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Medical Plans

[Company Name]'s medical plans offer a choice of options. Please review the details in order to ensure you're selecting the most appropriate plan for you and your family's needs.

Medical Plan Structure

We offer three medical plan options, all through [medical provider]. Each plan includes coverage for in-network and out-of-network services, annual deductibles, coinsurance, and an out-of-pocket maximum. Depending on the plan you select, you may have access to one or two PPO network options. The networks differ in which providers are included and the out-of-pocket costs.

Plan Options:

Traditional PPO Plan
HDHP Level 1
HDHP Level 2

Preferred Provider Organization (PPO)

A PPO is a network of healthcare providers who have agreed to provide services for a negotiated fee. When you use in-network providers, you receive a higher level of benefits. Once you have met your out-of-pocket maximum, the plan pays 100% of the cost for covered services for the rest of the plan year.

Why Choose a HDHP

High Deductible Health Plan (HDHP)

An HDHP allows you to actively manage your health spending. Once the deductibles are met, coverage is shared with the plan in a co-insurance arrangement until you have met your out-of-pocket maximum after which the plan pays 100% of the cost for covered services for the rest of the plan year.

[Your Company] will offer medical coverage through [Medical Provider]. The chart below is a brief outline of the plans. Please refer to the summary plan description for complete plan details.

BENEFIT
Network Name
MEDICAL BENEFITS
Calendar Year Deductible • Individual • Family
Out-of-Pocket Maximum • Individual • Family
Preventive Care
Primary Care Wellness Visit
Primary Care Visit
Specialist Visit
X-Ray (Non-Hospital)
Lab Test (Non-Hospital)
Imaging / MRI / CT / PET
Urgent Care
Emergency Room
Inpatient Facility
Inpatient Physician
Outpatient Surgery – Non-Hospital Facility
Outpatient Surgery – Hospital Facility
Outpatient Surgery – Physician

PRESCRIPTION DRUG PLAN

BENEFIT
PRESCRIPTION DRUG
Rx Deductible • Individual • Family
Rx Out-of-Pocket Max • Individual • Family
Preferred Generic
Non-Preferred Generic
Preferred Brand
Non-Preferred Brand
Preferred Specialty
Non-Preferred Specialty

Consider an In-Network Plan if:

You want access to both in-and out-of-network providers
You like having one doctor to manage your in-network care
You are willing to pay more to see out-of-network providers

Consider a Plus Plan if:

You want access to both in-and out-of-network providers
You like having one doctor to manage your in-network care
You are willing to pay more to see out-of-network providers

Consider a High Deductible Health Plan (HDHP) if:

You want to be able to see any provider, even a specialist, without a referral
You are willing to pay more to see out-of-network providers
You want tax-free savings on your healthcare costs
You want to build a savings account for future healthcare costs for you and your eligible family members
You want an extra way to add to your retirement savings