Health Insurance Plan Options

Medical Insurance Plans

Premier Silver 1250 PPO

Deductible: $1,250 Individual / $2,500 Family
Out-of-Pocket: $6,350 Individual / $12,700 Family
Office Visit: Primary Care Physician $35 / Specialist $50
Inpatient Hospital: 30% once medical deductible is satisfied
UC / ER/ Major Diag Copay: UC $50 / ER $150 / MD N/A
Pharmacy: Tier 1 $10 / Tier 2 $35 / Tier 3 $60 / Tier 4 $100 / MailOrder 2.5x

Premier Bronze 5900 PPO

Deductible: $5,900 Individual / $11,000 Family
Out-of-Pocket: $6,350 Individual / $12,700 Family
Office Visit: Primary Care Physician $35 for first 3 visits / Specialist $35 for first 3 visits
Inpatient Hospital: 0% once medical deductible is satisfied
UC / ER/ Major Diag Copay: 0% once medical deductible is satisfied
Pharmacy: Tier 1 $15 / Tier 2 $40 / Tier 3 $60 / 2x Mail Order

Select Plus Silver 2700 HSA

Deductible: $2,700 Individual / $5,400 Family
Out-of-Pocket: $5,000 Individual / $10,000 Family
Office Visit: 20% once medical deductible is satisfied
Inpatient Hospital: 20% once medical deductible is satisfied
UC / ER/ Major Diag Copay: 20% once medical deductible is satisfied
Pharmacy: Tier 1 $15 / Tier 2 $40 / Tier 3 $60 / 2x Mail Order

Select Plus Bronze 5500 HSA

Deductible: $5,500 Individual / $11,000 Family
Out-of-Pocket: $6,350 Individual / $12,700 Family
Office Visit: 30% once medical deductible is satisfied
Inpatient Hospital: 30% once medical deductible is satisfied
UC / ER/ Major Diag Copay: 30% once medical deductible is satisfied
Pharmacy: Tier 1 $15 / Tier 2 $40 / Tier 3 $60 / 2x Mail Order

Core Silver 2000 PPO

Deductible: $2,000 Individual / $4,000 Family
Out-of-Pocket: $5,000 Individual / $10,000 Family
Office Visit: Primary Care Physician $25 / Specialist $40
Inpatient Hospital: 30% once medical deductible is satisfied
UC / ER/ Major Diag Copay: UC $125 / ER $250 / MD N/A
Pharmacy: Tier 1 $10 / Tier 2 $30 / Tier 3 $50 / Mail Order 2.5x

Core Bronze 5500 HSA

Deductible: $5,500 Individual / $11,000 Family
Out-of-Pocket: $6,350 Individual / $12,700 Family
Office Visit: 30% once medical deductible is satisfied
Inpatient Hospital: 30% once medical deductible is satisfied
UC / ER/ Major Diag Copay: 30% once medical deductible is satisfied
Pharmacy: Tier 1 $10 / Tier 2 $30 / Tier 3 $50 / Mail Order
2.5x

Dental Insurance Plans

Dental Incentive PPO (Network)

Diagnostic Services: Covered
Preventative Services: Covered
Basic Services: 10%
Major Services: 60%
Orthodontic Services: 50%
Deductible: $0
Annual Max: $1500

Dental Passive PPO (Network)

Diagnostic Services: Covered
Preventative Services: Covered
Basic Services: 20%
Major Services: 50%
Orthodontic Services: 50%
Annual Max: $1500

Dental DMO

Call (831) 920-2841 for schedule of discount rates

Vision/HIPP/Life Insurance Plans

Vision

Exam Co-pays: $10
Eye Examination: 100%
Retail Frame Allowance: Up to $130
Discount on Frame Overage: 30%

Hospital Indemnity Plan (Network)

Hospital and ICU Admission: $1,500
Confinement: $200 per day
Dep Lodging: $200 per day
Dep Transportation: $200

Group Life Insurance

$50,000
$20,000

Sponsored Plans