Essential plans
Essential plans are affordable for employers and employees, while helping them avoid potential tax penalties.
Compare Essential Plans
We offer six different Essential Plans that are affordable while covering the bases for preventive and wellness services. Many of the Essential Plans also go a step further, offering limited outpatient and inpatient medical benefits to give employers maximum flexibility in addressing costs and plan benefits while still prioritizing employee health
| In-Network | Simple | Basic | Advantage | Edge | Care 1 | Plus | Premier |
| Deductible Single / Family | None | None | None | None | None | None | None |
| Out-of-Pocket Limit Single / Family | None | None | $7,900 / $15,800 | None | None | None | None |
| Annual Physical Adults, one (1) physical exam per benefit year to obtain recommended preventive and diagnostic services. | Covered in Full | Covered in Full | Covered in Full | Covered in Full | Covered in Full | Covered in Full | Covered in Full |
| Primary Care Office Visits | Not covered | $20 Copayment per visit. Limited to 6 visits per benefit year. | $20 Copayment per visit. Limited to 3 visits per benefit year. | $30 Copayment | $30 Copayment | $30 Copayment | $30 Copayment |
| Specialist Care Office Visits | Not covered | Not covered | $50 Copayment. Limited to 3 visits per year. | $50 Copayment | $50 Copayment | $50 Copayment | $50 Copayment |
| Physician Services in a Facility Hospital, Outpatient Surgery | Not covered | Not covered | Not covered | $150 Copayment, then 0% Coinsurance. Limited to $500 per year | $150 Copayment, then 0% Coinsurance. Limited to $500 per year | $150 Copayment, then 0% Coinsurance. Limited to $750 per year. | $150 Copayment, then 0% Coinsurance. Limited to $1,000 per year. |
| Physician Services in a Facility Emergency Room | Not covered | Not covered | Not covered | $75 Copayment, then 0% Coinsurance. Limited to $500 per year. | $75 Copayment, then 0% Coinsurance. Limited to $500 per year. | $75 Copayment, then 0% Coinsurance. Limited to $500 per year. | $75 Copayment, then 0% Coinsurance. Limited to $1,000 per year. |
| Inpatient Room and Care | Not covered | Not covered | Not covered | Covered in Full. Limited to $150 per day benefit, limited to 30 days per year. | $1,000 Copayment per admission, then 0% Coinsurance. Limited to $500 per day benefit, limited to 30 days per year. | $1,000 Copayment per admission, then 0% Coinsurance. Limited to $1,000 per day benefit, limited to 30 days per year. | $1,000 Copayment per admission, then 0% Coinsurance. Limited to $1,500 per day benefit, limited to 30 days per year. |
| Emergency Room Services | Not covered | Not covered | Not covered | $250 Copayment, then 0% Coinsurance. Limited to $1,000 per year. | $250 Copayment, then 0% Coinsurance. Limited to $1,500 per year. | $250 Copayment, then 0% Coinsurance. Limited to $1,500 per year. | $250 Copayment, then 0% Coinsurance. Limited to $2,000 per year. |
| Non-Preventive Prescription Services Prescription Drugs: Pharmacy Retail – up to a 30-Day Supply | Not covered | Not covered | $20 Copayment (Generic only up to $250 per prescription) | Not covered | $20 Copayment (Generic only up to $250 per prescription) | $20 Copayment (Generic only up to $250 per prescription) | $20 Copayment (Generic only up to $250 per prescription) |
| Preventive Prescription Services Prescription Drugs: Pharmacy Retail – up to a 30-Day Supply | Generic – Covered in full | Generic – Covered in full | Generic – Covered in full | Generic – Covered in full | Generic – Covered in full | Generic – Covered in full | Generic – Covered in full |
| Schedule of Benefits | Schedule of Benefits | Schedule of Benefits | Schedule of Benefits | Schedule of Benefits | Schedule of Benefits | Schedule of Benefits |
Simple
In-Network | |
| Deductible (Single / Family) | None |
| Out-of-Pocket Limit (Single / Family) | None |
| Annual Physical Adults, one (1) physical exam per benefit year to obtain recommended preventive and diagnostic services. | Covered in Full |
| Primary Care Office Visits | Not Covered |
| Specialist Care Office Visits | Not Covered |
| Physician Services in a Facility Hospital, Outpatient Surgery | Not Covered |
| Physician Services in a Facility Emergency Room | Not Covered |
| Inpatient Room and Care | Not Covered |
| Emergency Room Services | Not Covered |
| Non-Preventive Prescription Services Prescription Drugs: Pharmacy Retail – up to a 30-Day Supply | Not Covered |
| Preventive Prescription Services Prescription Drugs: Pharmacy Retail – up to a 30-Day Supply | Generic – Covered in full |
| Schedule of Benefits | |
Basic
In-Network | |
| Deductible (Single / Family) | None |
| Out-of-Pocket Limit (Single / Family) | None |
| Annual Physical Adults, one (1) physical exam per benefit year to obtain recommended preventive and diagnostic services. | Covered in Full |
| Primary Care Office Visits | $20 Copayment per visit. Limited to 6 visits per benefit year. |
| Specialist Care Office Visits | Not Covered |
| Physician Services in a Facility Hospital, Outpatient Surgery | Not Covered |
| Physician Services in a Facility Emergency Room | Not Covered |
| Inpatient Room and Care | Not Covered |
| Emergency Room Services | Not Covered |
| Non-Preventive Prescription Services Prescription Drugs: Pharmacy Retail – up to a 30-Day Supply | Not Covered |
| Preventive Prescription Services Prescription Drugs: Pharmacy Retail – up to a 30-Day Supply | Generic – Covered in full |
| Schedule of Benefits | |
Advantage
In-Network | |
| Deductible (Single / Family) | None |
| Out-of-Pocket Limit (Single / Family) | $7,900 / $15,800 |
| Annual Physical Adults, one (1) physical exam per benefit year to obtain recommended preventive and diagnostic services. | Covered in Full |
| Primary Care Office Visits | $20 Copayment per visit. Limited to 3 visits per benefit year. |
| Specialist Care Office Visits | $50 Copayment per visit. Limited to 3 visits per benefit year. |
| Physician Services in a Facility Hospital, Outpatient Surgery | Not Covered |
| Physician Services in a Facility Emergency Room | Not Covered |
| Inpatient Room and Care | Not Covered |
| Emergency Room Services | Not Covered |
| Non-Preventive Prescription Services Prescription Drugs: Pharmacy Retail – up to a 30-Day Supply | $20 Copayment (Generic only up to $250 per prescription) |
| Preventive Prescription Services Prescription Drugs: Pharmacy Retail – up to a 30-Day Supply | Generic – Covered in full |
| Schedule of Benefits | |
Edge
In-Network | |
| Deductible (Single / Family) | None |
| Out-of-Pocket Limit (Single / Family) | None |
| Annual Physical Adults, one (1) physical exam per benefit year to obtain recommended preventive and diagnostic services. | Covered in Full |
| Primary Care Office Visits | $30 Copayment |
| Specialist Care Office Visits | $50 Copayment |
| Physician Services in a Facility Hospital, Outpatient Surgery | $150 Copayment, then 0% Coinsurance. Limited to $500 per year. |
| Physician Services in a Facility Emergency Room | $75 Copayment, then 0% Coinsurance. Limited to $500 per year. |
| Inpatient Room and Care | Covered in Full. Limited to $150 per day benefit, limited to 30 days per year. |
| Emergency Room Services | $250 Copayment, then 0% Coinsurance. Limited to $1,000 per year. |
| Non-Preventive Prescription Services Prescription Drugs: Pharmacy Retail – up to a 30-Day Supply | Not Covered |
| Preventive Prescription Services Prescription Drugs: Pharmacy Retail – up to a 30-Day Supply) | Generic – Covered in full |
| Schedule of Benefits | |
Care 1
In-Network | |
| Deductible (Single / Family) | None |
| Out-of-Pocket Limit (Single / Family) | None |
| Annual Physical Adults, one (1) physical exam per benefit year to obtain recommended preventive and diagnostic services. | Covered in Full |
| Primary Care Office Visits | $30 Copayment |
| Specialist Care Office Visits | $50 Copayment |
| Physician Services in a Facility Hospital, Outpatient Surgery | $150 Copayment, then 0% Coinsurance. Limited to $500 per year. |
| Physician Services in a Facility Emergency Room | $75 Copayment, then 0% Coinsurance. Limited to $500 per year. |
| Inpatient Room and Care | $1,000 Copayment per admission, then 0% Coinsurance. Limited to $500 per day benefit, limited to 30 days per year. |
| Emergency Room Services | $250 Copayment, then 0% Coinsurance. Limited to $1,500 per year |
| Non-Preventive Prescription Services Prescription Drugs: Pharmacy Retail – up to a 30-Day Supply | $20 Copayment (Generic only up to $250 per prescription) |
| Preventive Prescription Services Prescription Drugs: Pharmacy Retail – up to a 30-Day Supply | Generic – Covered in full |
| Schedule of Benefits | |
Plus
In-Network | |
| Deductible (Single / Family) | None |
| Out-of-Pocket Limit (Single / Family) | None |
| Annual Physical Adults, one (1) physical exam per benefit year to obtain recommended preventive and diagnostic services. | Covered in Full |
| Primary Care Office Visits | $30 Copayment |
| Specialist Care Office Visits | $50 Copayment |
| Physician Services in a Facility Hospital, Outpatient Surgery | $150 Copayment, then 0% Coinsurance. Limited to $750 per year. |
| Physician Services in a Facility Emergency Room | $75 Copayment, then 0% Coinsurance. Limited to $500 per year. |
| Inpatient Room and Care | $1,000 Copayment per admission, then 0% Coinsurance. Limited to $1,000 per day benefit, limited to 30 days per year. |
| Emergency Room Services | $250 Copayment, then 0% Coinsurance. Limited to $1,500 per year |
| Non-Preventive Prescription Services Prescription Drugs: Pharmacy Retail – up to a 30-Day Supply | $20 Copayment (Generic only up to $250 per prescription) |
| Preventive Prescription Services Prescription Drugs: Pharmacy Retail – up to a 30-Day Supply | Generic – Covered in full |
| Schedule of Benefits | |
Premier
In-Network | |
| Deductible (Single / Family) | None |
| Out-of-Pocket Limit (Single / Family) | None |
| Annual Physical Adults, one (1) physical exam per benefit year to obtain recommended preventive and diagnostic services. | Covered in Full |
| Primary Care Office Visits | $30 Copayment |
| Specialist Care Office Visits | $50 Copayment |
| Physician Services in a Facility Hospital, Outpatient Surgery | $150 Copayment, then 0% Coinsurance. Limited to $1000 per year. |
| Physician Services in a Facility Emergency Room | $75 Copayment, then 0% Coinsurance. Limited to $1,000 per year. |
| Inpatient Room and Care | $1,000 Copayment per admission, then 0% Coinsurance. Limited to $1,500 per day benefit, limited to 30 days per year. |
| Emergency Room Services | $250 Copayment, then 0% Coinsurance. Limited to $2,000 per year. |
| Non-Preventive Prescription Services Prescription Drugs: Pharmacy Retail – up to a 30-Day Supply | $20 Copayment (Generic only up to $250 per prescription) |
| Preventive Prescription Services Prescription Drugs: Pharmacy Retail – up to a 30-Day Supply | Generic – Covered in full |
| Schedule of Benefits | |
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