.
📖 Plan Key Terms & Glossary
Show
▼
⚕️ Major Medical
A comprehensive health insurance plan covering a broad range of services including hospital stays, surgery, specialist visits, preventive care, and prescription drugs. Major medical plans typically carry higher monthly premiums in exchange for more complete coverage and lower out-of-pocket costs at the time of care.
🏧 HSA Plan
A high-deductible health plan paired with a Health Savings Account, allowing members to set aside pre-tax dollars for qualified medical expenses. HSA plans generally carry lower monthly premiums and give you more control over how your healthcare dollars are spent. Funds in the account roll over year to year and are never lost
🔖 Limited Medical
A health plan that covers a defined set of medical services rather than comprehensive coverage. Benefits are typically paid as fixed dollar amounts per service. Limited medical plans carry lower monthly premiums and are well suited for generally healthy individuals who want protection against everyday medical costs.
🩹 Accident / Hospital / Critical Illness
Supplemental insurance plans that pay a lump sum or fixed benefit directly to you when you experience a covered event — such as an accident, hospital stay, or serious diagnosis like cancer or heart attack. These plans are designed to complement your primary health coverage and help offset out-of-pocket costs.
💲 Deductible
The amount you are responsible for paying toward covered medical expenses before your insurance begins sharing costs. A $0/$0 deductible means coverage applies immediately.
💰 Max Out-of-Pocket
The maximum amount you will pay in a plan year for covered services. Once this limit is reached, the plan covers 100% of eligible expenses for the remainder of the year.
💳 Copay
A fixed dollar amount you pay for a specific covered service — such as a primary care visit, specialist consultation, or urgent care — regardless of whether your deductible has been met.
📉 Coinsurance
The percentage of covered medical costs you share with your insurer after your deductible has been satisfied. For example, 30% coinsurance means you pay 30% and the plan covers the remaining 70%.
👨⚕️ Doctor Visits – Deductible
Indicates whether office visit costs are applied toward your deductible before coverage begins, or whether copays apply from the first visit regardless of deductible status.
🩺 Doctor Visits
The number of covered physician visits per plan year, including primary care and specialist appointments. Some plans offer unlimited visits; others cap coverage at a set number annually.
⏳ Waiting Period
A defined period following enrollment during which certain benefits are not yet active. Waiting periods vary by benefit type and carrier — some plans offer immediate coverage with no waiting period.
🏷️ Rating Type
The method used to calculate your monthly premium. Community Rated plans charge the same rate for all enrollees regardless of age. Age Banded plans adjust premiums based on the member's age at enrollment.
💊 Rx Coverage
The level of prescription drug coverage included in the plan. Coverage may be limited to generic medications, extend to brand-name drugs, or include tiered copay structures across generic, brand, and specialty tiers.
🏨 Hospitalization
Inpatient hospital coverage, including the number of covered days per plan year and the cost-sharing structure — such as a daily copay or coinsurance after the deductible is met.
🔪 Surgeries
Coverage for inpatient and outpatient surgical procedures. Plans may specify a per-year limit on covered surgeries or apply standard deductible and coinsurance rules.
🚨 ER Admission
Emergency room coverage, including the number of covered visits per plan year and the applicable copay or coinsurance. Some plans waive cost-sharing if the visit results in a hospital admission.
🚑 Urgent Care
Coverage for urgent care center visits, typically at a lower cost-sharing level than emergency room services. Plans specify the number of covered visits per year and the applicable copay.
🔬 Lab Work
Coverage for diagnostic laboratory testing, including blood work and other clinical tests. Some plans cover lab work at 100% for preventive purposes; others apply visit limits or subject costs to the deductible.
💉 Lab Work – Deductible
Indicates whether laboratory services are subject to the plan deductible before coverage applies, or whether they are covered at a flat copay from the first service date.
🩻 Imaging
Coverage for diagnostic imaging services including X-rays, MRIs, and CT scans. Plans may specify an annual visit limit or apply deductible and coinsurance requirements.
🏥 Imaging – Deductible
Indicates whether imaging services are subject to the plan deductible before coverage applies, or whether a separate copay structure governs cost-sharing from the outset.
🤰 Pregnancy
Maternity benefit coverage, including prenatal care, labor, and delivery services. Plans may include an applicable waiting period before maternity benefits become active.
🧠 Mental Health
Coverage for mental health and behavioral health services, including outpatient therapy sessions and inpatient psychiatric care. Visit limits and cost-sharing structures vary by plan.
🛡️ Life Insurance
A life insurance benefit included as part of the plan, providing a specified death benefit for the primary member. Coverage amounts and terms vary by carrier and plan tier.
➕ Supplemental Benefits
Additional benefits bundled into the plan beyond core medical coverage — which may include accident coverage, critical illness benefits, hospital indemnity, or other ancillary protections.
💼 Work Requirement
Some association-based health plans require members to be actively employed as a condition of eligibility. Plans without this requirement are open to self-employed individuals and those between jobs.
📋 Guarantee Issue
A plan that does not require medical underwriting — meaning applicants cannot be declined based on health history or pre-existing conditions. Coverage is available to all eligible applicants.
🌿 Preventive Care
Routine health maintenance services such as annual physicals, screenings, and immunizations. ACA-compliant plans cover preventive care at 100% with no cost-sharing requirement.
🏦 HSA Account
A Health Savings Account — a tax-advantaged account that allows members enrolled in a qualifying high-deductible health plan to set aside pre-tax dollars for eligible medical expenses.
📱 Telehealth
Virtual medical consultations conducted via phone or video platform. Many plans include $0 copay telehealth access, enabling members to consult licensed physicians without an in-person visit.
⚕️ Pre-Existing Condition
A health condition that existed prior to the effective date of coverage. Depending on the plan type, a waiting period may apply before benefits related to pre-existing conditions become active.
🤝 Healthcare Advocacy
A dedicated support service that assists members in navigating claims, resolving billing disputes, understanding benefits, and coordinating care with providers on their behalf.
🏠 Hospital Indemnity
A supplemental benefit that pays a fixed cash amount per hospital admission or per day of inpatient confinement, helping offset costs not covered by the primary medical plan.
🦷 Dental Preventive
Coverage for routine preventive dental services including cleanings, exams, and X-rays. Preventive services are typically covered at 100% or subject to a nominal copay.
🔧 Dental Basic
Coverage for basic restorative dental procedures such as fillings, simple extractions, and periodontal treatments. Cost-sharing varies by plan and waiting periods may apply.
🪥 Dental Major
Coverage for major restorative dental work including crowns, bridges, dentures, and complex extractions. Major services typically carry higher cost-sharing and may require a waiting period of up to 12 months.
🔩 Dental Implants
Coverage for dental implant procedures. Not all dental plans include implant coverage — availability and benefit limits vary significantly by carrier and plan tier.
😁 Orthodontics
Coverage for orthodontic treatment including braces and aligners. Orthodontic benefits may be limited to dependent children or available to adults depending on the plan, and are subject to lifetime maximums.
🎯 Dental Maximum Benefit
The maximum dollar amount a dental plan will pay toward covered services within a plan year. Once this limit is reached, all remaining costs are the member's responsibility until the plan year resets.
👁️ Vision
Coverage for vision care services including eye exams, prescription lenses, frames, and contact lenses. Vision benefits may be included in the base plan or offered as a bundled add-on.
📎 Referral Required
Indicates whether a referral from a primary care physician is required before accessing specialist services. Plans that do not require referrals offer greater flexibility in seeking specialized care.
✅ Guarantee Issue
This plan does not require medical underwriting. All eligible applicants are accepted regardless of health history or pre-existing conditions.
🤰 Pregnancy Covered
Maternity benefits are included in this plan. Review the plan details for any applicable waiting period before maternity coverage becomes active.
🥉 Under $200/mo
Member-only monthly premium is estimated below $200. Actual rate is subject to age and enrollment tier selection.
🥈 $200–$400/mo
Member-only monthly premium is estimated between $200 and $400. Actual rate is subject to age and enrollment tier selection.
🥇 $400–$600/mo
Member-only monthly premium is estimated between $400 and $600. Actual rate is subject to age and enrollment tier selection.
👑 $600+/mo
Member-only monthly premium is estimated above $600. These plans typically offer the most comprehensive benefits and broadest network access.
💊 Prescription Coverage
This plan includes prescription drug benefits. Coverage tier and formulary details are available in the plan documents.
⏳ No Waiting Period
Coverage on this plan is effective immediately upon the policy start date. No waiting period applies to any covered benefit.
🏥 $0 Deductible
This plan carries no deductible. Covered services are accessible from the first date of coverage without requiring any prior out-of-pocket spending.
💳 Copays Before Deductible
This plan allows access to covered services at a fixed copay amount before the deductible has been satisfied, reducing upfront cost barriers for routine care.
🩺 Unlimited Doctor Visits
This plan does not impose an annual limit on covered physician visits, providing unrestricted access to primary care and specialist consultations as needed.
📊 Community Rated
Premiums on this plan are the same for all enrollees regardless of age. Your monthly rate will not increase solely due to getting older.
📈 Age Banded
Premiums on this plan are calculated based on the member's age at enrollment. Rates are subject to adjustment at each annual renewal.
💼 No Work Requirement
This plan does not require active employment as a condition of eligibility. Coverage is available to self-employed individuals, independent contractors, and those between positions.
🦷 Dental Plan
This is a standalone dental insurance plan providing coverage for preventive, basic, and major dental services. Medical benefits are not included.
📊 Level-Funded Plan
A hybrid funding arrangement typically used for small to mid-size employer groups. The employer pays a fixed monthly amount covering expected claims, stop-loss insurance, and administrative fees. Unused claims funds may be partially returned at year-end.
🔄 Reference-Based Pricing
A cost-containment model in which the plan establishes a maximum reimbursement benchmark — typically a percentage of Medicare rates — for covered services, rather than contracting with a traditional carrier network.
🏛️ Association Health Plan
A health plan made available through a membership-based trade or professional association. Association plans may offer access to group-rate coverage for self-employed individuals and small business owners who would otherwise purchase coverage in the individual market.
📜 Minimum Essential Coverage (MEC)
A category of health coverage that satisfies the federal requirement for having insurance under the Affordable Care Act. MEC plans cover preventive care at no cost but may not include comprehensive benefits beyond that baseline.
⚖️ Coordination of Benefits
The process by which two or more insurance plans determine their respective payment responsibilities when a member is covered under multiple policies. The primary plan pays first; the secondary plan may cover remaining eligible costs.
🗂️ Explanation of Benefits (EOB)
A statement issued by your insurance carrier following a medical claim. The EOB itemizes the services rendered, the amount billed, the plan's payment, and any remaining balance owed by the member. It is not a bill.
🔐 Prior Authorization
A requirement that certain medical services, procedures, or prescriptions receive advance approval from the insurance carrier before they are rendered. Failure to obtain prior authorization may result in reduced or denied benefits.
🔁 Continuation Coverage (COBRA)
A federal provision that allows individuals who lose employer-sponsored health coverage due to qualifying life events — such as job loss or reduction in hours — to continue their existing coverage for a limited period by paying the full premium.
📅 Open Enrollment
A designated annual period during which individuals may enroll in, modify, or cancel health insurance coverage. Outside of open enrollment, changes are generally only permitted following a qualifying life event.
🪪 Insurance ID Card
A card issued by your insurance carrier that serves as proof of coverage. It contains key information including your member ID, group number, plan name, and carrier contact details — required at most medical appointments.
🏗️ Self-Funded Plan
A plan in which the employer assumes direct financial responsibility for employee health claims rather than paying premiums to an insurance carrier. The employer typically purchases stop-loss coverage to limit exposure to catastrophic claims.
🧾 Explanation of Coverage (EOC)
A comprehensive document provided by the insurance carrier that details the full terms of your health plan, including covered services, exclusions, limitations, cost-sharing requirements, and member rights.
🌐 Out-of-Network
Providers, facilities, or services that do not have a contracted rate agreement with your insurance carrier. Using out-of-network services typically results in higher cost-sharing or no coverage depending on the plan type.
🗺️ In-Network
Providers and facilities that have established a contractual reimbursement agreement with your insurance carrier. Utilizing in-network services ensures access to negotiated rates and the plan's standard cost-sharing structure.
🚪 Out-of-Pocket Maximum
The maximum total amount you are required to pay for covered services in a plan year, including deductibles, copays, and coinsurance. After this threshold is reached, the plan covers 100% of eligible expenses.
🧩 Ancillary Benefits
Supplemental coverage products that complement a primary health plan — including dental, vision, life, disability, accident, critical illness, and hospital indemnity insurance.
⏱️ Elimination Period
The waiting period between the onset of a covered disability or condition and the date on which benefit payments begin. Commonly associated with disability insurance and some supplemental health products.
🔒 Guaranteed Renewability
A plan provision that ensures the carrier cannot cancel your coverage or refuse to renew your policy as long as premiums are paid, regardless of changes in your health status.
💹 Rate Action
A carrier-initiated adjustment to premium rates, typically applied at annual renewal. Rate actions may reflect changes in claims experience, medical cost trends, or regulatory requirements.
🏢 Group vs. Individual Coverage
Group coverage is sponsored by an employer or association and spreads risk across multiple members, often resulting in lower premiums. Individual coverage is purchased directly by the consumer and underwritten based on personal eligibility criteria.
🧬 Pre-Existing Condition
A diagnosed medical condition, illness, or injury that existed prior to the effective date of a new insurance policy. Depending on the plan type, benefits related to pre-existing conditions may be subject to a waiting period.
📞 Concierge Medicine
A healthcare model in which patients pay a recurring membership fee — separate from insurance — for enhanced access to a primary care physician, including same-day appointments, extended consultations, and direct physician communication.
🌱 Preventive vs. Diagnostic
Preventive services are routine screenings and wellness visits intended to detect or prevent illness before symptoms arise, typically covered at no cost. Diagnostic services are rendered in response to a specific symptom or complaint and are subject to standard cost-sharing.
⚡ Surprise Billing Protections
Federal and state regulations that protect insured individuals from unexpected bills when receiving emergency care or inadvertently treated by an out-of-network provider at an in-network facility.
🎓 Dependent Coverage
The extension of health insurance benefits to eligible family members of the primary insured, including a spouse and dependent children. Federal law requires most plans to offer dependent coverage through age 26.
Major Medical
Powered by
FAGE Tech
FAGE Tech
3500 Classic
💲
Deductible
$3,500 / $7,000 OON: $7,000 / $14,000
💰
Max Out of Pocket
$7,350 / $14,700 OON: $20,000 / $29,400
💳
Copay
$45 / $90 / $90 PCP / Specialist / Urgent Care
📉
Coinsurance
20% after deductible
💊
Rx Coverage
$0 / $15 / $65 / $100 Preventive / Generic / Preferred / Non-Preferred
🤰
Pregnancy
Covered
🧠
Mental Health
Covered 20% after deductible
💼
Work Requirement
No work requirement
⏳
Waiting Period
None
Monthly Premiums — Age Banded
Member Only
Enter age above
Member + Spouse
Enter age above
Member + Child
Enter age above
Family
Enter age above
Application fee: $75.00 one-time
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
5000 Classic
💲
Deductible
$5,000 / $10,000 OON: $10,000 / $20,000
💰
Max Out of Pocket
$7,350 / $14,700 OON: $14,700 / $29,400
💳
Copay
$45 / $90 / $90 PCP / Specialist / Urgent Care
📉
Coinsurance
20% after deductible
💊
Rx Coverage
$0 / $15 / $65 / $100 Preventive / Generic / Preferred / Non-Preferred
🤰
Pregnancy
Covered
🧠
Mental Health
Covered 20% after deductible
💼
Work Requirement
No work requirement
⏳
Waiting Period
None
Monthly Premiums — Age Banded
Member Only
Enter age above
Member + Spouse
Enter age above
Member + Child
Enter age above
Family
Enter age above
Application fee: $75.00 one-time
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
7350 Value
💲
Deductible
$7,350 / $14,700 OON: $14,700 / $29,400
💰
Max Out of Pocket
$7,350 / $14,700 OON: $14,700 / $29,400
💳
Copay
$50 / $100 / $100 PCP / Specialist / Urgent Care
📉
Coinsurance
20% after deductible
💊
Rx Coverage
$0 / $15 / $65 / $100 Preventive / Generic / Preferred / Non-Preferred
🤰
Pregnancy
Covered
🧠
Mental Health
Covered 20% after deductible
💼
Work Requirement
No work requirement
⏳
Waiting Period
None
Monthly Premiums — Age Banded
Member Only
Enter age above
Member + Spouse
Enter age above
Member + Child
Enter age above
Family
Enter age above
Application fee: $75.00 one-time
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
Copay 3500
💲
Deductible
$3,500 / $7,000 OON: $7,500 / $15,000
💰
Max Out of Pocket
$7,350 / $14,700 OON: $17,500 / $35,000
💳
Copay
$40 / $75 / $90 PCP / Specialist / Urgent Care
💊
Rx Coverage
$0 / $20 / $65 / $95 / $200 Preventive / Generic / Preferred / Non-Preferred / Specialty
🤰
Pregnancy
Covered
🧠
Mental Health
Covered 20% after deductible (outpatient & inpatient)
➕
Supplemental Benefits
Telemedicine $0 unlimited $20k Humana life included
💼
Work Requirement
No work requirement
⏳
Waiting Period
None
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
Copay 3500
💲
Deductible
$3,500 / $7,000 OON: $7,500 / $15,000
💰
Max Out of Pocket
$7,350 / $14,700 OON: $17,500 / $35,000
💳
Copay
$40 / $75 / $90 PCP / Specialist / Urgent Care
💊
Rx Coverage
$0 / $20 / $65 / $95 / $200 Preventive / Generic / Preferred / Non-Preferred / Specialty
🤰
Pregnancy
Covered
🧠
Mental Health
Covered 20% after deductible (outpatient & inpatient)
➕
Supplemental Benefits
Telemedicine $0 unlimited $20k Humana life included
💼
Work Requirement
No work requirement
⏳
Waiting Period
None
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
Copay 3500
💲
Deductible
$3,500 / $7,000 OON: $7,500 / $15,000
💰
Max Out of Pocket
$7,350 / $14,700 OON: $17,500 / $35,000
💳
Copay
$40 / $75 / $90 PCP / Specialist / Urgent Care
📉
Coinsurance
20% after deductible
💊
Rx Coverage
$0 / $20 / $65 / $95 / $200 Preventive / Generic / Preferred / Non-Preferred / Specialty
🤰
Pregnancy
Covered
🧠
Mental Health
Covered Inpatient & outpatient — 20% after deductible
🛡️
Life Insurance
$20,000 Humana Primary Member Only
➕
Supplemental Benefits
Hospital: $2,500 sick/$3,500 injury Surgery: $500/$1,000; ER: $100 sick/$250 injury; Adv. Imaging: $500 sick/$700 injury; PCP/Spec Visit: $25 (3x/yr); Health Screen: $50/yr; X-ray: $25 sick/$85 injury
💼
Work Requirement
Must be working
⏳
Waiting Period
None
Monthly Premiums — Community Rated
Member Only
$866.44/mo
Member + Spouse
$1,511.45/mo
Member + Child
$1,478.43/mo
Family
$2,147.72/mo
Application fee: $75.00 one-time
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
Copay 3500
💲
Deductible
$3,500 / $7,000 OON: $7,500 / $15,000
💰
Max Out of Pocket
$7,350 / $14,700 OON: $17,500 / $35,000
💳
Copay
$40 / $75 / $90 PCP / Specialist / Urgent Care
📉
Coinsurance
20% after deductible
💊
Rx Coverage
$0 / $20 / $65 / $95 / $200 Preventive / Generic / Preferred / Non-Preferred / Specialty
🤰
Pregnancy
Covered
🧠
Mental Health
Covered Inpatient & outpatient — 20% after deductible
🛡️
Life Insurance
$20,000 Humana Primary Member Only
💼
Work Requirement
Must be working
⏳
Waiting Period
None
Monthly Premiums — Community Rated
Member Only
$799.45/mo
Member + Spouse
$1,431.81/mo
Member + Child
$1,399.44/mo
Family
$2,055.61/mo
Application fee: $75.00 one-time
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
Copay 4500
💲
Deductible
$4,500 / $9,000 OON: $8,500 / $17,000
💰
Max Out of Pocket
$8,150 / $16,300 OON: $20,000 / $40,000
💳
Copay
$40 / $75 / $90 PCP / Specialist / Urgent Care
💊
Rx Coverage
$0 / $20 / $65 / $95 / $200 Preventive / Generic / Preferred / Non-Preferred / Specialty
🤰
Pregnancy
Covered
🧠
Mental Health
Covered 30% after deductible (outpatient & inpatient)
➕
Supplemental Benefits
Telemedicine $0 unlimited $20k Humana life included
💼
Work Requirement
No work requirement
⏳
Waiting Period
None
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
Copay 4500
💲
Deductible
$4,500 / $9,000 OON: $8,500 / $17,000
💰
Max Out of Pocket
$8,150 / $16,300 OON: $20,000 / $40,000
💳
Copay
$40 / $75 / $90 PCP / Specialist / Urgent Care
💊
Rx Coverage
$0 / $20 / $65 / $95 / $200 Preventive / Generic / Preferred / Non-Preferred / Specialty
🤰
Pregnancy
Covered
🧠
Mental Health
Covered 30% after deductible (outpatient & inpatient)
➕
Supplemental Benefits
Telemedicine $0 unlimited $20k Humana life included
💼
Work Requirement
No work requirement
⏳
Waiting Period
None
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
Copay 4500
💲
Deductible
$4,500 / $9,000 OON: $8,500 / $17,000
💰
Max Out of Pocket
$8,150 / $16,300 OON: $20,000 / $40,000
💳
Copay
$40 / $75 / $90 PCP / Specialist / Urgent Care
📉
Coinsurance
30% after deductible
💊
Rx Coverage
$0 / $20 / $65 / $95 / $200 Preventive / Generic / Preferred / Non-Preferred / Specialty
🤰
Pregnancy
Covered
🧠
Mental Health
Covered Inpatient & outpatient — 30% after deductible
🛡️
Life Insurance
$20,000 Humana Primary Member Only
➕
Supplemental Benefits
Hospital: $2,500 sick/$3,500 injury Surgery: $500/$1,000; ER: $100 sick/$250 injury; Adv. Imaging: $500 sick/$700 injury; PCP/Spec Visit: $25 (3x/yr); Health Screen: $50/yr; X-ray: $25 sick/$85 injury
💼
Work Requirement
Must be working
⏳
Waiting Period
None
Monthly Premiums — Community Rated
Member Only
$773.62/mo
Member + Spouse
$1,440.73/mo
Member + Child
$1,324.36/mo
Family
$1,892.97/mo
Application fee: $75.00 one-time
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
Copay 4500
💲
Deductible
$4,500 / $9,000 OON: $8,500 / $17,000
💰
Max Out of Pocket
$8,150 / $16,300 OON: $20,000 / $40,000
💳
Copay
$40 / $75 / $90 PCP / Specialist / Urgent Care
📉
Coinsurance
30% after deductible
💊
Rx Coverage
$0 / $20 / $65 / $95 / $200 Preventive / Generic / Preferred / Non-Preferred / Specialty
🤰
Pregnancy
Covered
🧠
Mental Health
Covered Inpatient & outpatient — 30% after deductible
🛡️
Life Insurance
$20,000 Humana Primary Member Only
💼
Work Requirement
Must be working
⏳
Waiting Period
None
Monthly Premiums — Community Rated
Member Only
$708.45/mo
Member + Spouse
$1,362.48/mo
Member + Child
$1,248.39/mo
Family
$1,805.85/mo
Application fee: $75.00 one-time
Plan Documents
Prior authorization may be required for certain services
HSA
Powered by
FAGE Tech
FAGE Tech
5000 HSA
💲
Deductible
$5,000 / $10,000 OON: $10,000 / $20,000
💰
Max Out of Pocket
$6,550 / $13,100 OON: $13,100 / $26,200
📉
Coinsurance
20% after deductible
💊
Rx Coverage
$0 / $15 / $65 / $100 Preventive / Generic (after ded.) / Preferred / Non-Preferred
🤰
Pregnancy
Covered
🧠
Mental Health
Covered 20% after deductible
💼
Work Requirement
No work requirement
⏳
Waiting Period
None
🏦
HSA Account
Lively HSA $25 contribution included
Monthly Premiums — Age Banded
Member Only
Enter age above
Member + Spouse
Enter age above
Member + Child
Enter age above
Family
Enter age above
Application fee: $75.00 one-time
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
HSA 3500
💲
Deductible
$3,500 / $7,500 OON: $7,500 / $15,000
💰
Max Out of Pocket
$7,000 / $14,000 OON: $17,500 / $35,000
💊
Rx Coverage
Generic & Brand 30% after deductible · $0 preventive generic
🤰
Pregnancy
Covered
🧠
Mental Health
Covered 30% after deductible (outpatient & inpatient)
➕
Supplemental Benefits
Telemedicine $0 unlimited $20k Humana life included
💼
Work Requirement
No work requirement
⏳
Waiting Period
None
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
HSA 3500
💲
Deductible
$3,500 / $7,500 OON: $7,500 / $15,000
💰
Max Out of Pocket
$7,000 / $14,000 OON: $17,500 / $35,000
💊
Rx Coverage
Generic & Brand 30% after deductible · $0 preventive generic
🤰
Pregnancy
Covered
🧠
Mental Health
Covered 30% after deductible (outpatient & inpatient)
➕
Supplemental Benefits
Telemedicine $0 unlimited $20k Humana life included
💼
Work Requirement
No work requirement
⏳
Waiting Period
None
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
HSA 3500
💲
Deductible
$3,500 / $7,000 OON: $7,500 / $15,000
💰
Max Out of Pocket
$7,000 / $14,000 OON: $17,500 / $35,000
📉
Coinsurance
30% after deductible
💊
Rx Coverage
$0 / 30% Preventive generic / Others after deductible
🤰
Pregnancy
Covered
🧠
Mental Health
Covered Inpatient & outpatient — 30% after deductible
🛡️
Life Insurance
$20,000 Humana Primary Member Only
🏦
HSA Account
Lively HSA
➕
Supplemental Benefits
Hospital: $2,500 sick/$3,500 injury Surgery: $500/$1,000; ER: $100 sick/$250 injury; Adv. Imaging: $500 sick/$700 injury; PCP/Spec Visit: $25 (3x/yr); Health Screen: $50/yr; X-ray: $25 sick/$85 injury
💼
Work Requirement
Must be working
⏳
Waiting Period
None
Monthly Premiums — Community Rated
Member Only
$736.81/mo
Member + Spouse
$1,358.57/mo
Member + Child
$1,240.78/mo
Family
$1,856.50/mo
Application fee: $75.00 one-time
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
HSA 3500
💲
Deductible
$3,500 / $7,000 OON: $7,500 / $15,000
💰
Max Out of Pocket
$7,000 / $14,000 OON: $17,500 / $35,000
📉
Coinsurance
30% after deductible
💊
Rx Coverage
$0 / 30% Preventive generic / Others after deductible
🤰
Pregnancy
Covered
🧠
Mental Health
Covered Inpatient & outpatient — 30% after deductible
🛡️
Life Insurance
$20,000 Humana Primary Member Only
🏦
HSA Account
Lively HSA
💼
Work Requirement
Must be working
⏳
Waiting Period
None
Monthly Premiums — Community Rated
Member Only
$672.36/mo
Member + Spouse
$1,281.93/mo
Member + Child
$1,166.45/mo
Family
$1,770.10/mo
Application fee: $75.00 one-time
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
HSA 8050
💲
Deductible
$8,050 / $16,100 OON: $16,100 / $32,200
💰
Max Out of Pocket
$8,050 / $16,100 OON: $24,000 / $48,000
💊
Rx Coverage
Covered (after deductible) Generics & brand up to $200 · above $200 not covered
🤰
Pregnancy
Covered
🧠
Mental Health
Covered 0% after deductible (outpatient & inpatient)
🏦
HSA Account
Lively HSA $25/mo employer contribution included
➕
Supplemental Benefits
Telemedicine $0 unlimited $20k Humana life included
💼
Work Requirement
No work requirement
⏳
Waiting Period
None
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
HSA 8050
💲
Deductible
$8,050 / $16,100 OON: $16,100 / $32,200
💰
Max Out of Pocket
$8,050 / $16,100 OON: $24,000 / $48,000
💊
Rx Coverage
Covered (after deductible) Generics & brand up to $200 · above $200 not covered
🤰
Pregnancy
Covered
🧠
Mental Health
Covered 0% after deductible (outpatient & inpatient)
🏦
HSA Account
Lively HSA $25/mo employer contribution included
➕
Supplemental Benefits
Telemedicine $0 unlimited $20k Humana life included
💼
Work Requirement
No work requirement
⏳
Waiting Period
None
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
HSA 8050
💲
Deductible
$8,050 / $16,100 OON: $16,100 / $32,200
💰
Max Out of Pocket
$8,050 / $16,100 OON: $24,000 / $48,000
💊
Rx Coverage
After deductible Up to $200 covered per script · >$200 not covered
🤰
Pregnancy
Covered
🧠
Mental Health
Covered Inpatient & outpatient — 0% after deductible
🛡️
Life Insurance
$20,000 Humana Primary Member Only
🏦
HSA Account
Lively HSA $25 contribution included
➕
Supplemental Benefits
Hospital: $2,500 sick/$3,500 injury Surgery: $500/$1,000; ER: $100 sick/$250 injury; Adv. Imaging: $500 sick/$700 injury; PCP/Spec Visit: $25 (3x/yr); Health Screen: $50/yr; X-ray: $25 sick/$85 injury
💼
Work Requirement
Must be working
⏳
Waiting Period
None
Monthly Premiums — Community Rated
Member Only
$636.58/mo
Member + Spouse
$994.01/mo
Member + Child
$1,096.14/mo
Family
$1,351.15/mo
Application fee: $75.00 one-time
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
HSA 8050
💲
Deductible
$8,050 / $16,100 OON: $16,100 / $32,200
💰
Max Out of Pocket
$8,050 / $16,100 OON: $24,000 / $48,000
💊
Rx Coverage
After deductible Up to $200 covered per script · >$200 not covered
🤰
Pregnancy
Covered
🧠
Mental Health
Covered Inpatient & outpatient — 0% after deductible
🛡️
Life Insurance
$20,000 Humana Primary Member Only
🏦
HSA Account
Lively HSA $25 contribution included
💼
Work Requirement
Must be working
⏳
Waiting Period
None
Monthly Premiums — Community Rated
Member Only
$574.10/mo
Member + Spouse
$924.52/mo
Member + Child
$1,024.65/mo
Family
$1,274.66/mo
Application fee: $75.00 one-time
Plan Documents
Prior authorization may be required for certain services
Limited Medical
Powered by
FAGE Tech
FAGE Tech
AHW 1
💲
Deductible
N/A – Indemnity plan
💳
Copay
$25 / $25 / $50 PCP / Specialist / Urgent Care
🩺
Doctor Visits
PCP 3per year/ Specialist 1 per year
💊
Rx Coverage
$0 preventive Non-preventive & brand: Not Covered
🏨
Hospitalization
$1,000/day · max $5,000/yr 12-mo pre-ex exclusion
💼
Work Requirement
No work requirement
📋
Guarantee Issue
Yes, 12 Month wait for pre- existing
🤝
Healthcare Advocacy
BillAssist hospital bill negotiation and financial assistance program included.
⏳
Waiting Period
30-day waiting period
Monthly Premiums — Community Rated
Member Only
$139.99/mo
Member + Spouse
$169.99/mo
Member + Child
$164.99/mo
Family
$209.99/mo
Pricing estimates based on individual member, age 45.
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
AHW 2
💲
Deductible
N/A – Indemnity plan
💳
Copay
$25 / $25 / $50 PCP / Specialist / Urgent Care
🩺
Doctor Visits
PCP 4 per year/ Specialist 2 per year
💊
Rx Coverage
$0 / $5 Preventive / Preferred generic (max $150/mo)
🏨
Hospitalization
$1,000/day · max $10,000/yr 12-mo pre-ex exclusion
💼
Work Requirement
No work requirement
📋
Guarantee Issue
Yes, 12 Month wait for pre- existing
🤝
Healthcare Advocacy
BillAssist hospital bill negotiation and financial assistance program included.
⏳
Waiting Period
30-day waiting period
Monthly Premiums — Community Rated
Member Only
$159.99/mo
Member + Spouse
$199.99/mo
Member + Child
$195.99/mo
Family
$239.99/mo
Pricing estimates based on individual member, age 45.
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
AHW 3
💲
Deductible
N/A – Indemnity plan
💳
Copay
$25 / $25 / $50 PCP / Specialist / Urgent Care
🩺
Doctor Visits
PCP 4 per year/ Specialist 4 per year
💊
Rx Coverage
$0 / $5 / $5–$10 Preventive / Preferred / Non-preferred · Brand: Not Covered
🏨
Hospitalization
$1,000/day · max $15,000/yr 12-mo pre-ex exclusion
💼
Work Requirement
No work requirement
📋
Guarantee Issue
Yes, 12 Month wait for pre- existing
🤝
Healthcare Advocacy
BillAssist hospital bill negotiation and financial assistance program included.
⏳
Waiting Period
30-day waiting period
Monthly Premiums — Community Rated
Member Only
$179.99/mo
Member + Spouse
$249.99/mo
Member + Child
$235.99/mo
Family
$289.99/mo
Pricing estimates based on individual member, age 45.
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
AHW 4
💲
Deductible
N/A – Indemnity plan
💳
Copay
$50 / $50 / $75 PCP / Specialist / Urgent Care
🩺
Doctor Visits
PCP 4 per year/ Specialist 4 per year
💊
Rx Coverage
$0 / $5 / $5–$10 Preventive / Preferred / Non-preferred · Brand: Not Covered
🏨
Hospitalization
$1,000/day · max $10,000/yr 12-mo pre-ex exclusion
🔪
Surgeries
$1,000 inpatient / $2,000 outpatient 12-mo pre-ex exclusion
🚨
ER
$1,000/incident If admitted only · 12-mo pre-ex exclusion
💼
Work Requirement
No work requirement
📋
Guarantee Issue
Yes, 12 Month wait for pre- existing
🤝
Healthcare Advocacy
BillAssist hospital bill negotiation and financial assistance program included.
⏳
Waiting Period
30-day waiting period
Monthly Premiums — Community Rated
Member Only
$199.99/mo
Member + Spouse
$279.99/mo
Member + Child
$269.99/mo
Family
$324.99/mo
Pricing estimates based on individual member, age 45.
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
AHW 5
💲
Deductible
N/A – Indemnity plan
💳
Copay
$50 / $75 / $75 PCP / Specialist / Urgent Care
🩺
Doctor Visits
PCP 5 per year/ Specialist 5 per year
💊
Rx Coverage
$0 / $5 / $5–$10 Preventive / Preferred / Non-preferred · Brand: Not Covered
🏨
Hospitalization
$1,500/day · max $15,000/yr 12-mo pre-ex exclusion
🔪
Surgeries
$1,500 inpatient / $4,500 outpatient 12-mo pre-ex exclusion
🚨
ER
$1,000/incident If admitted only · 12-mo pre-ex exclusion
💼
Work Requirement
No work requirement
📋
Guarantee Issue
Yes, 12 Month wait for pre- existing
🤝
Healthcare Advocacy
BillAssist hospital bill negotiation and financial assistance program included.
⏳
Waiting Period
30-day waiting period
Monthly Premiums — Community Rated
Member Only
$219.99/mo
Member + Spouse
$319.99/mo
Member + Child
$309.99/mo
Family
$374.99/mo
Pricing estimates based on individual member, age 45.
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
AHW 6
💲
Deductible
N/A Copay-based plan
💳
Copay
$35 / $75 / $85 PCP / Specialist / Urgent Care
🩺
Doctor Visits
Unlimited
💊
Rx Coverage
$0 / $5 Preventive / Non-preventive · Brand/Specialty: Not Covered
🚑
Urgent Care
$85 copay, no visit limit
🔬
Lab Work
$50 copay, non-hospital based only. No limit
🩻
Imaging
$500 copay 3 per yr — MRI/CT/PET/Nuclear
💼
Work Requirement
No work requirement
📋
Guarantee Issue
Yes, 12 Month wait for pre- existing
🤝
Healthcare Advocacy
BillAssist hospital bill negotiation and financial assistance program included.
⏳
Waiting Period
30-day waiting period
Monthly Premiums — Community Rated
Member Only
$199.99/mo
Member + Spouse
$279.99/mo
Member + Child
$279.99/mo
Family
$374.99/mo
Pricing estimates based on individual member, age 45.
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
DVP Essentials 2500
💲
Deductible
$2,500 / $5,000 In-Network
💳
Copay
$25 / $50 / $75 PCP / Specialist / Urgent Care
📉
Coinsurance
50% after deductible
🩺
Doctor Visits
4 combined/yr PCP + Specialist + MH
💊
Rx Coverage
$0 preventive Non-preventive & brand: Discount plan only
🏨
Hospitalization
5 days/yr
🔪
Surgeries
1 inpatient / 1 outpatient per yr
🚨
ER
1 visit/yr Copay included in hospitalization
🚑
Urgent Care
1 visit/yr
🔬
Lab Work
3 per year. NOT covered at a hospital.
🩻
Imaging
1 study/yr
🧠
Mental Health
Covered Subject to copays & visit limits
💼
Work Requirement
Must be working
⏳
Waiting Period
None
Monthly Premiums — Community Rated
Member Only
$570.67/mo
Member + Spouse
$770.67/mo
Member + Child
$720.67/mo
Family
$1,020.67/mo
Application fee: $75.00 one-time
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
DVP Essentials 2500
💲
Deductible
$2,500 / $5,000 In-Network
💳
Copay
$25 / $50 / $75 PCP / Specialist / Urgent Care
📉
Coinsurance
50% after deductible
🩺
Doctor Visits
4 combined/yr PCP + Specialist + MH
💊
Rx Coverage
$0 preventive Non-preventive & brand: Discount plan only
🏨
Hospitalization
5 days/yr
🔪
Surgeries
1 inpatient / 1 outpatient per yr
🚨
ER
1 visit/yr Copay included in hospitalization
🚑
Urgent Care
1 visit/yr
🔬
Lab Work
3 per year. NOT covered at a hospital.
🩻
Imaging
1 study/yr
🧠
Mental Health
Covered Subject to copays & visit limits
💼
Work Requirement
Must be working
⏳
Waiting Period
None
Monthly Premiums — Community Rated
Member Only
$504.00/mo
Member + Spouse
$704.00/mo
Member + Child
$654.00/mo
Family
$954.00/mo
Application fee: $75.00 one-time
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
DVP Essentials 5000
💲
Deductible
$5,000 / $10,000 In-Network
💳
Copay
$25 / $50 / $75 PCP / Specialist / Urgent Care
📉
Coinsurance
50% after deductible
🩺
Doctor Visits
2 combined/yr PCP + Specialist + MH
💊
Rx Coverage
$0 preventive Non-preventive & brand: Discount plan only
🏨
Hospitalization
5 days/yr
🔪
Surgeries
1 inpatient / 1 outpatient per yr
🚨
ER
1 visit/yr Copay included in hospitalization
🚑
Urgent Care
1 visit/yr
🔬
Lab Work
3 per year. NOT covered at a hospital.
🩻
Imaging
1 study/yr
🧠
Mental Health
Covered Subject to copays & visit limits
💼
Work Requirement
Must be working
⏳
Waiting Period
None
Monthly Premiums — Community Rated
Member Only
$491.65/mo
Member + Spouse
$730.67/mo
Member + Child
$680.67/mo
Family
$940.67/mo
Application fee: $75.00 one-time
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
DVP Essentials 5000
💲
Deductible
$5,000 / $10,000 In-Network
💳
Copay
$25 / $50 / $75 PCP / Specialist / Urgent Care
📉
Coinsurance
50% after deductible
🩺
Doctor Visits
2 combined/yr PCP + Specialist + MH
💊
Rx Coverage
$0 preventive Non-preventive & brand: Discount plan only
🏨
Hospitalization
5 days/yr
🔪
Surgeries
1 inpatient / 1 outpatient per yr
🚨
ER
1 visit/yr Copay included in hospitalization
🚑
Urgent Care
1 visit/yr
🔬
Lab Work
3 per year. NOT covered at a hospital.
🩻
Imaging
1 study/yr
🧠
Mental Health
Covered Subject to copays & visit limits
💼
Work Requirement
Must be working
⏳
Waiting Period
None
Monthly Premiums — Community Rated
Member Only
$424.99/mo
Member + Spouse
$664.00/mo
Member + Child
$614.00/mo
Family
$874.00/mo
Application fee: $75.00 one-time
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
DVP Essentials 7500
💲
Deductible
$7,500 / $15,000 In-Network
💳
Copay
$50 / $75 / $75 PCP / Specialist / Urgent Care
📉
Coinsurance
50% after deductible
🩺
Doctor Visits
2 combined/yr PCP + Specialist + MH
💊
Rx Coverage
$0 preventive Non-preventive & brand: Discount plan only (not covered)
🏨
Hospitalization
5 days/yr
🔪
Surgeries
1 inpatient / 1 outpatient per yr
🚨
ER
1 visit/yr Copay included in hospitalization
🚑
Urgent Care
1 visit/yr
🔬
Lab Work
3 per year. NOT covered at a hospital.
🩻
Imaging
1 study/yr
🧠
Mental Health
Covered Subject to copays & visit limits
💼
Work Requirement
Must be working
⏳
Waiting Period
None
Monthly Premiums — Community Rated
Member Only
$424.98/mo
Member + Spouse
$664.00/mo
Member + Child
$614.00/mo
Family
$874.00/mo
Application fee: $75.00 one-time
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
DVP Essentials 7500
💲
Deductible
$7,500 / $15,000 In-Network
💳
Copay
$50 / $75 / $75 PCP / Specialist / Urgent Care
📉
Coinsurance
50% after deductible
🩺
Doctor Visits
2 combined/yr PCP + Specialist + MH
💊
Rx Coverage
$0 preventive Non-preventive & brand: Discount plan only (not covered)
🏨
Hospitalization
5 days/yr
🔪
Surgeries
1 inpatient / 1 outpatient per yr
🚨
ER
1 visit/yr Copay included in hospitalization
🚑
Urgent Care
1 visit/yr
🔬
Lab Work
3 per year. NOT covered at a hospital.
🩻
Imaging
1 study/yr
🧠
Mental Health
Covered Subject to copays & visit limits
💼
Work Requirement
Must be working
⏳
Waiting Period
None
Monthly Premiums — Community Rated
Member Only
$364.99/mo
Member + Spouse
$604.00/mo
Member + Child
$554.00/mo
Family
$814.00/mo
Application fee: $75.00 one-time
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
MEC Choice
💲
Deductible
$0 / $0
💳
Copay
$35 / $75 / $85 PCP / Specialist / Urgent Care
💊
Rx Coverage
Preventive generic $0 / Generic $5 Brand & Specialty: Not Covered
🩺
Doctor Visits
4 PCP / 4 Specialist
🔬
Lab Work
$50 copay, 3/yr Non-hospital based only
🩻
Imaging
$500 copay, 3/yr CT/MRI/MRA/PET — prior auth required
🏨
Hospitalization
Not Covered
🚨
ER
Not Covered
🧠
Mental Health
Covered under Specialist 4 visits/yr
💼
Work Requirement
No work requirement
⏳
Waiting Period
None
Monthly Premiums — Community Rated
Member Only
$205.00/mo
Member + Spouse
$285.00/mo
Member + Child
$285.00/mo
Family
$391.67/mo
Application fee: $75.00 one-time
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
MEC Classic
💲
Deductible
$0 / $0
💊
Rx Coverage
Preventive generic $0 Non-preventive & brand: Not Covered
🩺
Doctor Visits
Not Covered
🏨
Hospitalization
Not Covered
🚨
ER
Not Covered
🔬
Lab Work
Not Covered
💼
Work Requirement
No work requirement
⏳
Waiting Period
None
Monthly Premiums — Community Rated
Member Only
$125.00/mo
Member + Spouse
$178.33/mo
Member + Child
$178.33/mo
Family
$231.67/mo
Application fee: $75.00 one-time
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
MEC Tier 1
💲
Deductible
$0 / $0
💊
Rx Coverage
$0 Preventive Only Non-preventive: Not Covered
🩺
Doctor Visits
Not Covered
🏨
Hospitalization
Not Covered
🚨
ER
Not Covered
🔬
Lab Work
Not Covered
🧠
Mental Health
Not Covered
📱
Telehealth
$0 copay Unlimited · Preventive & wellness included
⏳
Waiting Period
None
💼
Work Requirement
No work requirement
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
MEC Tier 2
💲
Deductible
$0 / $0
💳
Copay
$35 / $75 / $85 PCP / Specialist / Urgent Care
🩺
Doctor Visits
4 PCP / 4 Specialist Separate limits per year
💊
Rx Coverage
$0 / $5 Preventive / Generic · Non-generic: Not Covered
🏨
Hospitalization
Not Covered
🚨
ER
Not Covered
🚑
Urgent Care
$85 copay No visit limit stated
🔬
Lab Work
$50 copay 3/yr (lab & radiology) · CT/MRI/PET $500, 3/yr
🩻
Imaging
$500 copay 3 CT/MRI/PET per year
🧠
Mental Health
Covered $75 specialist copay · 4 visits/yr
📱
Telehealth
$0 copay Unlimited
⏳
Waiting Period
None
💼
Work Requirement
No work requirement
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
MEC Tier 3
💲
Deductible
$0 / $0
💳
Copay
$25 / $50 / $50 PCP / Specialist / Urgent Care
🩺
Doctor Visits
Unlimited
💊
Rx Coverage
$0 / $5 Preventive / Generic
🏨
Hospitalization
Not Covered
🔪
Surgeries
$400 copay Outpatient surgery only · Anesthesia included
🚨
ER
Not Covered
🚑
Urgent Care
$50 copay No visit limit stated
🔬
Lab Work
$50 copay No visit limit · CT/MRI/PET $350, 1/yr
🩻
Imaging
$350 copay 1 CT/MRI/PET per year
🧠
Mental Health
Covered $50 specialist copay
📱
Telehealth
$0 copay Unlimited
⏳
Waiting Period
None
💼
Work Requirement
No work requirement
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
MVP Advantage
💲
Deductible
$0 / $0
💳
Copay
$15 / $25 / $35 PCP / Specialist / Urgent Care
🩺
Doctor Visits
12 PCP / 12 Specialist (separate) per year
💊
Rx Coverage
$0 / $5 Preventive / Non-preventive · Brand/Specialty: Not Covered
🏨
Hospitalization
$350 copay/admission 10 days/yr
🔪
Surgeries
4 inpatient / 2 outpatient per yr
🚨
ER
$350 copay 2 visits/yr
🚑
Urgent Care
3 visits/yr
🔬
Lab Work
4 per year. NOT covered at a hospital.
🩻
Imaging
3 studies/yr
🤰
Pregnancy
12-month waiting period. Professional services $350. Delivery $350/admission.
🧠
Mental Health
Covered Under Specialist limit — 12 visits/yr
💼
Work Requirement
Must be working
⏳
Waiting Period
None
Monthly Premiums — Community Rated
Member Only
$744.56/mo
Member + Spouse
$1,182.45/mo
Member + Child
$1,036.48/mo
Family
$1,474.37/mo
Application fee: $75.00 one-time
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
MVP Advantage
💲
Deductible
$0 / $0
💳
Copay
$15 / $25 / $35 PCP / Specialist / Urgent Care
🩺
Doctor Visits
12 PCP / 12 Specialist (separate) per year
💊
Rx Coverage
$0 / $5 Preventive / Non-preventive · Brand/Specialty: Not Covered
🏨
Hospitalization
$350 copay/admission 10 days/yr
🔪
Surgeries
4 inpatient / 2 outpatient per yr
🚨
ER
$350 copay 2 visits/yr
🚑
Urgent Care
3 visits/yr
🔬
Lab Work
4 per year. NOT covered at a hospital.
🩻
Imaging
3 studies/yr
🤰
Pregnancy
12-month waiting period. Professional services $350. Delivery $350/admission.
🧠
Mental Health
Covered Under Specialist limit — 12 visits/yr
💼
Work Requirement
Must be working
⏳
Waiting Period
None
Monthly Premiums — Community Rated
Member Only
$677.89/mo
Member + Spouse
$1,115.79/mo
Member + Child
$969.81/mo
Family
$1,407.71/mo
Application fee: $75.00 one-time
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
MVP Basic
💲
Deductible
$0 / $0
💳
Copay
$25 / $50 / $50 PCP / Specialist / Urgent Care
🩺
Doctor Visits
8 PCP / 8 Specialist Separate limits per year
💊
Rx Coverage
$0 / $5 Preventive / Generic · Brand: Not Covered
🏨
Hospitalization
$350 copay/admission 5 days/yr
🔪
Surgeries
2 inpatient / 1 outpatient Per year · IP included in admission copay
🚨
ER
$350 copay 1 visit/yr · Ambulance $250 ground, 1/yr
🚑
Urgent Care
$50 copay 2 visits/yr
🔬
Lab Work
$50 copay 3/yr (lab & radiology) · CT/MRI/PET $350, 1/yr
🩻
Imaging
$350 copay 1 CT/MRI/PET per year
🧠
Mental Health
Covered $50 specialist copay · 8 visits/yr
⏳
Waiting Period
None Maternity: 12-month waiting period
💼
Work Requirement
No work requirement
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
MVP Basic
💲
Deductible
$0 / $0
💳
Copay
$25 / $50 / $50 PCP / Specialist / Urgent Care
🩺
Doctor Visits
8 PCP / 8 Specialist Separate limits per year
💊
Rx Coverage
$0 / $5 Preventive / Generic · Brand: Not Covered
🏨
Hospitalization
$350 copay/admission 5 days/yr
🔪
Surgeries
2 inpatient / 1 outpatient Per year · IP included in admission copay
🚨
ER
$350 copay 1 visit/yr · Ambulance $250 ground, 1/yr
🚑
Urgent Care
$50 copay 2 visits/yr
🔬
Lab Work
$50 copay 3/yr (lab & radiology) · CT/MRI/PET $350, 1/yr
🩻
Imaging
$350 copay 1 CT/MRI/PET per year
🧠
Mental Health
Covered $50 specialist copay · 8 visits/yr
⏳
Waiting Period
None Maternity: 12-month waiting period
💼
Work Requirement
No work requirement
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
MVP Basic
💲
Deductible
$0 / $0
💳
Copay
$25 / $50 / $50 PCP / Specialist / Urgent Care
🩺
Doctor Visits
8 PCP / 8 Specialist (separate) per year
💊
Rx Coverage
$0 / $5 Preventive / Non-preventive · Brand/Specialty: Not Covered
🏨
Hospitalization
$350 copay/admission 5 days/yr
🔪
Surgeries
2 inpatient / 1 outpatient per yr
🚨
ER
$350 copay 1 visit/yr
🚑
Urgent Care
2 visits/yr
🔬
Lab Work
3 per year. NOT covered at a hospital.
🩻
Imaging
1 study/yr
🧠
Mental Health
Covered Under Specialist limit — 8 visits/yr
💼
Work Requirement
Must be working
⏳
Waiting Period
None
Monthly Premiums — Community Rated
Member Only
$638.73/mo
Member + Spouse
$973.76/mo
Member + Child
$869.41/mo
Family
$1,204.45/mo
Application fee: $75.00 one-time
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
MVP Basic
💲
Deductible
$0 / $0
💳
Copay
$25 / $50 / $50 PCP / Specialist / Urgent Care
🩺
Doctor Visits
8 PCP / 8 Specialist (separate) per year
💊
Rx Coverage
$0 / $5 Preventive / Non-preventive · Brand/Specialty: Not Covered
🏨
Hospitalization
$350 copay/admission 5 days/yr
🔪
Surgeries
2 inpatient / 1 outpatient per yr
🚨
ER
$350 copay 1 visit/yr
🚑
Urgent Care
2 visits/yr
🔬
Lab Work
3 per year. NOT covered at a hospital.
🩻
Imaging
1 study/yr
🧠
Mental Health
Covered Under Specialist limit — 8 visits/yr
💼
Work Requirement
Must be working
⏳
Waiting Period
None
Monthly Premiums — Community Rated
Member Only
$572.07/mo
Member + Spouse
$907.09/mo
Member + Child
$802.75/mo
Family
$1,137.79/mo
Application fee: $75.00 one-time
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
MVP Enhanced
💲
Deductible
$0 / $0
💳
Copay
$15 / $25 / $35 PCP / Specialist / Urgent Care
🩺
Doctor Visits
12 PCP / 12 Specialist Separate limits per year
💊
Rx Coverage
$0 / $5 / $40 / $80 Preventive / Generic / Preferred Brand / Non-Preferred
🏨
Hospitalization
$350 copay/admission 10 days/yr
🔪
Surgeries
4 inpatient / 2 outpatient Per year · IP included in admission copay
🚨
ER
$350 copay 2 visits/yr · Ambulance $250 ground, 2/yr
🚑
Urgent Care
$35 copay 3 visits/yr
🔬
Lab Work
$50 copay 4/yr (lab & radiology) · CT/MRI/PET $350, 3/yr
🩻
Imaging
$350 copay 3 CT/MRI/PET per year
🤰
Pregnancy
12-month waiting period Professional services $350 · Delivery $350/admission
🧠
Mental Health
Covered $25 specialist copay · 12 visits/yr
⏳
Waiting Period
Maternity: 12 months
💼
Work Requirement
No work requirement
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
MVP Enhanced
💲
Deductible
$0 / $0
💳
Copay
$15 / $25 / $35 PCP / Specialist / Urgent Care
🩺
Doctor Visits
12 PCP / 12 Specialist Separate limits per year
💊
Rx Coverage
$0 / $5 / $40 / $80 Preventive / Generic / Preferred Brand / Non-Preferred
🏨
Hospitalization
$350 copay/admission 10 days/yr
🔪
Surgeries
4 inpatient / 2 outpatient Per year · IP included in admission copay
🚨
ER
$350 copay 2 visits/yr · Ambulance $250 ground, 2/yr
🚑
Urgent Care
$35 copay 3 visits/yr
🔬
Lab Work
$50 copay 4/yr (lab & radiology) · CT/MRI/PET $350, 3/yr
🩻
Imaging
$350 copay 3 CT/MRI/PET per year
🤰
Pregnancy
12-month waiting period Professional services $350 · Delivery $350/admission
🧠
Mental Health
Covered $25 specialist copay · 12 visits/yr
⏳
Waiting Period
Maternity: 12 months
💼
Work Requirement
No work requirement
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
MVP Fundamentals
💲
Deductible
$0 / $0
💳
Copay
$15 / $25 / $35 PCP / Specialist / Urgent Care
🩺
Doctor Visits
10 PCP / 10 Specialist Separate limits per year
💊
Rx Coverage
$0 / $5 Preventive / Generic · Brand: Not Covered
🏨
Hospitalization
$350 copay/admission 7 days/yr
🔪
Surgeries
3 inpatient / 2 outpatient Per year · IP included in admission copay
🚨
ER
$350 copay 1 visit/yr · Ambulance $250 ground, 1/yr
🚑
Urgent Care
$35 copay 3 visits/yr
🔬
Lab Work
$50 copay 3/yr (lab & radiology) · CT/MRI/PET $350, 2/yr
🩻
Imaging
$350 copay 2 CT/MRI/PET per year
🤰
Pregnancy
12-month waiting period Professional services $350 · Delivery $350/admission
🧠
Mental Health
Covered $25 specialist copay · 10 visits/yr
⏳
Waiting Period
Maternity: 12 months
💼
Work Requirement
No work requirement
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
MVP Fundamentals
💲
Deductible
$0 / $0
💳
Copay
$15 / $25 / $35 PCP / Specialist / Urgent Care
🩺
Doctor Visits
10 PCP / 10 Specialist Separate limits per year
💊
Rx Coverage
$0 / $5 Preventive / Generic · Brand: Not Covered
🏨
Hospitalization
$350 copay/admission 7 days/yr
🔪
Surgeries
3 inpatient / 2 outpatient Per year · IP included in admission copay
🚨
ER
$350 copay 1 visit/yr · Ambulance $250 ground, 1/yr
🚑
Urgent Care
$35 copay 3 visits/yr
🔬
Lab Work
$50 copay 3/yr (lab & radiology) · CT/MRI/PET $350, 2/yr
🩻
Imaging
$350 copay 2 CT/MRI/PET per year
🤰
Pregnancy
12-month waiting period Professional services $350 · Delivery $350/admission
🧠
Mental Health
Covered $25 specialist copay · 10 visits/yr
⏳
Waiting Period
Maternity: 12 months
💼
Work Requirement
No work requirement
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
MVP Value
💲
Deductible
$0 / $0
💳
Copay
$15 / $25 / $35 PCP / Specialist / Urgent Care
🩺
Doctor Visits
10 PCP / 10 Specialist (separate) per year
💊
Rx Coverage
$0 / $5 Preventive / Non-preventive · Brand/Specialty: Not Covered
🏨
Hospitalization
$350 copay/admission 7 days/yr
🔪
Surgeries
3 inpatient / 2 outpatient per yr
🚨
ER
$350 copay 1 visit/yr
🚑
Urgent Care
3 visits/yr
🔬
Lab Work
3 per year. NOT covered at a hospital.
🩻
Imaging
2 studies/yr
🤰
Pregnancy
12-month waiting period. Professional services $350. Delivery $350/admission.
🧠
Mental Health
Covered Under Specialist limit — 10 visits/yr
💼
Work Requirement
Must be working
⏳
Waiting Period
None
Monthly Premiums — Community Rated
Member Only
$698.16/mo
Member + Spouse
$1,104.51/mo
Member + Child
$976.40/mo
Family
$1,382.73/mo
Application fee: $75.00 one-time
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
MVP Value
💲
Deductible
$0 / $0
💳
Copay
$15 / $25 / $35 PCP / Specialist / Urgent Care
🩺
Doctor Visits
10 PCP / 10 Specialist (separate) per year
💊
Rx Coverage
$0 / $5 Preventive / Non-preventive · Brand/Specialty: Not Covered
🏨
Hospitalization
$350 copay/admission 7 days/yr
🔪
Surgeries
3 inpatient / 2 outpatient per yr
🚨
ER
$350 copay 1 visit/yr
🚑
Urgent Care
3 visits/yr
🔬
Lab Work
3 per year. NOT covered at a hospital.
🩻
Imaging
2 studies/yr
🤰
Pregnancy
12-month waiting period. Professional services $350. Delivery $350/admission.
🧠
Mental Health
Covered Under Specialist limit — 10 visits/yr
💼
Work Requirement
Must be working
⏳
Waiting Period
None
Monthly Premiums — Community Rated
Member Only
$631.49/mo
Member + Spouse
$1,037.84/mo
Member + Child
$909.73/mo
Family
$1,316.07/mo
Application fee: $75.00 one-time
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
MedAccess MVP
💲
Deductible
$0 / $0
💳
Copay
$25 / $50 / $50 PCP / Specialist / Urgent Care
🩺
Doctor Visits
6 PCP / 6 Specialist
💊
Rx Coverage
$0 / $10 Preventive / Non-preventive · Retail brand: Not Covered
🏨
Hospitalization
$350 copay/admission 3 days/yr
🔪
Surgeries
1 outpatient/yr Inpatient included in hospital stay
🚨
ER
$350 copay 1 visit/yr
🚑
Urgent Care
2 visits/yr
🔬
Lab Work
$50 copay, 3 per year.
🩻
Imaging
$350 copay 1/yr — non-hospital based only
🧠
Mental Health
Covered
💼
Work Requirement
No work requirement
⏳
Waiting Period
None
Monthly Premiums — Age Banded
Member Only
Enter age above
Member + Spouse
Enter age above
Member + Child
Enter age above
Family
Enter age above
Application fee: $60.00 one-time
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
MedAccess MVP Pro
💲
Deductible
$0 / $0
💳
Copay
$15 / $25 / $50 PCP / Specialist / Urgent Care
🩺
Doctor Visits
12 PCP / 12 Specialist
💊
Rx Coverage
$0 / 20% Preventive / Non-preventive retail · Preferred brand: Not Covered
🏨
Hospitalization
$350 copay/admission 10 days/yr
🔪
Surgeries
4 inpatient / 2 outpatient per yr
🚨
ER
$350 copay 2 visits/yr
🚑
Urgent Care
3 visits/yr
🔬
Lab Work
$50 copay, 4 per year.
🩻
Imaging
$350 copay 4/yr — non-hospital based only
🤰
Pregnancy
12-month waiting period. Professional services $350. Delivery $350/admission.
🧠
Mental Health
Covered
💼
Work Requirement
No work requirement
⏳
Waiting Period
None
Monthly Premiums — Age Banded
Member Only
Enter age above
Member + Spouse
Enter age above
Member + Child
Enter age above
Family
Enter age above
Application fee: $60.00 one-time
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
MedMax 1000
💲
Deductible
$1,000 / $2,000 In-Network
💳
Copay
$50 / $50 / $50 PCP / Specialist / Urgent Care
🩺
Doctor Visits
10 combined/yr PCP + Specialist + Urgetnt
💊
Rx Coverage
$0 All generics (before & after deductible) · Brand: Not Covered
🏨
Hospitalization
$1,000 copay 2 per yr, 10 days/admission · prior auth required
🔪
Surgeries
$250 outpatient / $1,000 inpatient 3 outpatient / 2 inpatient per yr
🚨
ER
$250 copay 2 accident / 2 sickness visits/yr
🚑
Urgent Care
10 visits/yr combined Shared with Specialist visits
🔬
Lab Work
$25 copay (after deductible). 3 per year.
🩻
Imaging
$50–$200 copay 3 X-rays/yr · 2 advanced/yr (MRI/CT/PET) · after deductible
🤰
Pregnancy
12-month waiting period.
🧠
Mental Health
Covered Outpatient: $50 copay, 15 days/yr · Inpatient: $250 copay, 15 days/yr
💼
Work Requirement
No work requirement
⏳
Waiting Period
None
Monthly Premiums — Age Banded
Member Only
Enter age above
Member + Spouse
Enter age above
Member + Child
Enter age above
Family
Enter age above
Pricing estimates based on individual member, age 45.
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
MedMax 1500
💲
Deductible
$1,500 / $3,000 In-Network
💳
Copay
$50 / $50 / $50 PCP / Specialist / Urgent Care
🩺
Doctor Visits
10 combined/yr PCP + Specialist + Urgetnt
💊
Rx Coverage
$0 All generics (before & after deductible) · Brand: Not Covered
🏨
Hospitalization
$1,000 copay 2 per yr, 10 days/admission · prior auth required
🔪
Surgeries
$250 outpatient / $1,000 inpatient 3 outpatient / 2 inpatient per yr
🚨
ER
$250 copay 2 accident / 2 sickness visits/yr
🚑
Urgent Care
10 visits/yr combined Shared with Specialist visits
🔬
Lab Work
$25 copay (after deductible). 3 per year.
🩻
Imaging
$50–$200 copay 3 X-rays/yr · 2 advanced/yr (MRI/CT/PET) · after deductible
🤰
Pregnancy
12-month waiting period.
🧠
Mental Health
Covered Outpatient: $50 copay, 15 days/yr · Inpatient: $250 copay, 15 days/yr
💼
Work Requirement
No work requirement
⏳
Waiting Period
None
Monthly Premiums — Age Banded
Member Only
Enter age above
Member + Spouse
Enter age above
Member + Child
Enter age above
Family
Enter age above
Pricing estimates based on individual member, age 45.
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
MedMax 250
💲
Deductible
$250 / $500 In-Network
💳
Copay
$50 / $50 / $50 PCP / Specialist / Urgent Care
🩺
Doctor Visits
10 combined/yr PCP + Specialist + Urgetnt
💊
Rx Coverage
$0 All generics (before & after deductible) · Brand: Not Covered
🏨
Hospitalization
$1,000 copay 2 per yr, 10 days/admission · prior auth required
🔪
Surgeries
$250 outpatient / $1,000 inpatient 3 outpatient / 2 inpatient per yr
🚨
ER
$250 copay 2 accident / 2 sickness visits/yr
🚑
Urgent Care
10 visits/yr combined Shared with Specialist visits
🔬
Lab Work
$25 copay (after deductible). 3 per year.
🩻
Imaging
$50–$200 copay 3 X-rays/yr · 2 advanced/yr (MRI/CT/PET) · after deductible
🤰
Pregnancy
12-month waiting period.
🧠
Mental Health
Covered Outpatient: $50 copay, 15 days/yr · Inpatient: $250 copay, 15 days/yr
💼
Work Requirement
No work requirement
⏳
Waiting Period
None
Monthly Premiums — Age Banded
Member Only
Enter age above
Member + Spouse
Enter age above
Member + Child
Enter age above
Family
Enter age above
Pricing estimates based on individual member, age 45.
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
MedMax 500
💲
Deductible
$500 / $1,000 In-Network
💳
Copay
$50 / $50 / $50 PCP / Specialist / Urgent Care
🩺
Doctor Visits
10 combined/yr PCP + Specialist + Urgetnt
💊
Rx Coverage
$0 All generics (before & after deductible) · Brand: Not Covered
🏨
Hospitalization
$1,000 copay 2 per yr, 10 days/admission · prior auth required
🔪
Surgeries
$250 outpatient / $1,000 inpatient 3 outpatient / 2 inpatient per yr
🚨
ER
$250 copay 2 accident / 2 sickness visits/yr
🚑
Urgent Care
10 visits/yr combined Shared with Specialist visits
🔬
Lab Work
$25 copay (after deductible). 3 per year.
🩻
Imaging
$50–$200 copay 3 X-rays/yr · 2 advanced/yr (MRI/CT/PET) · after deductible
🤰
Pregnancy
12-month waiting period.
🧠
Mental Health
Covered Outpatient: $50 copay, 15 days/yr · Inpatient: $250 copay, 15 days/yr
💼
Work Requirement
No work requirement
⏳
Waiting Period
None
Monthly Premiums — Age Banded
Member Only
Enter age above
Member + Spouse
Enter age above
Member + Child
Enter age above
Family
Enter age above
Pricing estimates based on individual member, age 45.
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
MedMax 750
💲
Deductible
$750 / $1,500 In-Network
💳
Copay
$50 / $50 / $50 PCP / Specialist / Urgent Care
🩺
Doctor Visits
10 combined/yr PCP + Specialist + Urgetnt
💊
Rx Coverage
$0 All generics (before & after deductible) · Brand: Not Covered
🏨
Hospitalization
$1,000 copay 2 per yr, 10 days/admission · prior auth required
🔪
Surgeries
$250 outpatient / $1,000 inpatient 3 outpatient / 2 inpatient per yr
🚨
ER
$250 copay 2 accident / 2 sickness visits/yr
🚑
Urgent Care
10 visits/yr combined Shared with Specialist visits
🔬
Lab Work
$25 copay (after deductible). 3 per year.
🩻
Imaging
$50–$200 copay 3 X-rays/yr · 2 advanced/yr (MRI/CT/PET) · after deductible
🤰
Pregnancy
12-month waiting period.
🧠
Mental Health
Covered Outpatient: $50 copay, 15 days/yr · Inpatient: $250 copay, 15 days/yr
💼
Work Requirement
No work requirement
⏳
Waiting Period
None
Monthly Premiums — Age Banded
Member Only
Enter age above
Member + Spouse
Enter age above
Member + Child
Enter age above
Family
Enter age above
Pricing estimates based on individual member, age 45.
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
MedValue 2000
💲
Deductible
$2,000 / $4,000 In-Network
💳
Copay
$50 / $50 / $50 PCP / Specialist / Urgent Care
📉
Coinsurance
None copay-based
🩺
Doctor Visits
4 combined/yr 2 before ded, 2 after
💊
Rx Coverage
$0 All generics (before & after ded.) · Brand: Not Covered
🏨
Hospitalization
$1,000 copay 1 per yr, 5-day limit · after deductible
🔪
Surgeries
1 inpatient / 1 outpatient per yr
🚨
ER
$500 copay 1 visit/yr · after deductible
🚑
Urgent Care
$50 copay 4-visit combined limit (PCP/Specialist/UC)
🔬
Lab Work
$25 copay (after deductible). 3 per benefit plan year. Each diagnostic category (lab, x-ray, advanced imaging) has its own separate 3/yr limit.
🩻
Imaging
$50–$400 copay 3 per yr · after deductible
💼
Work Requirement
No work requirement
🤝
Healthcare Advocacy
Med Defender Pro: Medical Bill Negotiator (helps negotiate unexpected medical costs).
⏳
Waiting Period
None .
Monthly Premiums — Age Banded
Member Only
Enter age above
Member + Spouse
Enter age above
Member + Child
Enter age above
Family
Enter age above
Pricing estimates based on individual member, age 45.
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
MedValue 4000
💲
Deductible
$4,000 / $8,000 In-Network
💳
Copay
$50 / $50 / $50 PCP / Specialist / Urgent Care
📉
Coinsurance
None copay-based
🩺
Doctor Visits
4 combined/yr 2 before ded, 2 after
💊
Rx Coverage
$0 All generics (before & after ded.) · Brand: Not Covered
🏨
Hospitalization
$1,000 copay 1 per yr, 5-day limit · after deductible
🔪
Surgeries
1 inpatient / 1 outpatient per yr
🚨
ER
$500 copay 1 visit/yr · after deductible
🚑
Urgent Care
$50 copay 4-visit combined limit (PCP/Specialist/UC)
🔬
Lab Work
$25 copay (after deductible). 3 per benefit plan year. Each diagnostic category (lab, x-ray, advanced imaging) has its own separate 3/yr limit.
🩻
Imaging
$50–$400 copay 3 per yr · after deductible
💼
Work Requirement
No work requirement
🤝
Healthcare Advocacy
Med Defender Pro: Medical Bill Negotiator (helps negotiate unexpected medical costs).
⏳
Waiting Period
None .
Monthly Premiums — Age Banded
Member Only
Enter age above
Member + Spouse
Enter age above
Member + Child
Enter age above
Family
Enter age above
Pricing estimates based on individual member, age 45.
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
MedValue 6000
💲
Deductible
$6,000 / $12,000 In-Network
💳
Copay
$50 / $50 / $50 PCP / Specialist / Urgent Care
📉
Coinsurance
None copay-based
🩺
Doctor Visits
4 combined/yr 2 before ded, 2 after
💊
Rx Coverage
$0 All generics (before & after ded.) · Brand: Not Covered
🏨
Hospitalization
$1,000 copay 1 per yr, 5-day limit · after deductible
🔪
Surgeries
1 inpatient / 1 outpatient per yr
🚨
ER
$500 copay 1 visit/yr · after deductible
🚑
Urgent Care
$50 copay 4-visit combined limit (PCP/Specialist/UC)
🔬
Lab Work
$25 copay (after deductible). 3 per benefit plan year. Each diagnostic category (lab, x-ray, advanced imaging) has its own separate 3/yr limit.
🩻
Imaging
$50–$400 copay 3 per yr · after deductible
💼
Work Requirement
No work requirement
🤝
Healthcare Advocacy
Med Defender Pro: Medical Bill Negotiator (helps negotiate unexpected medical costs).
⏳
Waiting Period
None .
Monthly Premiums — Age Banded
Member Only
Enter age above
Member + Spouse
Enter age above
Member + Child
Enter age above
Family
Enter age above
Pricing estimates based on individual member, age 45.
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
Vault Bronze
💲
Deductible
$0 / $0
💳
Copay
$25 / $50 / $50 PCP / Specialist / Urgent Care
📉
Coinsurance
50% after deductible
🩺
Doctor Visits
8 combined/yr PCP + Specialist + Outpatient MH
💊
Rx Coverage
$0 / ≤$15 / ≤$30 / ≤$40 T1 Preventive / T2 Generic / T3 Preferred / T4 Non-Preferred
🏨
Hospitalization
5 days/yr
🔪
Surgeries
2 inpatient / 1 outpatient per yr
🚨
ER
1 visit/yr Copay included in hospitalization
🚑
Urgent Care
2 visits/yr
🔬
Lab Work
$50 copay per visit, limit 3 per plan year. No benefit for services provided in a hospital.
🩻
Imaging
$350 copay 1 CT/MRI/MRA/PET per yr
🧠
Mental Health
Covered
💼
Work Requirement
No work requirement
📋
Guarantee Issue
Yes
⏳
Waiting Period
None
Monthly Premiums — Community Rated
Member Only
$725.35/mo
Member + Spouse
$999.24/mo
Member + Child
$932.88/mo
Family
$1,331.72/mo
Pricing estimates based on individual member, age 45.
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
Vault Elite Health Plus USA
💲
Deductible
$1,000 / $2,000
💳
Copay
$35 / $75 / $150 PCP / Specialist / Urgent Care
📉
Coinsurance
50% after deductible
💊
Rx Coverage
$0 / ≤$15 / ≤$30 / ≤$40 T1 Preventive (200+ $0 generics) / T2 / T3 / T4
🏨
Hospitalization
$500 copay 5 days/yr
🚨
ER
$500 copay 1 visit/yr
🔬
Lab Work
$50-$100 copay per visit depending on test/service. NOT covered if provided at a hospital.
🩻
Imaging
$500 copay CT/MRI/MRA/PET · not covered if hospital-based
🤰
Pregnancy
Subject to co-pays and limitations
🧠
Mental Health
Covered Subject to copays & visit limits
💼
Work Requirement
No work requirement
⏳
Waiting Period
30 days
Monthly Premiums — Community Rated
Member Only
18-64: $522.28/mo
Member + Spouse
18-64: $858.81/mo
Member + Child
18-64: $894.89/mo
Family
18-64: $1203.76/mo
Pricing estimates based on individual member, age 45.
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
Vault Elite Health USA
💲
Deductible
$2,500 / $5,000
💳
Copay
$50 / $100 / $200 PCP / Specialist / Urgent Care
📉
Coinsurance
50% after deductible
🩺
Doctor Visits
PCP/Unlimited, Specialist/May be subject to limitations
💊
Rx Coverage
$0 / ≤$15 / ≤$30 / ≤$40 T1 Preventive / T2 Generic / T3 Preferred / T4 Non-Preferred
🏨
Hospitalization
$500 copay 3 days/yr
🚨
ER
$500 copay 1 visit/yr
🔬
Lab Work
$60-$100 copay per visit depending on test/service. NOT covered at a hospital.
🩻
Imaging
$500 copay CT/MRI/MRA/PET · basic radiology $60–$100 range
🤰
Pregnancy
Subject to co-pays and limitations
🧠
Mental Health
Covered Subject to copays & visit limits
💼
Work Requirement
No work requirement
⏳
Waiting Period
30 days
Monthly Premiums — Age Banded
Member Only
Enter age above
Member + Spouse
Enter age above
Member + Child
Enter age above
Family
Enter age above
Application fee: $75.00 one-time
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
Vault Silver
💲
Deductible
$0 / $0
💳
Copay
$15 / $25 / $35 PCP / Specialist / Urgent Care
📉
Coinsurance
50% after deductible
🩺
Doctor Visits
10 combined/yr PCP + Specialist + MH outpatient
💊
Rx Coverage
$0 / ≤$15 / ≤$30 / ≤$40 T1 Preventive / T2 Generic / T3 Preferred / T4 Non-Preferred
🏨
Hospitalization
7 days/yr
🔪
Surgeries
3 inpatient / 2 outpatient per yr
🚨
ER
1 visit/yr Copay included in hospitalization
🚑
Urgent Care
3 visits/yr
🔬
Lab Work
$50 copay per visit, combined limit 3 per plan year. No benefit for services provided at a hospital.
🩻
Imaging
$350 copay 2 CT/MRI/MRA/PET per yr
🤰
Pregnancy
Covered 12 month waithing period
🧠
Mental Health
Covered
💼
Work Requirement
No work requirement
📋
Guarantee Issue
Yes
⏳
Waiting Period
None
Monthly Premiums — Community Rated
Member Only
$887.96/mo
Member + Spouse
$1,158.04/mo
Member + Child
$1,067.63/mo
Family
$1,536.90/mo
Pricing estimates based on individual member, age 45.
Plan Documents
Prior authorization may be required for certain services
Accident / Hospital / Critical
Powered by
FAGE Tech
FAGE Tech
Accident 10K
💲
Deductible
$50 deductible.
💊
Rx Coverage
Up to $500 per accident.
🔪
Surgeries
Cash Benefit
🚨
ER
Cash Benefit
🚑
Urgent Care
$150 cash benefit
🔬
Lab Work
Cash Benefit $250 per accident.
🩻
Imaging
Cash Benefit $250 per accident.
➕
Supplemental Benefits
Physical, Occupational, or Speech Therapy: $60 first visit, $30 each visit thereafter, limited to 10 visits per accident. DME: up to $100. Dental Treatment for Injured Teeth: $250 per tooth, up to $500 max. Broken Bone and Dislocation: up to $1,000 (in addition to ER, PT, imaging, ambulance, physician visits).
📋
Guarantee Issue
Yes
🤝
Healthcare Advocacy
Healthcare Advocacy powered by CareGuide Advocates (included).
⏳
Waiting Period
None
🏠
Hospital Indemnity
$10,000 per year
Monthly Premiums — Community Rated
Member Only
$79.99/mo
Member + Spouse
$119.99/mo
Member + Child
$119.99/mo
Family
$119.99/mo
Pricing estimates based on individual member, age 45.
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
Accident 5K
💲
Deductible
$50 deductible.
💊
Rx Coverage
Up to $500 per accident.
🔪
Surgeries
Cash Benefit
🚨
ER
Cash Benefit
🚑
Urgent Care
$150 cash benefit
🔬
Lab Work
Cash Benefit $250 per accident.
🩻
Imaging
Cash Benefit $250 per accident.
➕
Supplemental Benefits
Physical, Occupational, or Speech Therapy: $60 first visit, $30 each visit thereafter, limited to 10 visits per accident. DME: up to $100. Dental Treatment for Injured Teeth: $250 per tooth, up to $500 max. Broken Bone and Dislocation: up to $1,000 (in addition to ER, PT, imaging, ambulance, physician visits).
📋
Guarantee Issue
Yes
🤝
Healthcare Advocacy
Healthcare Advocacy powered by CareGuide Advocates (included).
⏳
Waiting Period
None
🏠
Hospital Indemnity
$5000 per year
Monthly Premiums — Community Rated
Member Only
$49.99/mo
Member + Spouse
$79.99/mo
Member + Child
$79.99/mo
Family
$79.99/mo
Pricing estimates based on individual member, age 45.
Plan Documents
Prior authorization may be required for certain services
Dental & Vision
Powered by
FAGE Tech
FAGE Tech
Cigna DHMO Dental
💲
Deductible
No deductibles.
📋
Guarantee Issue
Yes
⏳
Waiting Period
None no waiting periods for dental. No waiting periods noted for vision. Pre-existing conditions not excluded for dental (except work already in progress).
📎
Referral Required
Yes
🦷
Dental Preventive
$0 Co-Pay
🔧
Dental Basic
Covered Co-Pay
🪥
Dental Major
Covered Co-Pay
🔩
Dental Implants
Covered Co-Pay
😁
Orthodontics
Covered Co-Pay
🎯
Dental Max
None
Monthly Premiums — Community Rated
Member Only
$59.99/mo
Member + Spouse
$119.99/mo
Member + Child
$119.99/mo
Family
$119.99/mo
Pricing estimates based on individual member, age 45.
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
Cigna DHMO Dental + Vision
💲
Deductible
No deductibles.
📋
Guarantee Issue
Yes
⏳
Waiting Period
None no waiting periods for dental. No waiting periods noted for vision. Pre-existing conditions not excluded for dental (except work already in progress).
📎
Referral Required
Yes
🦷
Dental Preventive
$0 Co-Pay
🔧
Dental Basic
Covered Co-Pay
🪥
Dental Major
Covered Co-Pay
🔩
Dental Implants
Covered Co-Pay
😁
Orthodontics
Covered Co-Pay
🎯
Dental Max
None
👁️
Vision
Yes
Monthly Premiums
Member Only
$79.98/mo
Member + Spouse
$154.98/mo
Member + Child
$174.98/mo
Family
$174.98/mo
Pricing estimates based on individual member, age 45.
Plan Documents
Prior authorization may be required for certain services
Accident / Hospital / Critical
Powered by
FAGE Tech
FAGE Tech
Critical Illness 10K
💲
Deductible
No Deductible
➕
Supplemental Benefits
Maximum Basic Benefit: $10,000 lump sum. Covered conditions: Heart Attack 100% ($10,000), Stroke 100% ($10,000), Invasive Cancer 100% ($10,000), End Stage Renal Failure 100% ($10,000), Carcinoma in Situ 25% ($2,500). Recurrence benefit: 50% of initial schedule, limit 2 recurrences. Covered Spouse: 100% of benefit amount. Covered Children (birth–26): 50% of benefit amount. Benefit Coverage: 100% up to age 65; 50% ages 65–70. Wellness benefit: $50 once per year per employee and per spouse. Benefits paid as lump sum directly to primary member can be used however they choose.
📋
Guarantee Issue
Yes
🤝
Healthcare Advocacy
Healthcare Advocacy powered by CareGuide Advocates (included).
⏳
Waiting Period
30-day waiting period (applies to Invasive Cancer only). 12-month pre-existing conditions
Monthly Premiums — Community Rated
Member Only
$59.99/mo
Member + Spouse
$69.99/mo
Member + Child
$99.99/mo
Family
$110.99/mo
Pricing estimates based on individual member, age 45.
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
Critical Illness 20K
💲
Deductible
No Deductible
➕
Supplemental Benefits
Maximum Basic Benefit: $20,000 lump sum. Covered conditions: Heart Attack 100% ($20,000), Stroke 100% ($20,000), Invasive Cancer 100% ($20,000), End Stage Renal Failure 100% ($20,000), Carcinoma in Situ 25% ($5,000). Recurrence benefit: 50% of initial schedule, limit 2 recurrences. Covered Spouse: 100% of benefit amount. Covered Children (birth–26): 50% of benefit amount. Benefit Coverage: 100% up to age 65; 50% ages 65–70. Wellness benefit: $50 once per year per employee and per spouse. Benefits paid as lump sum directly to primary member can be used however they choose.
📋
Guarantee Issue
Yes
🤝
Healthcare Advocacy
Healthcare Advocacy powered by CareGuide Advocates (included).
⏳
Waiting Period
30-day waiting period (applies to Invasive Cancer only). 12-month pre-existing conditions
Monthly Premiums — Community Rated
Member Only
$89.99/mo
Member + Spouse
$109.99/mo
Member + Child
$159.99/mo
Family
$179.99/mo
Pricing estimates based on individual member, age 45.
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
Hospital Indemnity
💲
Deductible
No Deductible
🤰
Pregnancy
9 month waiting period
📋
Guarantee Issue
Yes
🤝
Healthcare Advocacy
Healthcare Advocacy powered by CareGuide Advocates (included).
⏳
Pre-Existing
12 Months
⏳
Waiting Period
30-day waiting period (applies to Invasive Cancer only). 12-month pre-existing conditions
🏠
Hospital Indemnity
Hospital/ICU Admission: $2,000 per admission, individual (1 per year) family (3 per year). Hospital/ICU Confinement: $200 per day, 30 days per year
Monthly Premiums — Community Rated
Member Only
$94.99/mo
Member + Spouse
$139.99/mo
Member + Child
$164.99/mo
Family
$209.99/mo
Pricing estimates based on individual member, age 45.
Plan Documents
Prior authorization may be required for certain services
Dental & Vision
Powered by
FAGE Tech
FAGE Tech
Solstice DHMO Dental
💲
Deductible
No deductibles.
📋
Guarantee Issue
Yes
⏳
Waiting Period
None no waiting periods. No pre-existing condition exclusions.
🦷
Dental Preventive
$0 Co-Pay
🔧
Dental Basic
Covered Co-Pay
🪥
Dental Major
Covered Co-Pay
🔩
Dental Implants
Covered Co-Pay
😁
Orthodontics
Covered Co-Pay
🎯
Dental Max
None
Monthly Premiums
Member Only
$59.99/mo
Member + Spouse
$84.99/mo
Member + Child
$94.99/mo
Family
$114.99/mo
Pricing estimates based on individual member, age 45.
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
Solstice DHMO Dental + Vision
💲
Deductible
No deductibles.
📋
Guarantee Issue
Yes
⏳
Waiting Period
None no waiting periods. No pre-existing condition exclusions.
🦷
Dental Preventive
$0 Co-Pay
🔧
Dental Basic
Covered Co-Pay
🪥
Dental Major
Covered Co-Pay
🔩
Dental Implants
Covered Co-Pay
😁
Orthodontics
Covered Co-Pay
🎯
Dental Max
None
👁️
Vision
Yes
Monthly Premiums
Member Only
$79.98/mo
Member + Spouse
$119.98/mo
Member + Child
$134.98/mo
Family
$164.98/mo
Pricing estimates based on individual member, age 45.
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
Solstice PPO Dental
💲
Deductible
$50/individual $150/family in network and out of network. Deductible waived for preventitive care
📋
Guarantee Issue
Yes
⏳
Waiting Period
No waiting periods for most services.
🦷
Dental Preventive
covered 100% in-network and out-of-network
🔧
Dental Basic
Covered 80% in- network and out-of-network
🪥
Dental Major
50% in-network and out-of-network
🎯
Dental Max
1500
Monthly Premiums
Member Only
$89.99/mo
Member + Spouse
$145.99/mo
Member + Child
$174.99/mo
Family
$245.99/mo
Pricing estimates based on individual member, age 45.
Plan Documents
Prior authorization may be required for certain services
Powered by
FAGE Tech
FAGE Tech
Solstice PPO Dental + Vision
💲
Deductible
$50/individual $150/family in network and out of network. Deductible waived for preventitive care
📋
Guarantee Issue
Yes
⏳
Waiting Period
No waiting periods for most services.
🦷
Dental Preventive
covered 100% in-network and out-of-network
🔧
Dental Basic
Covered 80% in- network and out-of-network
🪥
Dental Major
50% in-network and out-of-network
🎯
Dental Max
1500
👁️
Vision
Yes
Monthly Premiums
Member Only
$109.98/mo
Member + Spouse
$180.98/mo
Member + Child
$214.98/mo
Family
$295.98/mo
Pricing estimates based on individual member, age 45.
Plan Documents
Prior authorization may be required for certain services