Your medical benefit: to most, it’s the most important benefit we have available, but many of us don’t use our plan to the fullest. Medical benefits are not just for when you are sick… For example, if you use preventive benefits when you are well, you might actually be able to avoid getting sick!

Do you have questions about your prescription benefits? Check out this video to learn more!

  • Deductible

    The amount of covered expenses you must pay before the Plan starts paying benefits.

    In-network:

    Individual: $2,000

    Family: $4,000

  • Coinsurance

    Cost-sharing between you and the company. This is applied after you meet your deductible.

    In-network:

    You pay 20% (after deductible)

    Plan pays 80%

  • Out-of-Pocket Maximum

    The most you are required to pay out of your own pocket in a plan year. Some expenses may not apply.

    In-network:

    Individual: $6,000

    Family: $12,000

  • Doctor’s Office Visit

    In-network:

    You pay 20% (after deductible)

    Plan pays 80%

  • Specialist Office Visit

    Specialists include doctors trained in a specific area or function of the body, or a specific age group (cardiologist, pediatrician, orthopedic surgeon, neurologist, etc.).

    In-network:

    You pay 20% (after deductible)

    Plan pays 80%

  • Diagnostic, X-rays and Lab Tests

    Deductible - See Deductible above

    In-network:

    You pay 20% (after deductible)

    Plan pays 80%

  • Preventive/Well Child Care

    Care focused on prevention or early detection of health conditions. Includes routine physical exam, immunizations, cancer screenings, vision and hearing exams, etc.

    In-network:

    You pay $0

    Plan pays 100%

  • Emergency Room

    Provides accidental injury and medical emergency care. Note: Call your plan immediately if you are admitted to the hospital.

    In-network:

    You pay 20% (after deductible)

    Plan pays 80%

  • Urgent Care

    Non-emergency care received from an urgent care clinic or other medical facility; typically used after hours or when your regular doctor is not available.

    In-network:

    You pay 20% (after deductible)

    Plan pays 80%

  • Hospitalization

    Inpatient In-network:

    You pay 20% (after deductible)

    Plan pays 80%

    Outpatient In-network:

    You pay 20% (after deductible)

    Plan pays 80%

  • Are you required to use network providers?

    No (but your costs will be lower when you do)

  • Do you need a referral to a specialist?

    No.

  • Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

    A feature of high-deductible or consumer-driven medical plans, this is a tax-advantaged savings account you can use for medical expenses now or save for later.

    Yes.

  • Can I use a Health Care Flexible Spending Account (FSA)?

    An account you contribute to before taxes, then use the money for qualified health-related expenses.

    Yes.

Option A: High Deductible Plan

Provider: US-Rx

Phone: 877-200-5533

https://usrxcare.com/


Provider: CareFirst Administrators

Phone: 877-889-2478

https://www.cfablue.com/

High Deductible Plan Low Deductible Plan

Deductible

In-network:

Individual: $2,000

Family: $4,000

Deductible

In-network:

Individual: $500

Family: $1,000

Coinsurance

In-network:

You pay 20% (after deductible)

Plan pays 80%

Coinsurance

In-network:

You pay 20% (after deductible)

Plan pays 80%

Out-of-Pocket Maximum

In-network:

Individual: $6,000

Family: $12,000

Out-of-Pocket Maximum

In-network:

Individual: $3,000

Family: $6,000

Doctor’s Office Visit

In-network:

You pay 20% (after deductible)

Plan pays 80%

Doctor’s Office Visit

In-network:

You pay 20% (after deductible)

Plan pays 80%

Specialist Office Visit

In-network:

You pay 20% (after deductible)

Plan pays 80%

Specialist Office Visit

In-network:

You pay 20% (after deductible)

Plan pays 80%

Diagnostic, X-rays and Lab Tests

In-network:

You pay 20% (after deductible)

Plan pays 80%

Diagnostic, X-rays and Lab Tests

In-network:

You pay 20% (after deductible)

Plan pays 80%

Preventive/Well Child Care

In-network:

You pay $0

Plan pays 100%

Preventive/Well Child Care

In-network:

You pay $0

Plan pays 100%

Emergency Room

In-network:

You pay 20% (after deductible)

Plan pays 80%

Emergency Room

In-network:

You pay 20% (after deductible)

Plan pays 80%

Urgent Care

In-network:

You pay 20% (after deductible)

Plan pays 80%

Urgent Care

In-network:

You pay 20% (after deductible)

Plan pays 80%

Hospitalization

Inpatient In-network:

You pay 20% (after deductible)

Plan pays 80%

Outpatient In-network:

You pay 20% (after deductible)

Plan pays 80%

Hospitalization

Inpatient In-network:

You pay 20% (after deductible)

Plan pays 80%

Outpatient In-network:

You pay 20% (after deductible)

Plan pays 80%

Are you required to use network providers?

No (but your costs will be lower when you do)

Are you required to use network providers?

No (but your costs will be lower when you do)

Do you need a referral to a specialist?

No.

Do you need a referral to a specialist?

No.

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

Yes.

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

Yes.

Can I use a Health Care Flexible Spending Account (FSA)?

Yes.

Can I use a Health Care Flexible Spending Account (FSA)?

Yes.

Prescription Drug

Generic/Preferred/Non Preferred

Retail - up to 31 day supply

Retail - up to 90 day supply

Mail Order - up to 90 day supply

Medical Deductible Applies

$10/$30/$50 Copay

$25/$75/$125 Copay

$25/$75/$125 Copay

Navitus: Member Services 844-820-3260 Website: Navitus Health Systems - Redefining Pharmacy Benefits with You

Prescription Drug

Generic/Preferred/Non Preferred

Retail-up to 31 day supply

Retail- up to 90 day supply

Mail Order- Up to 90 day supply

$250 Individual/$750 Family Deductible

$15/$35/$75 Copay

$37.50/$87.50/$187.50 Copay

$37.50/$87.50/$187.50 Copay

Navitus: Member Services 844-820-3260 Website: Navitus Health Systems - Redefining Pharmacy Benefits with You

  • Deductible

    The amount of covered expenses you must pay before the Plan starts paying benefits.

    In-network:

    Individual: $500

    Family: $1,000

  • Coinsurance

    Cost-sharing between you and the company. This is applied after you meet your deductible.

    In-network:

    You pay 20% (after deductible)

    Plan pays 80%

  • Out-of-Pocket Maximum

    The most you are required to pay out of your own pocket in a plan year. Some expenses may not apply.

    In-network:

    Individual: $3,000

    Family: $6,000

  • Doctor’s Office Visit

    In-network:

    You pay 20% (after deductible)

    Plan pays 80%

  • Specialist Office Visit

    Specialists include doctors trained in a specific area or function of the body, or a specific age group (cardiologist, pediatrician, orthopedic surgeon, neurologist, etc.).

    In-network:

    You pay 20% (after deductible)

    Plan pays 80%

  • Diagnostic, X-rays and Lab Tests

    Deductible - See Deductible above

    In-network:

    You pay 20% (after deductible)

    Plan pays 80%

  • Preventive/Well Child Care

    Care focused on prevention or early detection of health conditions. Includes routine physical exam, immunizations, cancer screenings, vision and hearing exams, etc.

    In-network:

    You pay $0

    Plan pays 100%

  • Emergency Room

    Provides accidental injury and medical emergency care. Note: Call your plan immediately if you are admitted to the hospital.

    In-network:

    You pay 20% (after deductible)

    Plan pays 80%

  • Urgent Care

    Non-emergency care received from an urgent care clinic or other medical facility; typically used after hours or when your regular doctor is not available.

    In-network:

    You pay 20% (after deductible)

    Plan pays 80%

  • Hospitalization

    Inpatient In-network:

    You pay 20% (after deductible)

    Plan pays 80%

    Outpatient In-network:

    You pay 20% (after deductible)

    Plan pays 80%

  • Are you required to use network providers?

    No (but your costs will be lower when you do)

  • Do you need a referral to a specialist?

    No.

  • Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

    A feature of high-deductible or consumer-driven medical plans, this is a tax-advantaged savings account you can use for medical expenses now or save for later.

    Yes.

  • Can I use a Health Care Flexible Spending Account (FSA)?

    An account you contribute to before taxes, then use the money for qualified health-related expenses.

    Yes.

  • Prescription Drug

    Deductible - See Deductible above

    Generic/Preferred/Non Preferred

    Retail-up to 31 day supply

    Retail- up to 90 day supply

    Mail Order- Up to 90 day supply

    $250 Individual/$750 Family Deductible

    $15/$35/$75 Copay

    $37.50/$87.50/$187.50 Copay

    $37.50/$87.50/$187.50 Copay

Option B: Low Deductible Plan

Provider: US-Rx

Phone: 877-200-5533

https://usrxcare.com/


Provider: CareFirst Administrators

Phone: 877-889-2478

https://www.cfablue.com/

Low Deductible Plan High Deductible Plan

Deductible

In-network:

Individual: $500

Family: $1,000

Deductible

In-network:

Individual: $2,000

Family: $4,000

Coinsurance

In-network:

You pay 20% (after deductible)

Plan pays 80%

Coinsurance

In-network:

You pay 20% (after deductible)

Plan pays 80%

Out-of-Pocket Maximum

In-network:

Individual: $3,000

Family: $6,000

Out-of-Pocket Maximum

In-network:

Individual: $6,000

Family: $12,000

Doctor’s Office Visit

In-network:

You pay 20% (after deductible)

Plan pays 80%

Doctor’s Office Visit

In-network:

You pay 20% (after deductible)

Plan pays 80%

Specialist Office Visit

In-network:

You pay 20% (after deductible)

Plan pays 80%

Specialist Office Visit

In-network:

You pay 20% (after deductible)

Plan pays 80%

Diagnostic, X-rays and Lab Tests

In-network:

You pay 20% (after deductible)

Plan pays 80%

Diagnostic, X-rays and Lab Tests

In-network:

You pay 20% (after deductible)

Plan pays 80%

Preventive/Well Child Care

In-network:

You pay $0

Plan pays 100%

Preventive/Well Child Care

In-network:

You pay $0

Plan pays 100%

Emergency Room

In-network:

You pay 20% (after deductible)

Plan pays 80%

Emergency Room

In-network:

You pay 20% (after deductible)

Plan pays 80%

Urgent Care

In-network:

You pay 20% (after deductible)

Plan pays 80%

Urgent Care

In-network:

You pay 20% (after deductible)

Plan pays 80%

Hospitalization

Inpatient In-network:

You pay 20% (after deductible)

Plan pays 80%

Outpatient In-network:

You pay 20% (after deductible)

Plan pays 80%

Hospitalization

Inpatient In-network:

You pay 20% (after deductible)

Plan pays 80%

Outpatient In-network:

You pay 20% (after deductible)

Plan pays 80%

Are you required to use network providers?

No (but your costs will be lower when you do)

Are you required to use network providers?

No (but your costs will be lower when you do)

Do you need a referral to a specialist?

No.

Do you need a referral to a specialist?

No.

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

Yes.

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

Yes.

Can I use a Health Care Flexible Spending Account (FSA)?

Yes.

Can I use a Health Care Flexible Spending Account (FSA)?

Yes.

Prescription Drug

Generic/Preferred/Non Preferred

Retail-up to 31 day supply

Retail- up to 90 day supply

Mail Order- Up to 90 day supply

$250 Individual/$750 Family Deductible

$15/$35/$75 Copay

$37.50/$87.50/$187.50 Copay

$37.50/$87.50/$187.50 Copay

Navitus: Member Services 844-820-3260 Website: Navitus Health Systems - Redefining Pharmacy Benefits with You

Prescription Drug

Generic/Preferred/Non Preferred

Retail - up to 31 day supply

Retail - up to 90 day supply

Mail Order - up to 90 day supply

Medical Deductible Applies

$10/$30/$50 Copay

$25/$75/$125 Copay

$25/$75/$125 Copay

Navitus: Member Services 844-820-3260 Website: Navitus Health Systems - Redefining Pharmacy Benefits with You