Employee HEALTH BENEFITS
- Affordable Healthcare
- ACA Compliant
| Healthcare | Slate Premium | Crimson Enhanced | Crimson Deluxe | ||
|---|---|---|---|---|---|
| Minimum Essential Coverage | Limited PPO | Limited PPO | |||
| Out of Pocket Max (Individual/Family) | N/A | $8,550/$17,100 | $5,000/$10,000 | ||
| PPO Network Access | PHCS Practitioner & Ancillary | PHCS Practitioner & Ancillary Facilities at RBP | PHCS Practitioner & Ancillary Facilities at RBP | ||
| Preventative and Wellness | 100%, $0 Copay for ACA Services as Mandated by ACA for Adults, Women, and Children | Paid at 100% | Paid at 100% | ||
| 24/7/365 Telemedicine | Unlimited Consultations, $0 Copay | Unlimited Consultations, $0 Copay | Unlimited Consultations, $0 Copay | ||
| Virtual Behavior Health | Limit 3 Consultations, $0 Copay | Unlimited Consultations, $0 Copay | Unlimited Consultations, $0 Copay | ||
| Preventative Rx Benefit | 100%, $0 Copay for ACA Compliant Covered Generic Prescriptions | Tier 1: $0 Copay, ACA Generics Only | Tier 1: $0 Copay, ACA Generics Only | ||
| Non-Preventative Rx Benefit | Generic Only (Tier 1: $10 or less) | Retail Pharmacy Savings Card and Preferred Tier 1 Generics, $5 Copay | Retail Pharmacy Savings Card and Preferred Tier 1 Generics, $5 Copay | ||
| Primary Care In-Office Visit (Exam or Consultation) | Primary, Specialist & Urgent Care: $25 Copay, Max 8 Visits Combined | Primary & Specialist: $25 Copay, Max 8 Visits combined | Primary & Specialist: $15 Copay, Max 10 Visits combined | ||
| Specialist In-Office Visit (Exam or Consultation) | Primary, Specialist & Urgent Care: $25 Copay, Max 8 Visits Combined | Primary & Specialist: $50 Copay, Max 8 Visits combined | Primary & Specialist: $25 Copay, Max 10 Visits combined | ||
| Urgent Care In-Office Visit (Exam or Consultation) | Primary, Specialist & Urgent Care: $25 Copay, Max 8 Visits Combined | $50 Copay, Limit 2 Visits | $35 Copay, Limit 3 Visits | ||
| Diagnostic Services, Basic Laboratory In-Office (related to office visit, LabCorp, etc.) | $25 Copay, Max 8 Visits, Basic Combined with Basic X-Ray & Lab Services | $50 Copay, Limit 3 Visits, Combined with Radiology | $50 Copay, Limit 3 Visits, Combined with Radiology | ||
| Diagnostic Services, Basic Radiology (X-Rays) In-Office (related to office visit, LabCorp, etc.) | $25 Copay, Max 8 Visits, Basic Combined with Basic X-Ray & Lab Services | $50 Copay, Limit 3 Visits, Combined with Laboratory | $50 Copay, Limit 3 Visits, Combined with Laboratory | ||
| Diagnosis Services, Major In-Office (CT, MRI, PET) | N/A | $350 Copay, Limit 1 Visit | $350 Copay, Limit 2 Visits | ||
| Hospital Confinement | $1,000 per day, Max 10 Days | N/A | N/A | ||
| Inpatient Hospitalization & Inpatient Surgery | N/A | $350 Copay, Admission Limit to 5 days & 2 Surgeries | $350 Copay, Admission Limit to 7 days & 3 Surgeries | ||
| Outpatient Hospital Services | $500 per day, Max 10 Days | N/A | N/A | ||
| Outpatient Hospital or Free Standing Facility Services and Surgery | N/A | $350 Copay, Limit 1 Visit | $350 Copay, Limit 2 Visits | ||
| Outpatient Services: Limited to Mental and Behavior Health and Substance Abuse | N/A | $350 Copay, Limit 2 Visits, Combined with Outpatient Hospital and Chemical Dependency | $350 Copay, Limit 2 Visits, Combined with Outpatient Hospital and Chemical Dependency | ||
| Emergency Room Services | $250 Copay, $1,000 Annual Max Benefit | $350 Copay, Limit 1 Visit | $350 Copay, Limit 1 Visit | ||
| Non-Occupational Accident | N/A | N/A | N/A | ||
| Outpatient Services: Limited to Mental and Behavior Health and Substance Abuse | N/A | $350 Copay, Limit 2 Visits, Combined with Outpatient Hospital and Chemical Dependency | $350 Copay, Limit 2 Visits, Combined with Outpatient Hospital and Chemical Dependency | ||
| Emergency Room Services | $250 Copay, $1,000 Annual Max Benefit | $350 Copay, Limit 1 Visit | $350 Copay, Limit 1 Visit | ||
| Non-Occupational Accident | N/A | N/A | N/A | ||
| Patient Advocacy | Healthcare Navigation, High-Cost Prescription Search, Medical Bill Negotiation (Medical Events OOP over $1,000) | Healthcare Navigation, Search & Compare Pricing Tool, Medical Bill Negotiation over $1,000 Medical Events | Healthcare Navigation, Search & Compare Pricing Tool, Medical Bill Negotiation over $1,000 Medical Events | ||
| Treatment for Chemical Abuse and Dependency | N/A | Outpatient: $25 Copay/Day, 5 Day limit. Inpatient: $350 Copay/Day, 5 day limit. | Outpatient: $25 Copay/Day, 7 day limit. Inpatient: $25 Copay/Day, 7 day limit | ||
| Home Health Care | N/A | $25 Copay, Limit 10 Visits | $25 Copay, Limit 10 Visits | ||
| Maternity Care | N/A | N/A | Global Professional Services: $350. Childbirth + Delivery Copay: $350. |
* ACA = The Affordable Care Act (ACA) is a comprehensive U.S. health care reform law enacted in March 2010.
* PHCS = Private HealthCare Systems Network, operated by Claritev (formerly MultiPlan), is one of the largest and longest-standing independent Primary Preferred Provider Organization (PPO) networks in the United States.
* PPO = Preferred Provider Organization
* RBP = Refers to Reference-Based Pricing, a healthcare reimbursement model that sets provider payments based on a specific benchmark, often a multiple of Medicare rates, rather than negotiated insurance contracts. It is designed to control costs by reducing high variations in pricing for medical services.
| Vision | VSP Choice Network | Out-of-Network | |
|---|---|---|---|
| Benefit Frequencies Exam, Eyeglass Lenses/Contacts, Frames | Every 12 Months | Every 12 Months | |
| Deductible The amount you pay before benefits apply | $10 Exam, $25 glasses or frames | $10 Exam, $25 glasses or frames | |
| Annual Eye Exam | 100% | 100% | |
| Lenses: | |||
| - Single Vision | 100% | Up to $30 | |
| - Bifocal | 100% | Up to $50 | |
| - Trifocal | 100% | Up to $65 | |
| - Lenticular | 100% | Up to $100 | |
| - Progressive | Up to the providers lined bifocal contracted fee | Up to lined bifocal allowance | |
| Frames | $150 | Up to $70 | |
| Contacts : | |||
| - Elective | Up to $180 | Up to $145 | |
| - Standard Fit & follow up exam | Member cost up to $160 | No coverage | |
| Prescription safety glasses | Covered in lieu of regular eyeglasses or contacts; lens and frame allowances apply | No coverage |
* EyeMed Insight Vision Plan also available.
| Dental | In-Network | Out-of-Network | |
|---|---|---|---|
| Maximum Benefit The total amount insurance will pay per person/year | $2,000 | $2,000 | |
| Deductible The amount you pay before benefits apply | $0 Type 1, $50 Type 2&3, No Family Maximum | $0 Type 1, $50 Type 2&3, No Family Maximum | |
| Claim Allowance The highest insurance payment allowed for services | MAC | 90th U&C | |
| Preventative (Type 1) Exams, X-rays, cleanings, fluoride for children | 100% | 100% | |
| Basic (Type 2) Fillings, extractions, root canals, gum disease treatment, denture repair, sealants for children | 80% | 80% | |
| Major (Type 3) Crowns/repair, onlays, bridges, dentures, space retainers, anesthesia | 50% | 50% | |
| Adult and Child orthodontia | 50% ($1,500 Lifetime Max) | 50% ($1,500 Lifetime Max) |
* Multiple levels of dental plans also available
* MAC = Maximum Allowable Charge (common in dental and medical insurance). It refers to a limit on the amount an insurance plan will pay for a specific service or medication.
* 90th U&C = Refering to the 90th percentile Usual and Customary dental plan. It means the insurance company covers fees that are at or below the amount charged by 90% of dentists in a specific ZIP code area. This high percentile usually results in lower out-of-pocket costs for members, especially when using out-of-network providers, as the allowed amount is closer to the actual charges.
HEALTH BENEFITS Pricing
All Prices are Monthly
| Healthcare | Slate Premium | Crimson Enhanced | Crimson Deluxe | ||
|---|---|---|---|---|---|
| Age | 18-39 | 40-64 | 18-39 | 40-64 | |||
| Employee | $159 | $399 | $467 | $525 | $579 | ||
| Employee + Spouse | $199 | $489 | $723 | $838 | $890 | ||
| Employee + Child | $199 | $673 | $727 | $799 | $865 | ||
| Employee + Family | $229 | $993 | $1,081 | $1,146 | $1,255 |
| DENTAL | VISION | ||
|---|---|---|---|
| Employee | $51.32 | $8.40 | |
| Employee + Spouse | $102.92 | $16.20 | |
| Employee + Child | $102.92 | $15.04 | |
| Employee + Family | $193.64 | $22.84 |
ancillary Health benefits
- Designed to complement your core medical benefits
| Accident Insurance | Accident Insurance pays cash benefits directly to you, on top of any other coverage you have. You can use the money however you choose-to cover out-of-pocket medical costs or everyday expenses-with no restrictions on how it’s spent. |
| Critical Illness Insurance | Critical Illness coverage provides lump-sum cash benefits at diagnosis if a covered illness occurs. The money is paid directly to the individual and can be used however they choose - to help with deductibles, medication, treatment costs, or everyday expenses - with no restrictions on how it’s spent. |
| Hospital Indemnity Insurance | Hospital Indemnity Insurance pays cash benefits directly to the insured for hospital stays, including first-day confinement, daily confinement, and intensive care. The money can be used however the individual chooses - with no restrictions - helping protect personal savings and Health Savings Accounts (HSA) while covering medical or everyday expenses. |
| Short Term Disability Insurance | Disability insurance helps protect your income by replacing a portion of your paycheck if an illness or injury prevents you from working. The monthly benefit can be used for essential expenses like your mortgage, utilities, groceries, and insurance premiums. |
| Life Insurance | Whole Life Insurance provides lifelong financial protection with guaranteed premiums payable to age 95, a guaranteed death benefit, and built-in cash value you can use over time. Coverage ranges from $5,000 up to $250,000, offering peace of mind that your loved ones are protected through life’s uncertainties. |
| Identity Protection | Identity Protection Select offers comprehensive identity and financial monitoring to help safeguard against identity theft. If fraud occurs, you have access to a full-service remediation team, up to $1 million in identity theft reimbursement, and up to $500,000 in stolen funds reimbursement. |
| Pet Insurance | Your pets are family, and keeping them happy and healthy matters. With rising pet care costs, Total Pet Plan helps make care more affordable by offering the same trusted products and services your pets already use - just at a lower price. |
