Plan Breakdown

High Deductible Plans (HSA Qualified)

    • HDHP Option 1

    • Deductible:

      Individual: $1,500

      Family: $3,000

      Max. Out-of-Pocket:

      Individual: $1,500

      Family: $3,000

    • HDHP Option 2

    • Deductible:

      Individual: $2,500

      Family: $5,000

      Max. Out-of-Pocket:

      Individual: $2,500

      Family: $5,000

    • HDHP Option 3

    • Deductible:

      Individual: $3,000

      Family: $6,000

      Max. Out-of-Pocket:

      Individual: $3,000

      Family: $6,000

    • HDHP Option 4

    • Deductible:

      Individual: $3,500

      Family: $7,000

      Max. Out-of-Pocket:

      Individual: $3,500

      Family: $7,000

    • HDHP Option 6

    • Deductible:

      Individual: $2,500

      Family: $5,000

      Max. Out-of-Pocket:

      Individual: $5,000

      Family: $10,000

    • HDHP Option 7

    • Deductible:

      Individual: $5,000

      Family: $10,000

      Max. Out-of-Pocket:

      Individual: $6,900

      Family: $13,800

    • HDHP Option 8

    • Deductible:

      Individual: $6,000

      Family: $12,000

      Max. Out-of-Pocket:

      Individual: $6,900

      Family: $13,800

Major Medical

    • MM Choice Plus

    • Deductible:

      Individual: $500

      Family: $1,500

      Max. Out-of-Pocket:

      Individual: $2,500

      Family: $7,500

    • MM HD 1000

    • Deductible:

      Individual: $1,000

      Family: $3,000

      Max. Out-of-Pocket:

      Individual: $3,000

      Family: $9,000

    • MM HD 2000 Enhanced

    • Deductible:

      Individual: $2,000

      Family: $6,000

      Max. Out-of-Pocket:

      Individual: $4,000

      Family: $12,000

    • MM HD 5000

    • Deductible:

      Individual: $5,000

      Family: $12,700

      Max. Out-of-Pocket:

      Individual: $6,850

      Family: $13,700

Preferred Plans

    • Premier Plus

    • Deductible:

      Individual: $1,750

      Family: $3,500

      Max. Out-of-Pocket:

      Individual: $5,000

      Family: $10,000

    • Prime Plus

    • Deductible:

      Individual: $2,750

      Family: $5,500

      Max. Out-of-Pocket:

      Individual: $7,900

      Family: $15,800

    • Select Plus

    • Deductible:

      Individual: $3,250

      Family: $6,500

      Max. Out-of-Pocket:

      Individual: $7,900

      Family: $15,800

    • Value

    • Deductible:

      Individual: $4,500

      Family: $9,000

      Max. Out-of-Pocket:

      Individual: $7,900

      Family: $15,800

    • Value Plus

    • Deductible:

      Individual: $7,900

      Family: $15,800

      Max. Out-of-Pocket:

      Individual: $7,900

      Family: $15,800

Dental Plan Benefits

Plan details for HDHP Option 1
  • Deductible (In-Network)

  • $1,500 / $3,000
  • Coinsurance (In-Network)

  • 0%
  • Max OOP (In-Network)

  • $1,500 / $3,000
  • Deductible (Out-Network)

  • $3,000 / $6,000
  • Coinsurance (Out-Network)

  • 50%
  • Rx

  • Deductible
  • Doctor

  • Deductible
  • ER

  • Deductible
Plan details for HDHP Option 2
  • Deductible (In-Network)

  • $2500 / $5000
  • Coinsurance (In-Network)

  • 0%
  • Max OOP (In-Network)

  • $2,500 / $5,000
  • Deductible (Out-Network)

  • $5,000 / $10,000
  • Coinsurance (Out-Network)

  • 50%
  • Rx

  • Deductible
  • Doctor

  • Deductible
  • ER

  • Deductible
Plan details for HDHP Option 3
  • Deductible (In-Network)

  • $3,000 / $60,00
  • Coinsurance (In-Network)

  • 0%
  • Max OOP (In-Network)

  • $3,000 / $6,000
  • Deductible (Out-Network)

  • $6,000 / $12,000
  • Coinsurance (Out-Network)

  • 50%
  • Rx

  • Deductible
  • Doctor

  • Deductible
  • ER

  • Deductible
Plan details for HDHP Option 4
  • Deductible (In-Network)

  • $3,500 / $7,000
  • Coinsurance (In-Network)

  • 0%
  • Max OOP (In-Network)

  • $3,500 / $7,000
  • Deductible (Out-Network)

  • $7,000 / $14,000
  • Coinsurance (Out-Network)

  • 50%
  • Rx

  • Deductible
  • Doctor

  • Deductible
  • ER

  • Deductible
Plan details for HDHP Option 6
  • Deductible (In-Network)

  • $2,500 / $5,000
  • Coinsurance (In-Network)

  • 20%
  • Max OOP (In-Network)

  • $5,000 / $10,000
  • Deductible (Out-Network)

  • $5,000 / $10,000
  • Coinsurance (Out-Network)

  • 50%
  • Rx

  • Deductible
  • Doctor

  • Deductible
  • ER

  • Deductible
Plan details for HDHP Option 7
  • Deductible (In-Network)

  • $5,000 / $10,000
  • Coinsurance (In-Network)

  • 10%
  • Max OOP (In-Network)

  • $6,900 / $13,800
  • Deductible (Out-Network)

  • $10,000 / $30,000
  • Coinsurance (Out-Network)

  • 50%
  • Rx

  • Deductible
  • Doctor

  • Deductible
  • ER

  • Deductible
Plan details for HDHP Option 8
  • Deductible (In-Network)

  • $6,000 / $12,000
  • Coinsurance (In-Network)

  • 10%
  • Max OOP (In-Network)

  • $6,900 / $13,800
  • Deductible (Out-Network)

  • $10,000 / $30,000
  • Coinsurance (Out-Network)

  • 50%
  • Rx

  • Deductible
  • Doctor

  • Deductible
  • ER

  • Deductible
Plan details for MM Choice Plus
  • Deductible (In-Network)

  • $500 / $1,500
  • Coinsurance (In-Network)

  • 20%
  • Max OOP (In-Network)

  • $2,500 / $7,500
  • Deductible (Out-Network)

  • $1,000 / $3,000
  • Coinsurance (Out-Network)

  • 50%
  • Rx

  • Deductible
  • Doctor

  • Deductible
  • ER

  • $100
Plan details for MM HD 1000
  • Deductible (In-Network)

  • $1,000 / $3,000
  • Coinsurance (In-Network)

  • 20%
  • Max OOP (In-Network)

  • $3,000 / $9,000
  • Deductible (Out-Network)

  • $2,000 / $6,000
  • Coinsurance (Out-Network)

  • 50%
  • Rx

  • Deductible
  • Doctor

  • Deductible
  • ER

  • $100
Plan details for MM HD 2000 Enhanced
  • Deductible (In-Network)

  • $2,000 / $6,000
  • Coinsurance (In-Network)

  • 20%
  • Max OOP (In-Network)

  • $4,000 / $12,000
  • Deductible (Out-Network)

  • $4,000 / $12,000
  • Coinsurance (Out-Network)

  • 50%
  • Rx

  • $5 / $35 / $60
  • Doctor

  • $30 / $50
  • ER

  • $100
Plan details for MM HD 5000
  • Deductible (In-Network)

  • $5,000 / $12,700
  • Coinsurance (In-Network)

  • 20%
  • Max OOP (In-Network)

  • $6,850 / $13,700
  • Deductible (Out-Network)

  • $10,000 / $30,000
  • Coinsurance (Out-Network)

  • 50%
  • Rx

  • Deductible
  • Doctor

  • Deductible
  • ER

  • $100
Plan details for Premier Plus
  • Deductible (In-Network)

  • $1,750 / $3,500
  • Coinsurance (In-Network)

  • 30%
  • Max OOP (In-Network)

  • $5,000 / $10,000
  • Deductible (Out-Network)

  • $3,500 / $7000
  • Coinsurance (Out-Network)

  • 50%
  • Rx

  • $12 / $40 / $100
  • Doctor

  • $30 / $60
  • ER

  • $300
Plan details for Prime Plus
  • Deductible (In-Network)

  • $2,750 / $5,500
  • Coinsurance (In-Network)

  • 30%
  • Max OOP (In-Network)

  • $7,900 / $15,800
  • Deductible (Out- Network)

  • $5,000 / $10,000
  • Coinsurance (Out-Network)

  • 50%
  • Rx

  • $12 / $40 / $100
  • Doctor

  • $30 / $60
  • ER

  • $300
Plan details for Select Plus
  • Deductible (In-Network)

  • $3,250 / $6,500
  • Coinsurance (In-Network)

  • 30%
  • Max OOP (In-Network)

  • $7,900 / $15,800
  • Deductible (Out-Network)

  • $6,500 / $13,000
  • Coinsurance (Out-Network)

  • 50%
  • Rx

  • $12 / $40 / $100
  • Doctor

  • $30 / $60
  • ER

  • $300
Plan details for Value
  • Deductible (In-Network)

  • $4,500 / $9,000
  • Coinsurance (In-Network)

  • 20%
  • Max OOP (In-Network)

  • $7,900 / $15,800
  • Deductible (Out-Network)

  • $9,000 / $18,000
  • Coinsurance (Out-Network)

  • 50%
  • Rx

  • $12 / $40 / $100
  • Doctor

  • $30 / $60
  • ER

  • $300
Plan details for Value Plus
  • Deductible (In-Network)

  • $7,900 / $15,800
  • Coinsurance (In-Network)

  • 0%
  • Max OOP (In-Network)

  • $7,900 / $15,800
  • Deductible (Out-Network)

  • $10,000 / $30,000
  • Coinsurance (Out-Network)

  • 50%
  • Rx

  • $12 / $40 / $100
  • Doctor

  • $30 / $60
  • ER

  • $300
Plan details for Basic
  • Calendar Deductible

  • Individual $50
    Family 3 Individuals
  • Deductible Applies

  • Class II & III
  • Calendar Year Maximum Benefit

  • $1,000
  • Orthodontia

  • N/A
  • Highlights of Covered Services

    Class I-Diagnostic & Preventative
    Oral evaluations, routine cleanings, bitewing X-rays, fluoride treatments, sealants, intraoral complete series X-rays or panoramic film, other X-rays

  • 100%
  • Class II-Basic
    Palliative treatment, fillings, simple extractions, space maintainers

  • 75%
  • Class III-Major
    Crowns, crown buildup, stainless steel crowns, root canal therapy, periodontics, oral surgery, biopsy, general anesthesia and intravenous sedation, full and partial dentures, inlays, onlays bridges

  • 45%
  • Out of Network claims paid at the 80th percentile of usual and customary (UCR)

Plan details for Enhanced
  • Calendar Deductible

  • Individual $50
    Family 3 Individuals
  • Deductible Applies

  • Class II & III
  • Calendar Year Maximum Benefit

  • $1,000 (Class I claims do NOT count against annual maximum)
  • Orthodontia

  • Adult & Child
  • Highlights of Covered Services

    Class I-Diagnostic & Preventative
    Oral evaluations, routine cleanings, bitewing X-rays, fluoride treatments, sealants, intraoral complete series X-rays or panoramic film, other X-rays

  • 100%
  • Class II-Basic
    Palliative treatment, fillings, simple extractions, space maintainers, root canal therapy, periodontics, biopsy, general anesthesia and intravenous sedation

  • 80%
  • Class III-Major
    Crowns, crown buildup, stainless steel crowns, oral surgery, full and partial dentures, inlays, onlays bridges

  • 50%
  • Class IV
    Orthodontic extractions, full or partial bands, appliances (removable and fixed)

  • 50%
  • Family Tier

    Employee Only

  • $34.34
  • Employee + Spouse

  • $68.63
  • Employee + Children

  • $80.31
  • Family

  • $115.47
  • Out of Network claims paid at the 90th percentile of usual and customary (UCR)