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Plan Overview
- Premium savings making this plan ideal for cost-sensitive employers
- Care coordinated by a medical home team
- Ultimate plan design flexibility
- ExpressCare services are covered in full; deductible waived
- An annual eye exam from participating providers after a $10 copay (copay only applies to adults)
- Designation of Medical Home required
- No referrals required for in-network specialty care
- Premium savings making this plan ideal for cost-sensitive employers
- Care coordinated by a medical home team
- Ultimate plan design flexibility
- ExpressCare services are covered in full; deductible waived
- An annual eye exam from participating providers after a $10 copay (copay only applies to adults)
- Designation of Medical Home required
- No referrals required for in-network specialty care
- Live 24/7 customer service
- Online access to account information anytime–from paying providers to viewing claims
- Integrated plan setup, enrollment, claims administration and billing so that health plan and member accounts are set up in one convenient place
- A fully-equipped employer portal for all your contribution and reporting needs
- Free HealthEquity mobile app gives members on-the-go access to account information
- An annual eye exam from participating providers after a $10 copay (copay only applies to adults)
- Lowest premiums of all Option Advantage plans
- Comprehensive, robust coverage and predictable costs
- Ultimate plan design flexibility
- Most benefits subject to the deductible
- Deductible waived on in-network PCP visits, including Naturopaths, preventative services, ExpressCare, and prescription drugs only.
- An annual eye exam from participating providers after a $10 copay (copay only applies to adults)
- Comprehensive, robust coverage and predictable costs
- Ultimate plan design flexibility
- Deductible waived on in-network PCP, specialists, urgent care visits, allergy shots and outpatient physical therapy
- First $500 of in-network lab and X-ray services covered in full; deductible waived
- ExpressCare services are covered in full; deductible waived
- An annual eye exam from participating providers after a $10 copay (copay only applies to adults)
- Comprehensive, robust coverage and predictable costs
- Ultimate plan design flexibility
- Deductible waived on in-network PCP, specialists, ER, urgent care, allergy shots, outpatient physical therapy and lab and X-ray, and imaging services (PET, CT, MRI)
- Deductible waived on in-network delivery, postnatal and routine newborn nursery care; delivery is 10x PCP copay
- ExpressCare services are covered in full; deductible waived
- An annual eye exam from participating providers after a $10 copay (copay only applies to adults)
- Comprehensive, robust coverage
- Predictable costs
- Ultimate plan design flexibility
- Many services are not subject to the deductible
- Coverage to in-network providers only
- An annual eye exam from participating providers after a $10 copay (copay only applies to adults)
Free In-Network Services
ACA preventive care
ProvRN
LifeBalance
Disease management for chronic conditions
Health coaching
ID protection
Travel assistance
ACA preventive care
ProvRN
LifeBalance
Disease management for chronic conditions
Health coaching
ID protection
Travel assistance
ACA preventive care
ProvRN
LifeBalance
Disease management for chronic conditions
Health coaching
ID protection
Travel assistance
ACA preventive care
ProvRN
LifeBalance
Disease management for chronic conditions
Health coaching
ID protection
Travel assistance
ACA preventive care
ProvRN
LifeBalance
Disease management for chronic conditions
Health coaching
ID protection
Travel assistance
ACA preventive care
ProvRN
LifeBalance
Disease management for chronic conditions
Health coaching
ID protection
Travel assistance
ACA preventive care
ProvRN
LifeBalance
Disease management for chronic conditions
Health coaching
ID protection
Travel assistance
Provider Network Options
Choice Networks
Tailored network medical home model
No referrals required for in-network specialty care
Connect Networks
Tailored network medical home model
No referrals required for in-network specialty care
Connect + Signature + Extend PPO Networks
Options include medical home model and Broad PPO-style network
No referrals required for in-network specialty care
Signature + Extend PPO Networks
Broad PPO-style network
No referrals required for in-network specialty care
Signature + Extend PPO Networks
Broad PPO-style network
No referrals required for in-network specialty care
Signature + Extend PPO Networks
Broad PPO-style network
No referrals required for in-network specialty care
Signature + Extend PPO Networks
Broad PPO-style network
No referrals required for in-network specialty care
Plan Design
Cannot combine in- and out-of-network deductible and out-of-pocket maximum
Cannot combine in- and out-of-network deductible and out-of-pocket maximum
Option to combine in- and out-of-network deductible and out-of-pocket maximum
Option to combine in- and out-of-network deductible and out-of-pocket maximum
Option to combine in- and out-of-network deductible and out-of-pocket maximum
Option to combine in- and out-of-network deductible and out-of-pocket maximum
Rich coverage with deductible waived on most services
Plan Benefits
Most services covered before the deductible is met
Deductible waived for in-network PCP and specialist visits
Deductible waived for in-network urgent care visits
Specialist copay differs from PCP copay
Option to pair plan with an integrated health account
Most services covered before the deductible is met
Deductible waived for in-network PCP and specialist visits
Deductible waived for in-network urgent care visits
Specialist copay differs from PCP copay
Option to pair plan with an integrated health account
Most services covered after the deductible is met
Deductible applies for in-network PCP and specialist visits
Deductible applies for in-network urgent care visits
Specialist coinsurance is the same as the PCP coinsurance
Option to pair plan with an integrated health account
Most services covered after the deductible is met
Deductible is waived for in-network PCP, applies for specialist visits
Deductible applies for in-network urgent care visits
Specialist copay can match or differ from PCP copay
Option to pair plan with an integrated health account
Most services covered before deductible is met
Deductible waived for in-network PCP and specialist visits
Deductible waived for in-network urgent care visits
Specialist copay can match or differ from PCP copay
Option to pair plan with an integrated health account
Most services covered before the deductible is met
Deductible waived for in-network PCP and specialist visits
Deductible waived for in-network urgent care visits
Specialist copay can match or differ from PCP copay
Option to pair plan with an integrated health account
Most services covered before the deductible is met
Deductible waived for in-network PCP and specialist visits
Deductible waived for in-network urgent care visits
Specialist copay can match or differ from PCP copay
Option to pair plan with an integrated health account
We create unique benefit packages to meet the specific needs of each of our large group employers and their employees.
Please contact your producer or account manager for more details.
SALES & ENROLLMENT SUPPORT
Need options? Got questions? We’ve got answers.
Sometimes connecting with a real person is the shortest path to a solution. Our sales team is here for you at:
503-574-5067 or 833-395-2043, Monday through Friday.
8 a.m. to 5 p.m. (Pacific Time).