At-a-glance benefit comparison

Compare the standard and high option cost-sharing using the chart below. Both plans give you the same access to care and membership benefits.

2019 plan benefits

Deductible

$350 single/$700 family
Standard plan
$0 single/$0 family
High plan

Your medical-only deductible is the amount you pay before the health plan starts to pay for certain services. Some services have a copayment before you meet your deductible including primary care and specialist visits. 

Primary care visits

$25 copayment
Standard plan
$20 copayment
High plan

Virtual care 

Covered in full
Standard plan
Covered in full
High plan

Virtual care is great option when you have a non-life-threatening condition but can't wait for a doctor's appointment. The best part? We cover in-network virtual care in full which means you won't pay anything out-of-pocket to receive care. 

Specialist visits

$45 copayment
Standard plan
$35 copayment
High plan

Urgent care facility

$75 copayment
Standard plan
$75 copayment
High plan

Allergy testing, serum & injections

Covered in full
Standard plan
Covered in full
High plan

Covered in full means you will pay nothing out-of-pocket for these services when you receive care.

Outpatient surgery professional services

20% coinsurance
Standard plan
0% coinsurance
High plan

Coinsurance is your portion of the cost for the medical service. The standard plan coinsurance applies after you meet your deductible.

Inpatient and outpatient labs & X-ray services

20% coinsurance
Standard plan
10% coinsurance
High plan

Coinsurance is your portion of the cost for the medical service. The standard plan coinsurance applies after you meet your deductible.

Emergency room

$150 copayment
Standard plan
$150 copayment
High plan

Copayment waived if admitted.
For the standard plan, copayment applies after you meet your deductible.

Ambulance services

$150 copayment
Standard plan
$150 copayment
High plan

For the standard plan, copayment applies after you meet your deductible.

Prescription drugs - Standard plan


Generic: $20 copayment
Preferred brand: $60 copayment
Non-preferred brand: $90 copayment
Preferred specialty: 20% coinsurance ($200 limit for 31-day supply)
Non-preferred specialty: 20% coinsurance ($400 limit for 31-day supply)

Use our online Approved Drug List to search by drug name, see what drugs your plan covers and check what your copayment will be.

Prescription drugs - High plan


Generic: $15 copayment
Preferred brand: $50 copayment
Non-preferred brand: $80 copayment
Preferred specialty: 20% coinsurance ($150 limit for 31-day supply)
Non-preferred specialty: 20% coinsurance ($300 limit for 31-day supply)

Use our online Approved Drug List to search by drug name, see what drugs your plan covers and check what your copayment will be.

Prior deductible carryover

Yes
Standard plan
Not applicable
High plan