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2025 Plan Breakdown

High Deductible Plans (HSA Qualified)

    • HDHP Option 1

    • Deductible:

      Individual: $1,650

      Family: $3,300

      Max. Out-of-Pocket:

      Individual: $1,650

      Family: $3,300

    • Learn More

    • HDHP Option 2

    • Deductible:

      Individual: $2,500

      Family: $5,000

      Max. Out-of-Pocket:

      Individual: $3,750

      Family: $7,500

    • Learn More

    • HDHP Option 6

    • Deductible:

      Individual: $3,500

      Family: $7,000

      Max. Out-of-Pocket:

      Individual: $7,000

      Family: $12,000

    • Learn More

    • HDHP Option 7

    • Deductible:

      Individual: $4,000

      Family: $8,000

      Max. Out-of-Pocket:

      Individual: $7,250

      Family: $14,000

    • Learn More

    • HDHP Option 8

    • Deductible:

      Individual: $6,000

      Family: $12,000

      Max. Out-of-Pocket:

      Individual: $7,500

      Family: $15,000

    • Learn More

Major Medical

    • MM Choice Plus

    • Deductible:

      Individual: $500

      Family: $1,500

      Max. Out-of-Pocket:

      Individual: $2,500

      Family: $7,500

    • Learn More

    • MM HD 2000 Enhanced

    • Deductible:

      Individual: $2,000

      Family: $6,000

      Max. Out-of-Pocket:

      Individual: $4,000

      Family: $12,000

    • Learn More

Specialty Plans

    • Premier Plus

    • Deductible:

      Individual: $1,750

      Family: $3,500

      Max. Out-of-Pocket:

      Individual: $5,000

      Family: $10,000

    • Learn More

    • Prime Plus

    • Deductible:

      Individual: $3,000

      Family: $6,000

      Max. Out-of-Pocket:

      Individual: $7,900

      Family: $15,800

    • Learn More

    • Select Plus

    • Deductible:

      Individual: $3,500

      Family: $7,000

      Max. Out-of-Pocket:

      Individual: $7,900

      Family: $15,800

    • Learn More

Dental Plan Benefits

Plan details for HDHP Option 1

  • Deductible (In-Network)

  • $1,650 / $3,300

  • Coinsurance (In-Network)

  • 0%

  • Max OOP (In-Network)

  • $1,650 / $3,300

  • Deductible (Out-Network)

  • $3,300 / $6,600

  • Coinsurance (Out-Network)

  • 50%

  • Rx

  • Deductible

  • Doctor

  • Deductible

  • ER

  • Deductible
Plan details for HDHP Option 2

  • Deductible (In-Network)

  • $2500 / $5000

  • Coinsurance (In-Network)

  • 10%

  • Max OOP (In-Network)

  • $3,750 / $7,500

  • Deductible (Out-Network)

  • $5,000 / $10,000

  • Coinsurance (Out-Network)

  • 50%

  • Rx

  • Deductible

  • Doctor

  • Deductible

  • ER

  • Deductible
Plan details for HDHP Option 6

  • Deductible (In-Network)

  • $3,500 / $7,000

  • Coinsurance (In-Network)

  • 30%

  • Max OOP (In-Network)

  • $7,000 / $12,000

  • Deductible (Out-Network)

  • $5,000 / $10,000

  • Coinsurance (Out-Network)

  • 50%

  • Rx

  • 30% after Deductible

  • Doctor (In-Network)

  • 30% after Deductible

  • ER

  • 30% after Deductible
Plan details for HDHP Option 7

  • Deductible (In-Network)

  • $4,000 / $8,000

  • Coinsurance (In-Network)

  • 20%

  • Max OOP (In-Network)

  • $7,250 / $14,000

  • Deductible (Out-Network)

  • $7,500 / $20,000

  • Coinsurance (Out-Network)

  • 50%

  • 30 day Rx

  • 20% after Deductible

  • Doctor (In-Network)

  • 20% after Deductible

  • ER

  • 20% after Deductible
Plan details for HDHP Option 8

  • Deductible (In-Network)

  • $6,000 / $12,000

  • Coinsurance (In-Network)

  • 10%

  • Max OOP (In-Network)

  • $7,500 / $15,000

  • Deductible (Out-Network)

  • $10,000 / $30,000

  • Coinsurance (Out-Network)

  • 50%

  • Rx

  • 10% after Deductible

  • Doctor (In-Network)

  • 10% after Deductible

  • ER

  • 10% after 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

  • 20% after Deductible

  • Doctor (In-Network)

  • 20% after Deductible

  • ER

  • $100 + Coinsurance
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 (In-Network)

  • $30 / $50

  • ER

  • $100 + Coinsurance
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 / $80 / $200 / $250

  • Doctor (In-Network)

  • $30 / $60

  • ER

  • $300 + Coinsurance
Plan details for Prime Plus

  • Deductible (In-Network)

  • $3,000 / $6,000

  • 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 / $80 / $200 / $250

  • Doctor (In-Network)

  • $30 / $60

  • ER

  • $300 + Coinsurance
Plan details for Select Plus

  • Deductible (In-Network)

  • $3,500 / $7,000

  • 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 / $80 / $200 / $250

  • Doctor (In-Network)

  • $30 / $60

  • ER

  • $300 + Coinsurance
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)

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