Affordable Ohio Health Insurance Plans

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Humana individual health insurance plans in Ohio are available at attractive prices. Both on and off-Marketplace coverage may return in 2021 although Senior Medicare and Group plans are currently offered. Once the under-65 OE period ends, coverage can be purchased from other carriers by qualifying for one of several SEP (Special Enrollment Period) exemptions. You can view free quotes on our website, compare multiple plans and apply for benefits in less than 15 minutes.

Medigap (Supplement and Advantage) contracts are offered to persons that have reached age 65 and are Medicare-eligible. Since MedSup plans are standardized (no difference in benefits from one carrier to another), the specific plan will have to be available in the County where you reside. 2021 Prices can vary in each county. Advantage plans may also have differences in copays, deductibles, and out-of-pocket expenses.

On And Off-Exchange Plans Previously Available

All on and off-Exchange policies cover qualified preventive benefits at 100%. There are no copays or deductibles to meet. Another cost-saving feature is the network-negotiated price reductions you receive when utilizing in-network facilities. Whether it’s a small or large claim, savings can be as much as 80%. Although inpatient and outpatient hospital expenses are heavily discounted, smaller items also receive reductions, including x-rays, blood tests, and Urgent Care visits.

A total of 10 plans were previously offered. Several HMO plans were available both on and off the Marketplace. Additional PPO options were offered only off the Exchange. Coverage is transferable to other states if you move and are eligible for a “Special Enrollment” exclusion. Prices, however, will vary, depending on the area of service.

Previously-Available Plans For Individuals And Families Under Age 65

HMO

Humana HMO plans are offered as Exchange contracts and are therefore available for federal subsidies. A local network of physicians, specialists and hospitals is available and should be used to secure the lowest costs. Drugs are administered through the “Select RX” network, which includes Walmart, CVS, Sams Club and RightSourceRX.com. During Open Enrollment in Ohio, many low-cost options are offered. The subsidy is offered in the form of an instant tax-credit and automatically reduces your premium. Comprehensive Gold-tier plans will provide lower out-of-pocket costs.

A Primary Care Physician (PCP) helps coordinate your treatment and recommends specific specialists that can provide the best medical care. Staying “in-network” reduces your healthcare expenses, since other than emergencies, out-of-network expenses are typically paid by the subscriber.

The three available networks for Ohio are:

Dayton HMOx – Anchored by Premier Health Partners. Covers Butler and Warren counties.

Dayton HMOx – Anchored by Premier Health Partners. Covers Greene, Montgomery, Preble and Miami counties.

Cincinnati/ Northern KY HMOx -Includes TriHealth and St. Elizabeth Healthcare (Children’s, Good Samaritan, and  Bethesda North Hospitals).

The prescription and provider lookup link, will easily find doctors, hospitals, and other facilities in your area.

Previously Available Under Age 65 HMO Plans

Catastrophic

Basic 7150 is the “catastrophic” tier contract. Thus, you must be under age 30 to apply for coverage unless you qualify for a “financial hardship” exemption. The deducible is $7,150 with no coinsurance. Therefore, once the deductible has been met, all covered expenses are paid without any additional out-of-pocket costs. Three office visits are allowed each year (primary care physician) with only a $15 copay applicable. And yes, the person pictured below will only pay $15 when she visits her physician! NOTE: Behavioral, mental, and substance abuse outpatient service visits also receive the $15 copay.

Non-emergency ER visits are not covered. Examples would be seeking treatment for a common cold or flu, when a pcp or urgent-care visit would be more suitable. All covered drugs are paid at 100% after the deductible has been met. Children 19 and younger can receive one vision exam and a pair of glasses each year, after the deductible has been met.

Bronze

Bronze 6550  is the cheapest non-catastrophic plan offered and is thus available to all ages. The deductible is $6,550 with 0% coinsurance. Thus, once the deductible is met, all covered claims are paid at 100% with no out-of-pocket expenses.  Negotiated discounts will help reduce out-of-pocket expenses for many common procedures.

Silver

Silver 4150 features a $4,150 deductible with office visit copays of $20 and $40. The maximum out-of-pocket expenses are $7,150 with 20% coinsurance. Since Silver-tier plans are eligible for “cost-sharing,” if you qualify for a subsidy, this option must be strongly considered. Generic and brand drugs are subject to $18 and $50 copays. Non-preferred brand and specialty drugs are subject to 50% coinsurance. ER visits must meet a $600 copay along with the deductible. Out-of-network treatment does not count towards your deductible.

Gold

Gold 1400 – $1,400 deductible with $20 and $40 office visit copays. Maximum out-of-pocket expenses are $6,000 with 20% coinsurance. Tier 1, 2, and 3 drugs receive $5, $10, and $20 copays respectively. Tier 4 and 5 drugs are subject to 35% coinsurance.

Platinum

There are no Platinum-tier plans offered by Humana in Ohio.

PPO

PPO plans utilize the ChoiceCare network, which is the largest collection of providers that Humana offers. With more than 600,000 doctors and practitioners, almost 4,000 hospitals and 60,000 pharmacies, you won’t have trouble finding treatment anywhere in the state. Out-of-network benefits are provided, but you will incur a much higher cost.

However, PPO contracts are only available “Off The Marketplace,” so federal subsidies can not be used with these plans.

Humana Senior Health Insurance Plans In Ohio

Annual enrollment (AEP) occurs between October 15th and December 7th each year. Your effective date of changes or new policies you purchase is January 1st. You can change from one Medicare Advantage or dug prescription plan to another, and also return to conventional Medicare coverage and purchase a Supplement (Medigap) policy. NOTE: From January 1 to February 15th, you can return to original benefits provided by the Federal Government (MA Disenrollment Period).

Typically, about 15 or 16 plans are available in areas of the Buckeye State. Medicare Supplement (Medigap), Medicare Advantage, and Drug Prescription policies are offered to eligible applicants. Generally, you must be age 65 or over, unless you have a qualified exception.

Medicare Supplement  – 2021 Available plans include Plan A, Plan B, Plan C, Plan F, Plan F (High Deductible), Plan K, Plan L, and Plan N. Plans K and L pay the Part A deductible, but because of higher-out-of-pocket costs, premiums are often the lowest of all available options. However, there is a maximum cap on your total expenses for the year. Plan N also features lower rates. Plan F (HD) features a $2,300 deductible and significantly lower premiums.

Current monthly rates are shown below for 65 and 70-year-old males. Female rates are lower.

Montgomery (Dayton area), Greene, Champaign, Darke, Miami, Pickaway, Preble, Clark, Shelby, Ross, Pike, and Warren Counties

Age 65

$115 – Plan A

$137 – Plan F

$46 – Plan G (HD)

$116 – Plan G

$91 – Plan N

Age 70

$120 – Plan A

$143 – Plan F

$50 – Plan G (HD)

$120 – Plan G

$95 – Plan N

 

Cuyahoga and Lake Counties (Cleveland Area) and Portage, Columbiana, Mahoning, Trumball, and Medina Counties

Age 65

$100 – Plan A

$115 – Plan N

$134 – Plan G

Age 70

$64- Plan F (HD)

$117 – Plan A

$135 – Plan N

$157 – Plan G

$194 – Plan F

 

Franklin, Licking, and Delaware Counties (Columbus Area)

$52 – Plan F (HD)

$92 – Plan A

$106 – Plan N

$124 – Plan G

$153 – Plan F

 

Mercer, Logan, Fairfield, Wayne, and Marion Counties

$52 – Plan F (HD)

$76 – Plan K

$101 – Plan N

$107 – Plan L

$133 – Plan A

$139 – Plan B

$161 – Plan C

$165 – Plan F

 

Hamilton, Butler, and Clermont Counties (Cincinnati Area), Madison County, and Summit County (Akron Area)

$52 – Plan F (HD)

$92 – Plan A

$106 – Plan N

$124 – Plan G

$153 – Plan F

Medicare Advantage

Medicare Advantage – Available plans are listed below. The Gold Choice option allows you to use any provider that accepts the terms and conditions of reimbursement. Advantage plans are very popular Senior options because of their low cost (sometimes the premium is $0) and extra benefits, such as dental, vision, and hearing. Rates can vary by county.

Several of the most popular and highest-rated (US News & World Report) Medicare Advantage plans in the state are the Humana Gold Plus plans that also include drug prescription benefits. $0 premium contracts are available in many counties, including Butler, Carroll, Clark, Clermont, Delaware, Fairfield, Franklin, Hamilton, Licking, Mahoning, Portage, Stark, Summit, Trumbull, Warren, and Wayne.

The deductible ranges from $100 to $360 (depending where you live), and the maximum out-of-pocket expenses range from $3,900 to $6,700. in-hospital expenses range from $295-$350 for 1-6 days. Generally, the office visit copays are $10 and $45. RX benefits will vary, but typically, Tier 1 and Tier 2 drugs (Preferred Generic and Generic) are 100% covered when 90-day mail-order cost sharing is used.

The Choice PPO and Gold Plus HMO plans include the following additional benefits:

Routine hearing coverage

Over-the-counter drugs and related supplies

Fitness program with helpful supervision

Dental services

Hearing Services

HumanaChoice PPO (R5495-001) – $0 monthly premium and maximum out-of-pocket expenses of $7,550. Office visit copays are $15 and $50 with inpatient hospital copay of $375 for the first five days. The ER and Urgent Care copays are $90 and $15-$50 respectively. Estimated copays of additional services are $0-$35 for lab services, $15-$110 for outpatient x-rays, $0-$105 for diagnostic tests and procedures, and $45-$425 for diagnostic radiology.

The skilled nursing facility copay is $0 for the first 20 days, and $178 for days 21-100. Occupational, speech, and physical therapy copays are $20-$40. The inpatient mental health services copay is $375 for the first four days, and $0 for days 5-90. Outpatient group and individual (mental health) copays are $40. Ground ambulance services are covered with a $270 copay. Prescription drug benefits are not covered. 3.0 Summary Star rating.

HumanaChoice PPO (R5495-002) – $99 monthly premium with $380 deductible and maximum out-of-pocket expenses of $6,700. Office visit copays are $20 and $50 with inpatient hospital copay of $390 for the first five days. The ER and Urgent Care copays are $90 and $20-$50 respectively. Estimated copays of additional services are $0-$35 for lab services, $20-$110 for outpatient x-rays, $0-$110 for diagnostic tests and procedures, and $50-$350 for diagnostic radiology.

The skilled nursing facility copay is $0 for the first 20 days, and $184 for days 21-100. The physical therapy copays are $15-$40. Outpatient group and individual (mental health) copays are $40. Ground ambulance services are covered with a $290 copay.

The 30-day preferred retail pharmacy copays are $16 (Tier 1), $19 (Tier 2), $47 (Tier 3), $100 (Tier 4), and $100 (Tier 5). The 90-day preferred mail-order copays are $48 (Tier 1), $57 (Tier 2), $141 (Tier 3), and $300 (Tier 4).  4.0 Summary Star rating.

HumanaChoice PPO (H5216-109) – $19 monthly premium with $150 deductible and maximum out-of-pocket expenses of $5,700. Office visit copays are $15 and $45 with inpatient hospital copay of $415 for the first four days. The ER and Urgent Care copays are $90 and $15-$45 respectively. Estimated copays of additional services are $0-$35 for lab services, $15-$110 for outpatient x-rays, $0-$105 for diagnostic tests and procedures, and $45-$350 for diagnostic radiology.

The skilled nursing facility copay is $0 for the first 20 days, and $184 for days 21-100. Occupational, speech, and physical therapy copays are $15-$40. The inpatient mental health services copay is $415 for the first four days, and $0 for days 5-90. Outpatient group and individual (mental health) copays are $40. Ground ambulance services are covered with a $290 copay.

The 30-day preferred retail pharmacy copays are $2 (Tier 1), $8 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 30% (Tier 5). The 90-day preferred mail-order copays are $6 (Tier 1), $24 (Tier 2), $141 (Tier 3), and $300 (Tier 4).  4.0 Summary Star rating.

 

HumanaChoice PPO (H5216-023) – $56 monthly premium with $175 deductible and maximum out-of-pocket expenses of $6,700. Office visit copays are $15 and $45 with inpatient hospital copay of $390 for the first five days. The ER and Urgent Care copays are $90 and $15-$45 respectively. Estimated copays of additional services are $0-$35 for lab services, $15-$110 for outpatient x-rays, $45 or 20% for radiation therapy, $0-$105 for diagnostic tests and procedures, and $45-$350 for diagnostic radiology.

The skilled nursing facility copay is $0 for the first 20 days, and $178 for days 21-100. Occupational, speech, and physical therapy copays are $15-$40. The pulmonary and cardiac rehabilitation copay is $15. The inpatient mental health services copay is $350 for the first four days, and $0 for days 5-90. Outpatient group and individual (mental health) copay is $40. Ground ambulance services are covered with a $270 copay.

The 30-day preferred retail pharmacy copays are $7 (Tier 1), $17 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 29% (Tier 5). The 90-day preferred mail-order copays are $0 (Tier 1), $0 (Tier 2), $131 (Tier 3), and $290 (Tier 4). A $175 pharmacy Part D deductible applies to Tiers 3, 4, and 5. 4.0 Summary Star rating.

HumanaChoice PPO (H5225-030) – $154 monthly premium with $100 deductible and maximum out-of-pocket expenses of $3,400. Office visit copays are $5 and $30 with inpatient hospital copay of $295 for the first seven days. The ER and Urgent Care copays are $90 and $5-$30 respectively. Estimated copays of additional services are $0-$35 for lab services, $5-$110 for outpatient x-rays, $0-$90 for diagnostic tests and procedures, and $30-$350 for diagnostic radiology.

The skilled nursing facility copay is $20 for the first 20 days, and $178 for days 21-100. Occupational, speech, and physical therapy copays are $10-$40. Outpatient group and individual (mental health) copays are $30. Ground ambulance services are covered with a $270 copay.

The 30-day preferred retail pharmacy copays are $2 (Tier 1), $4 (Tier 2), $47 (Tier 3), $97 (Tier 4), and 31% (Tier 5). The 90-day preferred mail-order copays are $0 (Tier 1), $0 (Tier 2), $131 (Tier 3), and $281 (Tier 4). A $100 pharmacy Part D deductible applies to Tiers 3, 4, and 5. 4.0 Summary Star rating.

Humana Gold Plus HMO (H6622-021) – $0 monthly premium with $0 deductible and maximum out-of-pocket expenses of $5,000. Office visit copays are $0 and $40 with inpatient hospital copay of $390 for the first five days. The ER and Urgent Care copays are $90 and $0-$40 respectively. Estimated copays of additional services are $0-$35 for lab services, $0-$110 for outpatient x-rays, $0-$110 for diagnostic tests and procedures, and $40-$350 for diagnostic radiology.

The skilled nursing facility copay is $0 for the first 20 days, and $178 for days 21-100. Occupational, speech, and physical therapy copays are $10-$40. Outpatient group and individual (mental health) copays are $40. Ground ambulance services are covered with a $270 copay.

The 30-day preferred retail pharmacy copays are $2 (Tier 1), $10 (Tier 2), $47 (Tier 3), $97 (Tier 4), and 33% (Tier 5). The 90-day preferred mail-order copays are $0 (Tier 1), $0 (Tier 2), $131 (Tier 3), and $281 (Tier 4). 4.0 Summary Star rating.

Humana Gold Plus HMO (H6622-055) – $15 monthly premium with $0 deductible and maximum out-of-pocket expenses of $6,700. Office visit copays are $0 and $25 with inpatient hospital copay of $350 for the first seven days. The ER and Urgent Care copays are $120 and $0-$25 respectively. Estimated copays of additional services are $0-$35 for lab services, $0-$110 for outpatient x-rays, $0-$105 for diagnostic tests and procedures, and $25-$350 for diagnostic radiology.

The skilled nursing facility copay is $0 for the first 20 days, and $178 for days 21-100. Occupational, speech, and physical therapy copays are $10-$40. Outpatient group and individual (mental health) copays are $25. Ground ambulance services are covered with a $270 copay.

The 30-day preferred retail pharmacy copays are $0 (Tier 1), $5 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 33% (Tier 5). The 90-day preferred mail-order copays are $0 (Tier 1), $0 (Tier 2), $131 (Tier 3), and $290 (Tier 4). 4.0 Summary Star rating.

Humana Cleveland Clinic Preferred HMO (H6622-023) – $0 monthly premium with $0 deductible and maximum out-of-pocket expenses of $3,200. Office visit copays are $0 and $25 with inpatient hospital copay of $350 for the first six days. The ER and Urgent Care copays are $120 and $0-$25 respectively. Estimated copays of additional services are $0-$25 for lab services, $0-$110 for outpatient x-rays, $0-$105 for diagnostic tests and procedures, and $25-$350 for diagnostic radiology.

The skilled nursing facility copay is $0 for the first 20 days, and $178 for days 21-100. Occupational, speech, and physical therapy copays are $10-$40. Outpatient group and individual (mental health) copays are $35. Ground ambulance services are covered with a $270 copay.

The 30-day preferred retail pharmacy copays are $0 (Tier 1), $5 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 33% (Tier 5). The 90-day preferred mail-order copays are $0 (Tier 1), $0 (Tier 2), $131 (Tier 3), and $290 (Tier 4). 4.0 Summary Star rating.

Humana Honor (H5216-218) – $0 monthly premium and maximum out-of-pocket expenses of $6,700. Office visit copays are $15 and $45 with inpatient hospital copay of $350 for the first five days. The ER and Urgent Care copays are $90 and $15-$45 respectively. Estimated copays of additional services are $0-$25 for lab services, $0-$45 for outpatient x-rays, $0-$105 for diagnostic tests and procedures, and $15-$350 for diagnostic radiology.

The skilled nursing facility copay is $0 for the first 20 days, and $178 for days 21-100. Occupational, speech, and physical therapy copays are $20-$40. Outpatient group and individual (mental health) copays are $40. Ground ambulance services are covered with a $270 copay.

Prescription Drug Plans

WalMart Value RX Plan – Plan ID: PDP S5884-193. For WalMart and Sam’s Club.  The monthly premium is $17.20 and the deductible is $445 for Tiers 3, 4, and 5. Preferred cost-sharing copays for retail (30-day and 90-day) are $1 and $3 (Preferred Generic), $4 and $12 (Generic), 19% and 19% (Preferred Brand), 35% and 35% (Non-Preferred), and 25% and N/A (Specialty). Preferred cost-sharing copays for mail order (30-day and 90-day) are $1 and $3 (Preferred Generic), $4 and $12 (Generic), 19% and 19% (Preferred Brand), 35% and 35% (Non-Preferred), and 25% and N/A (Specialty). 3,160 formulary drugs are offered and the Summary Star Rating is 3.5. 31,584 Ohio residents are enrolled in this plan.

Basic Rx Plan – Plan ID: PDP S5884-137.  The monthly premium is $36.60 and the deductible is $445. Preferred cost-sharing copays for retail (30-day and 90-day) are $0 and $0 (Preferred Generic), $1 and $3 (Generic), 25% and 25% (Preferred Brand), 35% and 35% (Non-Preferred), and 25% and N/A (Specialty). Preferred cost-sharing copays for mail order (30-day and 90-day) are $0 and $0 (Preferred Generic), $1 and $0 (Generic), 20% and 15% (Preferred Brand), 35% and 30% (Non-Preferred), and 25% and N/A (Specialty). 3,057 formulary drugs are offered and the Summary Star Rating is 3.5. 21,326 Ohio residents are enrolled in this plan.

Premier Rx Plan – Plan ID: PDP S5884-160.  The monthly premium is $67.30 and the deductible is $445 for Tiers 3, 4, and 5. Preferred cost-sharing copays for retail (30-day and 90-day) are $1 and $3 (Preferred Generic), $4 and $12 (Generic), $45 and $126 (Preferred Brand), 49% and 44% (Non-Preferred), and 25% and N/A (Specialty). Preferred cost-sharing copays for mail order (30-day and 90-day) are $1 and $0 (Preferred Generic), $4 and $0 (Generic), $45 and $125 (Preferred Brand), 49% and 49% (Non-Preferred), and 25% and N/A (Specialty). 3,233 formulary drugs are offered and the Summary Star Rating is 3.5. 52,349 Ohio residents are enrolled in this plan.

Areas Of Ohio That Feature Lowest Rates

Each individual and family scenario is different, especially considering that subsidy amounts will greatly differ. But typically, the areas in the state that feature the lowest rates for PPO policies are listed below. NOTE: One reason that Cincinnati is high on the list is the presence of the College of Medicine and Academic Health Center (pictured above) and its contribution to the community. The combination of education, research and patient care contributes to keeping treatment prices down.

Cincinnati

Middletown

Dayton

East Canton

Mansfield

Steubenville

Athens

North Columbus

Chillicothe

Six Available Dental Plans (Monthly Premiums Shown Per Individual)

$6.99 Savings Plan –  No deductible and no annual maximum. There are also no waiting periods. This discount plan provides savings on most procedures. Examples are: Routine cleaning and exam ($14), x-rays ($18), fillings ($45), simple extractions ($43), 0ral surgery ($43), root canals ($214), crowns ($295), and dentures ($360). This is not an insurance product.

$13.99 Value –  HMO plan with no deductible or policy maximum. $15 office visit copay with no waiting period. In-network providers must be used and a primary care dentist must be selected at the time of enrollment. Routine cleanings, exams, and x-rays are covered at 100%. Fillings have $30 and $45 copays.Copays on additional services include $55 for simple extractions, $60 for oral surgery, $175 for a root canal, $410 for a crown, and $550 for dentures. A discount on orthodontics may be available.

$16.99 Preventive Value –  $50 and $150 deductibles per person/family. There are no administrative, association, or enrollment fees. No annual maximum coverage per year. PPO plan where any dentist can be utilized, although in-network providers offer a discount. Routine cleanings, exams and x-rays are covered at 100% after lifetime deductible. Silver-colored and tooth-colored fillings, and simple extractions are covered at 50% after lifetime deductible. However, oral surgery, root canals, crowns, dentures, and orthodontics are not covered.

$19.99 Preventive Plus –  $50 and $150 deductibles per person/family. $1,000 annual maximum benefit.  PPO plan where any dentist can be utilized, although in-network providers offer a discount. Six-month waiting period on basic services. Routine cleanings, exams and x-rays are covered at 100% after lifetime deductible. Silver-colored and tooth-colored fillings, and simple extractions are covered at 50% after lifetime deductible. Oral surgery is covered at 50% after the deductible. A discount may apply to root canals, crowns, dentures, and orthodontics.

$38.99 Complete Dental –  $50 and $150 deductibles per person/family. $1,250 annual maximum benefit first year and $1,500 thereafter.  PPO plan where any dentist can be utilized, although in-network providers offer a discount. Six-month waiting period on basic services. Routine cleanings, exams and x-rays are covered at 100% after lifetime deductible. Silver-colored and tooth-colored fillings, and simple extractions are covered at 80% after lifetime deductible. Oral surgery, root canals, crowns, and dentures are covered at 50% after the deductible. Orthodontics may receive discount.

 

Humana Vision Plan In Ohio

Humana Vision PPO is available “off-Marketplace” in most parts of the state. The monthly rate is $14.99.There is a single enrollment fee of $35 and a $1 per month administration fee, and no waiting periods for benefits. Annual routine exams are covered with a $15 copay, and annual contact lens exams are covered with a $40 copay. A $150 allowance is provided for frames and contact lenses (including disposable).

Standard plastic lenses (single vision, bifocal, or trifocal) are covered with a $25 copay. Non-participating provider allowances are $25, $40, and $55. UV coating, tint, and standard scratch-resistance lens options have a $15 copay. Standard polycarbonate, anti-reflective coating, and progressive lens have $40, $45, and $65 copays.

An examination, and purchase of lenses or contact lenses (and a frame) are covered once per year. Possible discounts may lower the price for scratch-resistant and anti-reflective coatings. Lasik procedures done at LasikPlus, TLC and QualSight Lasik will receive discounted prices.The HumanaOne Vision Care plan is also accepted at many major participating providers including LensCrafters, Sears, JCPenney, Target and Pearle Vision. Also, more than 30,000 ophthalmologists and optometrists accept Humana vision insurance.

Group Benefits Through Employer

Large and small group coverage is offered to Ohio groups. Unlike private healthcare plans, options are available in most areas of the state, with a wide variety of deductible and out-of-pocket expense options. Flexible billing arrangements can be made and broad nationwide networks allow customers to choose among many facilities. Listed below are the most popular employer-sponsored benefits:

Health – Humana Simplicity shows costs upfront and makes budgeting much easier. “Total Health” provides options for companies with 100 or more employees. Level funded premiums (10 or more employees) is designed for catastrophic coverage. Coinsurance, copay, and high-deductible (HDHP) options are also offered.

Dental –  100% preventative benefits are included with optional orthodontic coverage. Advantage Plus, Prepaid/DHMO, Dental PPO, Preventative Plus, and Traditional Preferred plans are offered.

Vision – Rates are typically inexpensive, and not as costly as dental coverage. Vision Exam Plus (annual eye exam included) and Materials Only (lenses, frames, and contact lenses) plans are available.

Disability – Conventional and alternative treatment is available.

Life – Group term life insurance provides small and large face amounts of tax-free benefits to beneficiaries of employees. Term contracts are the least expensive policy and are ideal if you need large amounts of coverage for the least cost. Basic coverage is provided as a multiple of your annual compensation, with up to $10,000 of additional benefits available for your spouse. Supplemental coverage is offered in addition to the Basic amount, and is generally paid by the employee.

Group Medicare – Retired employees may be able to consider a Medicare Advantage plan, which often provides more comprehensive benefits than original Medicare. The insurer administers the plan instead of the federal government. Prescription plans are also offered with mail-delivery pharmacy available (see below).

Pharmacy – Plans can be set up to provide separate coverage or work with existing in-force prescription drug benefits. Both small and large companies are eligible, and specialty medications can also be ordered. Printable drug lists are regularly updated. Thousands of pharmacies are available, including several mail-order options. Printable drug lists are provided to help consumers understand choices, and coordinate prescriptions with the primary-care physician.

Wellness – Healthy employees are more productive, and several programs are offered to improve workplace culture and satisfy needs of workers. Personal health coaching (smoking cessation and weight loss) and employee assistance programs (EAP) can provide a positive rate-of-return for both employee and worker. “Go365” is designed to reduce medical claims and has been very effective. Additional programs include holistic well-being, Goal-Guru, Kurbo, Weight Watchers, flu vaccinations, and Biometrics screenings.

Additional online services are provided to all customers. These free services include access to claim information, online bill-paying, prescription search, and help with enrollment.

 

Employee Benefit Plan Options

 

Simplicity Plans

Preventative Care Visits – $0 copay

Sick Visits – $40 copay

Specialist Visits – $80

Telemedicine – $20

Urgent Care – $100

Advanced Imaging – $425

ER – $425

Inpatient Hospital – $1,500 per day for 3 days

Outpatient Surgery – $1,500

 

Canopy Plans

Preventative Care Visits – $0 copay

Sick Visits – $20 copay

Specialist Visits – $60-$80

Telemedicine – $20

Urgent Care – $100

Retail Clinic – $20

Individual Deductible – $2,500-$7,000

Inpatient Out-Of-Pocket Maximum – $5,500-$7,900

Coinsurance – 50%-100%