
Deductible — per person
$750
Deductible — family
$1,500
Out-of-pocket maximum — per person
$9,200
Out-of-pocket maximum — family
$18,400
Plan and member share after deductible
None listed . flat copays after deductible
Preventive care
$0 copay Deductible does not apply
Telemedicine
$0 copay . deductible does not apply Virtual primary care, urgent care, mental health
Primary care visit
$50 copay after deductible 10 visits per year combined (primary care + specialist + urgent care)
Specialist visit
$50 copay after deductible 10 visits per year combined (primary care + specialist + urgent care)
Urgent care
$50 copay after deductible 10 visits per year combined (primary care + specialist + urgent care)
Chiropractic
$50 copay after deductible 12 visits per year
Laboratory tests
$25 copay after deductible 3 per year
3 tests per year are listed. Confirm whether this limit applies to each test type or to all three combined.
Radiology (X-ray)
$50 copay after deductible 3 per year
3 tests per year are listed. Confirm whether this limit applies to each test type or to all three combined.
Advanced imaging (CT / MRI / PET)
$200 copay after deductible 3 per year. prior authorization
3 tests per year are listed. Confirm whether this limit applies to each test type or to all three combined.
Emergency room
$250 copay after deductible 2 per year for accident + 2 per year for sickness
Ambulance / emergency transport
$250 copay after deductible 2 per year
Hospital stay
$1,000 copay after deductible 2 hospitalizations per year, 10-day limit each. prior authorization
Confirm whether the $1,000 hospital copay is charged once per admission or separately for surgery.
Inpatient surgery
$1,000 copay after deductible 2 surgeries per year. elective surgery not covered. prior authorization
Confirm whether the $1,000 hospital copay is charged once per admission or separately for surgery.
Outpatient surgery / facility
$250 copay after deductible 3 surgeries per year (office + outpatient). elective not covered. prior authorization
Surgery in a medical office
$250 copay after deductible Counts toward the 3 surgeries per year. prior authorization
Anesthesia / surgeon fees
Included in the surgery copay (surgeon, anesthesia, related services)
Confirm whether the $1,000 hospital copay is charged once per admission or separately for surgery.
Delivery
$250 copay routine vaginal / $500 copay routine C-section, after deductible 12-month waiting period
Prenatal / other maternity care
Covered 100% (office visits, lab, radiology, prenatal / postnatal care) Genetic testing excluded unless medically necessary. 12-month waiting period
Physical / occupational / speech therapy
$50 copay after deductible 16 visits per year combined (PT, OT, speech, cardiac rehab)
Home health care
$50 copay after deductible 10 days per year
Skilled nursing facility
$50 copay after deductible 10 days per year
Durable medical equipment
$50 copay per item after deductible 5 items per year
Infusions / chemotherapy / radiotherapy
$100 copay after deductible 10 visits per year combined. prior authorization
Allergy care
Shots: $25 copay, 24 visits per year Visits / testing: $50 copay, 2 visits per year (after deductible)
Hospice
Not listed. Confirm with an advisor.
Outpatient mental health
$50 copay after deductible 15 days per year
Inpatient mental health
$250 copay after deductible 15 days per year (within the inpatient hospitalization limit)
Preventive generic prescriptions
$0 copay Covered before the deductible
Generic prescriptions
$0 copay after deductible
Preferred-brand prescriptions
Not listed. Confirm with an advisor.
Other brand prescriptions
Not listed. Confirm with an advisor.
Specialty prescriptions
Not listed. Confirm with an advisor.
Prescription conditions
Only generic prescriptions is listed
Bill negotiation and patient assistance
Included
Out-of-network deductible — per person / family
Not listed. Confirm with an advisor.
Out-of-network maximum — per person / family
Not listed. Confirm with an advisor.
Out-of-network plan and member share
Not listed. Confirm with an advisor.
Office visits outside the network
Not listed. Confirm with an advisor.
Lab and hospital outside the network
Not listed. Confirm with an advisor.
Emergency room outside the network
Not listed. Confirm with an advisor.
Prescriptions outside the network
Not listed. Confirm with an advisor.

Option 6

$909.00 / month

Limits to check

Office visits: 10 combined per year. Hospital: 2 stays per year, up to 10 days each. Elective surgery is not covered. Maternity has a 12-month waiting period.

Benefits and cost sharing
Plan structure
Deductible Value Plan
Provider network
PPO provider network. Check your doctors before choosing.
ERISA sponsorship
Yes
Lifetime benefit maximum
Not listed. Confirm with an advisor.
Out-of-network coverage
Not listed. Confirm with an advisor.
How you pay for care
Deductible first, then flat copays with per-year visit limits. Telemedicine and preventive care are not subject to the deductible.
Deductible — per person
$1,000
Deductible — family
$2,000
Out-of-pocket maximum — per person
$9,200
Out-of-pocket maximum — family
$18,400
Plan and member share after deductible
None listed . flat copays after deductible
Preventive care
$0 copay Deductible does not apply
Telemedicine
$0 copay . deductible does not apply Virtual primary care, urgent care, mental health
Primary care visit
$50 copay after deductible 10 visits per year combined (primary care + specialist + urgent care)
Specialist visit
$50 copay after deductible 10 visits per year combined (primary care + specialist + urgent care)
Urgent care
$50 copay after deductible 10 visits per year combined (primary care + specialist + urgent care)
Chiropractic
$50 copay after deductible 12 visits per year
Laboratory tests
$25 copay after deductible 3 per year
3 tests per year are listed. Confirm whether this limit applies to each test type or to all three combined.
Radiology (X-ray)
$50 copay after deductible 3 per year
3 tests per year are listed. Confirm whether this limit applies to each test type or to all three combined.
Advanced imaging (CT / MRI / PET)
$200 copay after deductible 3 per year. prior authorization
3 tests per year are listed. Confirm whether this limit applies to each test type or to all three combined.
Emergency room
$250 copay after deductible 2 per year for accident + 2 per year for sickness
Ambulance / emergency transport
$250 copay after deductible 2 per year
Hospital stay
$1,000 copay after deductible 2 hospitalizations per year, 10-day limit each. prior authorization
Confirm whether the $1,000 hospital copay is charged once per admission or separately for surgery.
Inpatient surgery
$1,000 copay after deductible 2 surgeries per year. elective surgery not covered. prior authorization
Confirm whether the $1,000 hospital copay is charged once per admission or separately for surgery.
Outpatient surgery / facility
$250 copay after deductible 3 surgeries per year (office + outpatient). elective not covered. prior authorization
Surgery in a medical office
$250 copay after deductible Counts toward the 3 surgeries per year. prior authorization
Anesthesia / surgeon fees
Included in the surgery copay (surgeon, anesthesia, related services)
Confirm whether the $1,000 hospital copay is charged once per admission or separately for surgery.
Delivery
$250 copay routine vaginal / $500 copay routine C-section, after deductible 12-month waiting period
Prenatal / other maternity care
Covered 100% (office visits, lab, radiology, prenatal / postnatal care) Genetic testing excluded unless medically necessary. 12-month waiting period
Physical / occupational / speech therapy
$50 copay after deductible 16 visits per year combined (PT, OT, speech, cardiac rehab)
Home health care
$50 copay after deductible 10 days per year
Skilled nursing facility
$50 copay after deductible 10 days per year
Durable medical equipment
$50 copay per item after deductible 5 items per year
Infusions / chemotherapy / radiotherapy
$100 copay after deductible 10 visits per year combined. prior authorization
Allergy care
Shots: $25 copay, 24 visits per year Visits / testing: $50 copay, 2 visits per year (after deductible)
Hospice
Not listed. Confirm with an advisor.
Outpatient mental health
$50 copay after deductible 15 days per year
Inpatient mental health
$250 copay after deductible 15 days per year (within the inpatient hospitalization limit)
Preventive generic prescriptions
$0 copay Covered before the deductible
Generic prescriptions
$0 copay after deductible
Preferred-brand prescriptions
Not listed. Confirm with an advisor.
Other brand prescriptions
Not listed. Confirm with an advisor.
Specialty prescriptions
Not listed. Confirm with an advisor.
Prescription conditions
Only generic prescriptions is listed
Bill negotiation and patient assistance
Included
Out-of-network deductible — per person / family
Not listed. Confirm with an advisor.
Out-of-network maximum — per person / family
Not listed. Confirm with an advisor.
Out-of-network plan and member share
Not listed. Confirm with an advisor.
Office visits outside the network
Not listed. Confirm with an advisor.
Lab and hospital outside the network
Not listed. Confirm with an advisor.
Emergency room outside the network
Not listed. Confirm with an advisor.
Prescriptions outside the network
Not listed. Confirm with an advisor.

Option 7

$889.00 / month

Limits to check

Office visits: 10 combined per year. Hospital: 2 stays per year, up to 10 days each. Elective surgery is not covered. Maternity has a 12-month waiting period.

Benefits and cost sharing
Plan structure
Deductible Value Plan
Provider network
PPO provider network. Check your doctors before choosing.
ERISA sponsorship
Yes
Lifetime benefit maximum
Not listed. Confirm with an advisor.
Out-of-network coverage
Not listed. Confirm with an advisor.
How you pay for care
Deductible first, then flat copays with per-year visit limits. Telemedicine and preventive care are not subject to the deductible.
Deductible — per person
$1,500
Deductible — family
$3,000
Out-of-pocket maximum — per person
$9,200
Out-of-pocket maximum — family
$18,400
Plan and member share after deductible
None listed . flat copays after deductible
Preventive care
$0 copay Deductible does not apply
Telemedicine
$0 copay . deductible does not apply Virtual primary care, urgent care, mental health
Primary care visit
$50 copay after deductible 10 visits per year combined (primary care + specialist + urgent care)
Specialist visit
$50 copay after deductible 10 visits per year combined (primary care + specialist + urgent care)
Urgent care
$50 copay after deductible 10 visits per year combined (primary care + specialist + urgent care)
Chiropractic
$50 copay after deductible 12 visits per year
Laboratory tests
$25 copay after deductible 3 per year
3 tests per year are listed. Confirm whether this limit applies to each test type or to all three combined.
Radiology (X-ray)
$50 copay after deductible 3 per year
3 tests per year are listed. Confirm whether this limit applies to each test type or to all three combined.
Advanced imaging (CT / MRI / PET)
$200 copay after deductible 3 per year. prior authorization
3 tests per year are listed. Confirm whether this limit applies to each test type or to all three combined.
Emergency room
$250 copay after deductible 2 per year for accident + 2 per year for sickness
Ambulance / emergency transport
$250 copay after deductible 2 per year
Hospital stay
$1,000 copay after deductible 2 hospitalizations per year, 10-day limit each. prior authorization
Confirm whether the $1,000 hospital copay is charged once per admission or separately for surgery.
Inpatient surgery
$1,000 copay after deductible 2 surgeries per year. elective surgery not covered. prior authorization
Confirm whether the $1,000 hospital copay is charged once per admission or separately for surgery.
Outpatient surgery / facility
$250 copay after deductible 3 surgeries per year (office + outpatient). elective not covered. prior authorization
Surgery in a medical office
$250 copay after deductible Counts toward the 3 surgeries per year. prior authorization
Anesthesia / surgeon fees
Included in the surgery copay (surgeon, anesthesia, related services)
Confirm whether the $1,000 hospital copay is charged once per admission or separately for surgery.
Delivery
$250 copay routine vaginal / $500 copay routine C-section, after deductible 12-month waiting period
Prenatal / other maternity care
Covered 100% (office visits, lab, radiology, prenatal / postnatal care) Genetic testing excluded unless medically necessary. 12-month waiting period
Physical / occupational / speech therapy
$50 copay after deductible 16 visits per year combined (PT, OT, speech, cardiac rehab)
Home health care
$50 copay after deductible 10 days per year
Skilled nursing facility
$50 copay after deductible 10 days per year
Durable medical equipment
$50 copay per item after deductible 5 items per year
Infusions / chemotherapy / radiotherapy
$100 copay after deductible 10 visits per year combined. prior authorization
Allergy care
Shots: $25 copay, 24 visits per year Visits / testing: $50 copay, 2 visits per year (after deductible)
Hospice
Not listed. Confirm with an advisor.
Outpatient mental health
$50 copay after deductible 15 days per year
Inpatient mental health
$250 copay after deductible 15 days per year (within the inpatient hospitalization limit)
Preventive generic prescriptions
$0 copay Covered before the deductible
Generic prescriptions
$0 copay after deductible
Preferred-brand prescriptions
Not listed. Confirm with an advisor.
Other brand prescriptions
Not listed. Confirm with an advisor.
Specialty prescriptions
Not listed. Confirm with an advisor.
Prescription conditions
Only generic prescriptions is listed
Bill negotiation and patient assistance
Included
Out-of-network deductible — per person / family
Not listed. Confirm with an advisor.
Out-of-network maximum — per person / family
Not listed. Confirm with an advisor.
Out-of-network plan and member share
Not listed. Confirm with an advisor.
Office visits outside the network
Not listed. Confirm with an advisor.
Lab and hospital outside the network
Not listed. Confirm with an advisor.
Emergency room outside the network
Not listed. Confirm with an advisor.
Prescriptions outside the network
Not listed. Confirm with an advisor.

Higher deductible, fewer included visits

Two of four combined office visits are available before the deductible. Hospital stays have a five-day limit.

Option 8

$939.99 / month

Limits to check

Office visits: 4 combined per year (2 before and 2 after deductible). Hospital: 1 stay per year, up to 5 days. Elective surgery is not covered.

Benefits and cost sharing
Plan structure
High Deductible Value Plan
Provider network
PPO provider network. Check your doctors before choosing.
ERISA sponsorship
Yes
Lifetime benefit maximum
Not listed. Confirm with an advisor.
Out-of-network coverage
Not listed. Confirm with an advisor.
How you pay for care
Deductible first, then flat copays with tight per-year limits. Telemedicine, preventive care and 2 office visits are available before the deductible.
Deductible — per person
$2,000
Deductible — family
$4,000
Out-of-pocket maximum — per person
$9,200
Out-of-pocket maximum — family
$18,400
Plan and member share after deductible
None listed . flat copays after deductible
Preventive care
$0 copay (100%) Deductible does not apply
Telemedicine
$0 copay . deductible does not apply Virtual primary care, urgent care, mental health
Primary care visit
$50 copay 4 visits per year combined (primary care + specialist + urgent care): 2 before deductible, 2 after
Specialist visit
$50 copay 4 visits per year combined (primary care + specialist + urgent care): 2 before deductible, 2 after
Urgent care
$50 copay 4 visits per year combined (primary care + specialist + urgent care): 2 before deductible, 2 after
Chiropractic
Not listed. Confirm with an advisor.
Laboratory tests
$25 copay after deductible 3 per year
3 tests per year are listed. Confirm whether this limit applies to each test type or to all three combined.
Radiology (X-ray)
$50 copay after deductible 3 per year
3 tests per year are listed. Confirm whether this limit applies to each test type or to all three combined.
Advanced imaging (CT / MRI / PET)
$400 copay after deductible 3 per year. prior authorization
3 tests per year are listed. Confirm whether this limit applies to each test type or to all three combined.
Emergency room
$500 copay after deductible 1 emergency care visit per year
Ambulance / emergency transport
$500 copay after deductible "Emergency Services" . 1 per year
Emergency services are listed once per year. Confirm whether ambulance transport is included.
Hospital stay
$1,000 copay after deductible 1 hospitalization per year, 5-day limit. prior authorization
Confirm whether the $1,000 hospital copay is charged once per admission or separately for surgery.
Inpatient surgery
$1,000 copay after deductible 1 surgery per year. elective surgery not covered. prior authorization
Confirm whether the $1,000 hospital copay is charged once per admission or separately for surgery.
Outpatient surgery / facility
$500 copay after deductible 1 surgery per year (office + outpatient). elective not covered. prior authorization
Surgery in a medical office
$500 copay after deductible Counts toward the 1 surgery per year. prior authorization
Anesthesia / surgeon fees
Included in the surgery copay (surgeon, anesthesia, related services)
Confirm whether the $1,000 hospital copay is charged once per admission or separately for surgery.
Delivery
Not listed. Confirm with an advisor.
Prenatal / other maternity care
Not listed. Confirm with an advisor.
Physical / occupational / speech therapy
$50 copay after deductible 8 visits per year combined (physical & occupational only)
Home health care
Not listed. Confirm with an advisor.
Skilled nursing facility
Not listed. Confirm with an advisor.
Durable medical equipment
$50 copay per item after deductible 2 items per year
Infusions / chemotherapy / radiotherapy
Not listed. Confirm with an advisor.
Allergy care
Not listed. Confirm with an advisor.
Hospice
Not listed. Confirm with an advisor.
Outpatient mental health
Not listed. Confirm with an advisor.
Inpatient mental health
Not listed. Confirm with an advisor.
Preventive generic prescriptions
$0 copay Covered before the deductible
Generic prescriptions
$0 copay after deductible
Preferred-brand prescriptions
Not listed. Confirm with an advisor.
Other brand prescriptions
Not listed. Confirm with an advisor.
Specialty prescriptions
Not listed. Confirm with an advisor.
Prescription conditions
Only generic prescriptions is listed
Bill negotiation and patient assistance
Included
Out-of-network deductible — per person / family
Not listed. Confirm with an advisor.
Out-of-network maximum — per person / family
Not listed. Confirm with an advisor.
Out-of-network plan and member share
Not listed. Confirm with an advisor.
Office visits outside the network
Not listed. Confirm with an advisor.
Lab and hospital outside the network
Not listed. Confirm with an advisor.
Emergency room outside the network
Not listed. Confirm with an advisor.
Prescriptions outside the network
Not listed. Confirm with an advisor.

Option 9

$879.99 / month

Limits to check

Office visits: 4 combined per year (2 before and 2 after deductible). Hospital: 1 stay per year, up to 5 days. Elective surgery is not covered.

Benefits and cost sharing
Plan structure
High Deductible Value Plan
Provider network
PPO provider network. Check your doctors before choosing.
ERISA sponsorship
Yes
Lifetime benefit maximum
Not listed. Confirm with an advisor.
Out-of-network coverage
Not listed. Confirm with an advisor.
How you pay for care
Deductible first, then flat copays with tight per-year limits. Telemedicine, preventive care and 2 office visits are available before the deductible.
Deductible — per person
$4,000
Deductible — family
$8,000
Out-of-pocket maximum — per person
$9,200
Out-of-pocket maximum — family
$18,400
Plan and member share after deductible
None listed . flat copays after deductible
Preventive care
$0 copay (100%) Deductible does not apply
Telemedicine
$0 copay . deductible does not apply Virtual primary care, urgent care, mental health
Primary care visit
$50 copay 4 visits per year combined (primary care + specialist + urgent care): 2 before deductible, 2 after
Specialist visit
$50 copay 4 visits per year combined (primary care + specialist + urgent care): 2 before deductible, 2 after
Urgent care
$50 copay 4 visits per year combined (primary care + specialist + urgent care): 2 before deductible, 2 after
Chiropractic
Not listed. Confirm with an advisor.
Laboratory tests
$25 copay after deductible 3 per year
3 tests per year are listed. Confirm whether this limit applies to each test type or to all three combined.
Radiology (X-ray)
$50 copay after deductible 3 per year
3 tests per year are listed. Confirm whether this limit applies to each test type or to all three combined.
Advanced imaging (CT / MRI / PET)
$400 copay after deductible 3 per year. prior authorization
3 tests per year are listed. Confirm whether this limit applies to each test type or to all three combined.
Emergency room
$500 copay after deductible 1 emergency care visit per year
Ambulance / emergency transport
$500 copay after deductible "Emergency Services" . 1 per year
Emergency services are listed once per year. Confirm whether ambulance transport is included.
Hospital stay
$1,000 copay after deductible 1 hospitalization per year, 5-day limit. prior authorization
Confirm whether the $1,000 hospital copay is charged once per admission or separately for surgery.
Inpatient surgery
$1,000 copay after deductible 1 surgery per year. elective surgery not covered. prior authorization
Confirm whether the $1,000 hospital copay is charged once per admission or separately for surgery.
Outpatient surgery / facility
$500 copay after deductible 1 surgery per year (office + outpatient). elective not covered. prior authorization
Surgery in a medical office
$500 copay after deductible Counts toward the 1 surgery per year. prior authorization
Anesthesia / surgeon fees
Included in the surgery copay (surgeon, anesthesia, related services)
Confirm whether the $1,000 hospital copay is charged once per admission or separately for surgery.
Delivery
Not listed. Confirm with an advisor.
Prenatal / other maternity care
Not listed. Confirm with an advisor.
Physical / occupational / speech therapy
$50 copay after deductible 8 visits per year combined (physical & occupational only)
Home health care
Not listed. Confirm with an advisor.
Skilled nursing facility
Not listed. Confirm with an advisor.
Durable medical equipment
$50 copay per item after deductible 2 items per year
Infusions / chemotherapy / radiotherapy
Not listed. Confirm with an advisor.
Allergy care
Not listed. Confirm with an advisor.
Hospice
Not listed. Confirm with an advisor.
Outpatient mental health
Not listed. Confirm with an advisor.
Inpatient mental health
Not listed. Confirm with an advisor.
Preventive generic prescriptions
$0 copay Covered before the deductible
Generic prescriptions
$0 copay after deductible
Preferred-brand prescriptions
Not listed. Confirm with an advisor.
Other brand prescriptions
Not listed. Confirm with an advisor.
Specialty prescriptions
Not listed. Confirm with an advisor.
Prescription conditions
Only generic prescriptions is listed
Bill negotiation and patient assistance
Included
Out-of-network deductible — per person / family
Not listed. Confirm with an advisor.
Out-of-network maximum — per person / family
Not listed. Confirm with an advisor.
Out-of-network plan and member share
Not listed. Confirm with an advisor.
Office visits outside the network
Not listed. Confirm with an advisor.
Lab and hospital outside the network
Not listed. Confirm with an advisor.
Emergency room outside the network
Not listed. Confirm with an advisor.
Prescriptions outside the network
Not listed. Confirm with an advisor.

Option 10

$859.99 / month

Limits to check

Office visits: 4 combined per year (2 before and 2 after deductible). Hospital: 1 stay per year, up to 5 days. Elective surgery is not covered.

Benefits and cost sharing
Plan structure
High Deductible Value Plan
Provider network
PPO provider network. Check your doctors before choosing.
ERISA sponsorship
Yes
Lifetime benefit maximum
Not listed. Confirm with an advisor.
Out-of-network coverage
Not listed. Confirm with an advisor.
How you pay for care
Deductible first, then flat copays with tight per-year limits. Telemedicine, preventive care and 2 office visits are available before the deductible.
Deductible — per person
$6,000
Deductible — family
$12,000
Out-of-pocket maximum — per person
$9,200
Out-of-pocket maximum — family
$18,400
Plan and member share after deductible
None listed . flat copays after deductible
Preventive care
$0 copay (100%) Deductible does not apply
Telemedicine
$0 copay . deductible does not apply Virtual primary care, urgent care, mental health
Primary care visit
$50 copay 4 visits per year combined (primary care + specialist + urgent care): 2 before deductible, 2 after
Specialist visit
$50 copay 4 visits per year combined (primary care + specialist + urgent care): 2 before deductible, 2 after
Urgent care
$50 copay 4 visits per year combined (primary care + specialist + urgent care): 2 before deductible, 2 after
Chiropractic
Not listed. Confirm with an advisor.
Laboratory tests
$25 copay after deductible 3 per year
3 tests per year are listed. Confirm whether this limit applies to each test type or to all three combined.
Radiology (X-ray)
$50 copay after deductible 3 per year
3 tests per year are listed. Confirm whether this limit applies to each test type or to all three combined.
Advanced imaging (CT / MRI / PET)
$400 copay after deductible 3 per year. prior authorization
3 tests per year are listed. Confirm whether this limit applies to each test type or to all three combined.
Emergency room
$500 copay after deductible 1 emergency care visit per year
Ambulance / emergency transport
$500 copay after deductible "Emergency Services" . 1 per year
Emergency services are listed once per year. Confirm whether ambulance transport is included.
Hospital stay
$1,000 copay after deductible 1 hospitalization per year, 5-day limit. prior authorization
Confirm whether the $1,000 hospital copay is charged once per admission or separately for surgery.
Inpatient surgery
$1,000 copay after deductible 1 surgery per year. elective surgery not covered. prior authorization
Confirm whether the $1,000 hospital copay is charged once per admission or separately for surgery.
Outpatient surgery / facility
$500 copay after deductible 1 surgery per year (office + outpatient). elective not covered. prior authorization
Surgery in a medical office
$500 copay after deductible Counts toward the 1 surgery per year. prior authorization
Anesthesia / surgeon fees
Included in the surgery copay (surgeon, anesthesia, related services)
Confirm whether the $1,000 hospital copay is charged once per admission or separately for surgery.
Delivery
Not listed. Confirm with an advisor.
Prenatal / other maternity care
Not listed. Confirm with an advisor.
Physical / occupational / speech therapy
$50 copay after deductible 8 visits per year combined (physical & occupational only)
Home health care
Not listed. Confirm with an advisor.
Skilled nursing facility
Not listed. Confirm with an advisor.
Durable medical equipment
$50 copay per item after deductible 2 items per year
Infusions / chemotherapy / radiotherapy
Not listed. Confirm with an advisor.
Allergy care
Not listed. Confirm with an advisor.
Hospice
Not listed. Confirm with an advisor.
Outpatient mental health
Not listed. Confirm with an advisor.
Inpatient mental health
Not listed. Confirm with an advisor.
Preventive generic prescriptions
$0 copay Covered before the deductible
Generic prescriptions
$0 copay after deductible
Preferred-brand prescriptions
Not listed. Confirm with an advisor.
Other brand prescriptions
Not listed. Confirm with an advisor.
Specialty prescriptions
Not listed. Confirm with an advisor.
Prescription conditions
Only generic prescriptions is listed
Bill negotiation and patient assistance
Included
Out-of-network deductible — per person / family
Not listed. Confirm with an advisor.
Out-of-network maximum — per person / family
Not listed. Confirm with an advisor.
Out-of-network plan and member share
Not listed. Confirm with an advisor.
Office visits outside the network
Not listed. Confirm with an advisor.
Lab and hospital outside the network
Not listed. Confirm with an advisor.
Emergency room outside the network
Not listed. Confirm with an advisor.
Prescriptions outside the network
Not listed. Confirm with an advisor.

Deductible-based medical options

Compare copays and coinsurance carefully. Costs and prescription terms differ between these options.

Option 11

$2,000.32 / month

This price assumes payment by bank transfer (ACH).

Limits to check

Covered services remain subject to plan terms. Several benefits, including maternity and therapy, are not listed; confirm them before choosing.

Benefits and cost sharing
Plan structure
Classic Major Medical
Provider network
PPO provider network. Check your doctors before choosing.
ERISA sponsorship
Yes
Lifetime benefit maximum
No maximum
Out-of-network coverage
Yes. Separate deductibles and cost sharing apply; see details.
How you pay for care
Copays for office visits and prescriptions; deductible, then 20% coinsurance for lab, imaging, emergency care and hospital.
Deductible — per person
$3,500
Deductible — family
$7,000
Out-of-pocket maximum — per person
$7,350
Out-of-pocket maximum — family
$14,700
Plan and member share after deductible
Plan pays 80%; you pay 20%.
Preventive care
$0 copay
Telemedicine
Telemedicine included; cost details not listed.
Primary care visit
$45 copay
Specialist visit
$90 copay
Urgent care
$90 copay
Chiropractic
$20 copay
Laboratory tests
20% coinsurance After the applicable deductible.
Radiology (X-ray)
20% coinsurance After the applicable deductible.
Advanced imaging (CT / MRI / PET)
20% coinsurance After the applicable deductible.
Emergency room
20% coinsurance After the applicable deductible.
Ambulance / emergency transport
Not listed. Confirm with an advisor.
Hospital stay
20% coinsurance (physician fees & facility) After the applicable deductible.
Inpatient surgery
Not listed separately (see inpatient hospital)
Outpatient surgery / facility
20% coinsurance (outpatient hospital: physician fees & facility) After the applicable deductible.
Surgery in a medical office
Not listed. Confirm with an advisor.
Anesthesia / surgeon fees
Not listed. Confirm with an advisor.
Delivery
Not listed. Confirm with an advisor.
Prenatal / other maternity care
Not listed. Confirm with an advisor.
Physical / occupational / speech therapy
Not listed. Confirm with an advisor.
Home health care
Not listed. Confirm with an advisor.
Skilled nursing facility
Not listed. Confirm with an advisor.
Durable medical equipment
Not listed. Confirm with an advisor.
Infusions / chemotherapy / radiotherapy
Not listed. Confirm with an advisor.
Allergy care
Not listed. Confirm with an advisor.
Hospice
Not listed. Confirm with an advisor.
Outpatient mental health
Not listed. Confirm with an advisor.
Inpatient mental health
Not listed. Confirm with an advisor.
Preventive generic prescriptions
$0 copay
Generic prescriptions
$15 copay
Preferred-brand prescriptions
$65 copay
Other brand prescriptions
$100 copay
Specialty prescriptions
50% coinsurance
Prescription conditions
Participating pharmacy only. Brand requested when a generic exists: brand copay + cost difference (not counted toward out-of-pocket maximum).
Bill negotiation and patient assistance
Not listed. Confirm with an advisor.
Out-of-network deductible — per person / family
$7,000 / $14,000
Out-of-network maximum — per person / family
$14,700 / $29,400
Out-of-network plan and member share
Plan pays 60%; you pay 40%.
Office visits outside the network
40% coinsurance
Lab and hospital outside the network
40% coinsurance
Emergency room outside the network
20% coinsurance (same as in-network)
Prescriptions outside the network
N/A . participating pharmacy only

Option 12

$1,886.59 / month

This price assumes payment by bank transfer (ACH).

Limits to check

Covered services remain subject to plan terms. Several benefits, including maternity and therapy, are not listed; confirm them before choosing.

Benefits and cost sharing
Plan structure
Classic Major Medical
Provider network
PPO provider network. Check your doctors before choosing.
ERISA sponsorship
Yes
Lifetime benefit maximum
No maximum
Out-of-network coverage
Yes. Separate deductibles and cost sharing apply; see details.
How you pay for care
Copays for office visits and prescriptions; deductible, then 20% coinsurance for lab, imaging, emergency care and hospital.
Deductible — per person
$5,000
Deductible — family
$10,000
Out-of-pocket maximum — per person
$7,350
Out-of-pocket maximum — family
$14,700
Plan and member share after deductible
Plan pays 80%; you pay 20%.
Preventive care
$0 copay
Telemedicine
Telemedicine included; cost details not listed.
Primary care visit
$45 copay
Specialist visit
$90 copay
Urgent care
$90 copay
Chiropractic
$20 copay
Laboratory tests
20% coinsurance After the applicable deductible.
Radiology (X-ray)
20% coinsurance After the applicable deductible.
Advanced imaging (CT / MRI / PET)
20% coinsurance After the applicable deductible.
Emergency room
20% coinsurance After the applicable deductible.
Ambulance / emergency transport
Not listed. Confirm with an advisor.
Hospital stay
20% coinsurance (physician fees & facility) After the applicable deductible.
Inpatient surgery
Not listed separately (see inpatient hospital)
Outpatient surgery / facility
20% coinsurance (outpatient hospital: physician fees & facility) After the applicable deductible.
Surgery in a medical office
Not listed. Confirm with an advisor.
Anesthesia / surgeon fees
Not listed. Confirm with an advisor.
Delivery
Not listed. Confirm with an advisor.
Prenatal / other maternity care
Not listed. Confirm with an advisor.
Physical / occupational / speech therapy
Not listed. Confirm with an advisor.
Home health care
Not listed. Confirm with an advisor.
Skilled nursing facility
Not listed. Confirm with an advisor.
Durable medical equipment
Not listed. Confirm with an advisor.
Infusions / chemotherapy / radiotherapy
Not listed. Confirm with an advisor.
Allergy care
Not listed. Confirm with an advisor.
Hospice
Not listed. Confirm with an advisor.
Outpatient mental health
Not listed. Confirm with an advisor.
Inpatient mental health
Not listed. Confirm with an advisor.
Preventive generic prescriptions
$0 copay
Generic prescriptions
$15 copay
Preferred-brand prescriptions
$65 copay
Other brand prescriptions
$100 copay
Specialty prescriptions
50% coinsurance
Prescription conditions
Participating pharmacy only. Brand requested when a generic exists: brand copay + cost difference (not counted toward out-of-pocket maximum).
Bill negotiation and patient assistance
Not listed. Confirm with an advisor.
Out-of-network deductible — per person / family
$10,000 / $20,000
Out-of-network maximum — per person / family
$14,700 / $29,400
Out-of-network plan and member share
Plan pays 60%; you pay 40%.
Out-of-network office visits show conflicting percentages. Confirm your share with an advisor.
Office visits outside the network
Preventive / primary care / specialist: 60% as printed Chiropractic / urgent care: 40%
Out-of-network office visits show conflicting percentages. Confirm your share with an advisor.
Lab and hospital outside the network
40% coinsurance
Emergency room outside the network
20% coinsurance (same as in-network)
Prescriptions outside the network
N/A . participating pharmacy only

Option 13

$1,735.53 / month

This price assumes payment by bank transfer (ACH).

Limits to check

Covered services remain subject to plan terms. Several benefits, including maternity and therapy, are not listed; confirm them before choosing.

Benefits and cost sharing
Plan structure
Classic Major Medical
Provider network
PPO provider network. Check your doctors before choosing.
ERISA sponsorship
Yes
Lifetime benefit maximum
No maximum
Out-of-network coverage
Yes. Separate deductibles and cost sharing apply; see details.
How you pay for care
Deductible, then 20% coinsurance for all services; prescriptions copays apply after the deductible.
Deductible — per person
$5,000
Deductible — family
$10,000
Out-of-pocket maximum — per person
$6,550
Out-of-pocket maximum — family
$13,100
Plan and member share after deductible
Plan pays 80%; you pay 20%.
Preventive care
$0 copay
Telemedicine
Telemedicine included; cost details not listed.
Primary care visit
20% coinsurance After the applicable deductible.
Specialist visit
20% coinsurance After the applicable deductible.
Urgent care
20% coinsurance After the applicable deductible.
Chiropractic
20% coinsurance After the applicable deductible.
Laboratory tests
20% coinsurance After the applicable deductible.
Radiology (X-ray)
20% coinsurance After the applicable deductible.
Advanced imaging (CT / MRI / PET)
20% coinsurance After the applicable deductible.
Emergency room
20% coinsurance After the applicable deductible.
Ambulance / emergency transport
Not listed. Confirm with an advisor.
Hospital stay
20% coinsurance (physician fees & facility) After the applicable deductible.
Inpatient surgery
Not listed separately (see inpatient hospital)
Outpatient surgery / facility
20% coinsurance (outpatient hospital: physician fees & facility) After the applicable deductible.
Surgery in a medical office
Not listed. Confirm with an advisor.
Anesthesia / surgeon fees
Not listed. Confirm with an advisor.
Delivery
Not listed. Confirm with an advisor.
Prenatal / other maternity care
Not listed. Confirm with an advisor.
Physical / occupational / speech therapy
Not listed. Confirm with an advisor.
Home health care
Not listed. Confirm with an advisor.
Skilled nursing facility
Not listed. Confirm with an advisor.
Durable medical equipment
Not listed. Confirm with an advisor.
Infusions / chemotherapy / radiotherapy
Not listed. Confirm with an advisor.
Allergy care
Not listed. Confirm with an advisor.
Hospice
Not listed. Confirm with an advisor.
Outpatient mental health
Not listed. Confirm with an advisor.
Inpatient mental health
Not listed. Confirm with an advisor.
Preventive generic prescriptions
$0 copay
Generic prescriptions
$15 copay after deductible
Preferred-brand prescriptions
$65 copay after deductible
Other brand prescriptions
$100 copay after deductible
Specialty prescriptions
50% coinsurance
Prescription conditions
Participating pharmacy only. Brand requested when a generic exists: brand copay + cost difference (not counted toward out-of-pocket maximum).
Bill negotiation and patient assistance
Not listed. Confirm with an advisor.
Out-of-network deductible — per person / family
$10,000 / $20,000
Out-of-network maximum — per person / family
$13,100 / $26,200
Out-of-network plan and member share
Plan pays 50%; you pay 50%.
Office visits outside the network
50% coinsurance
Lab and hospital outside the network
50% coinsurance
Emergency room outside the network
20% coinsurance (same as in-network)
Prescriptions outside the network
N/A . participating pharmacy only

Option 14

$1,665.36 / month

This price assumes payment by bank transfer (ACH).

Limits to check

Covered services remain subject to plan terms. Several benefits, including maternity and therapy, are not listed; confirm them before choosing.

Benefits and cost sharing
Plan structure
Classic Major Medical
Provider network
PPO provider network. Check your doctors before choosing.
ERISA sponsorship
Yes
Lifetime benefit maximum
No maximum
Out-of-network coverage
Yes. Separate deductibles and cost sharing apply; see details.
How you pay for care
Deductible equals the out-of-pocket max; office-visit copays; plan pays 100% after the deductible.
Deductible — per person
$7,350
Deductible — family
$14,700
Out-of-pocket maximum — per person
$7,350
Out-of-pocket maximum — family
$14,700
Plan and member share after deductible
Plan pays 100%; you pay 0%.
Preventive care
$0 copay
Telemedicine
Telemedicine included; cost details not listed.
Primary care visit
$50 copay
Specialist visit
$100 copay
Urgent care
$100 copay
Chiropractic
$20 copay
Laboratory tests
0% coinsurance After the applicable deductible.
Radiology (X-ray)
0% coinsurance After the applicable deductible.
Advanced imaging (CT / MRI / PET)
0% coinsurance After the applicable deductible.
Emergency room
0% coinsurance After the applicable deductible.
Ambulance / emergency transport
Not listed. Confirm with an advisor.
Hospital stay
0% coinsurance (physician fees & facility) After the applicable deductible.
Inpatient surgery
Not listed separately (see inpatient hospital)
Outpatient surgery / facility
0% coinsurance (outpatient hospital: physician fees & facility) After the applicable deductible.
Surgery in a medical office
Not listed. Confirm with an advisor.
Anesthesia / surgeon fees
Not listed. Confirm with an advisor.
Delivery
Not listed. Confirm with an advisor.
Prenatal / other maternity care
Not listed. Confirm with an advisor.
Physical / occupational / speech therapy
Not listed. Confirm with an advisor.
Home health care
Not listed. Confirm with an advisor.
Skilled nursing facility
Not listed. Confirm with an advisor.
Durable medical equipment
Not listed. Confirm with an advisor.
Infusions / chemotherapy / radiotherapy
Not listed. Confirm with an advisor.
Allergy care
Not listed. Confirm with an advisor.
Hospice
Not listed. Confirm with an advisor.
Outpatient mental health
Not listed. Confirm with an advisor.
Inpatient mental health
Not listed. Confirm with an advisor.
Preventive generic prescriptions
$0 copay
Generic prescriptions
0% coinsurance
Preferred-brand prescriptions
0% coinsurance
Other brand prescriptions
0% coinsurance
Specialty prescriptions
0% coinsurance
Prescription conditions
Participating pharmacy only. Brand requested when a generic exists: brand copay + cost difference (not counted toward out-of-pocket maximum).
Bill negotiation and patient assistance
Not listed. Confirm with an advisor.
Out-of-network deductible — per person / family
$14,700 / $29,400
Out-of-network maximum — per person / family
$14,700 / $29,400
Out-of-network plan and member share
Plan pays 100%; you pay 0%.
Office visits outside the network
0% coinsurance
Lab and hospital outside the network
0% coinsurance
Emergency room outside the network
0% coinsurance
Prescriptions outside the network
N/A . participating pharmacy only

Coverage must be confirmed in the complete plan terms. Not listed does not mean free, unlimited, covered or excluded. Annual service limits can apply even when an out-of-pocket maximum is shown. Employment or group requirements may apply.

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