Compare your 2023 health plans
Use the chart below to compare plan benefits and costs.
Compare your benefit choices | ||||
---|---|---|---|---|
Plan details | Trio HMO | Access+ HMO | HDHP PPO | |
In-network | In-network | In-network | Non-network | |
Calendar-year deductible | $5,000 Individual/ $10,000 Family | $5,000 Individual/ $10,000 Family | ||
Medical out-of-pocket maximum | $1000 Individual/ $3000 family | $1000 Individual/ $3000 family | $6,000 Individual/ $12,000 Family | $6,000 Individual/ $12,000 Family |
Hospital and physician services | ||||
Primary care physician | $25/visit | $25/visit | 20% Deductible applies | 50% Deductible applies |
Specialist care office visit (referred by PCP on HMO) | $25/visit | $25/visit | 20% Deductible applies | 50% Deductible applies |
Preventive health exam | $0/visit | $0/visit | $0 | Not covered |
Outpatient x-ray, pathology and laboratory (non-hospital facilities) | $25/visit | $25/visit | 20% Deductible applies | 50% Deductible applies |
Outpatient surgery in hospital | $0 | $0 | 20% Deductible applies | 50% Subject to a Benefit maximum of $350/day Deductible applies |
Inpatient facility services | $500/admission | $500/admission | $100/admission plus 20% Deductible applies | 50% Subject to a Benefit maximum of $600/day Deductible applies |
Virtual services | ||||
Teladoc (virtual medical doctor visits) | $0 | $0 | $0 Deductible applies | Not covered |
Teladoc (mental health professional video or phone consultation) | $0 | $0 | $0 Deductible applies | Not covered |
Emergency care | ||||
Urgent care center | $25/visit | $25/visit | 20% Deductible applies | 50% Deductible applies |
Emergency room services facilities | $125/visit | $125/visit | $150/visit plus 20% Deductible applies | $150/visit plus 20% Deductible applies |
Ambulance services | $0 | $0 | 20% Deductible applies | 20% Deductible applies |
Specialty services | ||||
Pregnancy and maternity care (Prenatal and Postnatal) | $25/visit | $25/visit | 20% Deductible applies | 50% Deductible applies |
Acupuncture services | $15/visit | $15/visit | 20% Deductible applies | 50% Deductible applies |
Chiropractic services | $15/visit | $15/visit | 20% Deductible applies | 50% Deductible applies |
Mental health office visit | $0 | $0 | 20% Deductible applies | 50% Deductible applies |
Mental health inpatient services facilities | $500/admission | $500/admission | $100/admission (plus 20% Deductible applies) | 50% Deductible applies |
Substance abuse (inpatient/outpatient facilities) | $500/admission inpatient /$0 outpatient | $500/admission inpatient /$0 outpatient | $100/admission plus 20% Deductible applies Inpatient/ 20% Deductible applies Outpatient |
50% Deductible applies |
Pharmacy benefits | ||||
Retail prescription (30-day supply) | ||||
Contraceptive drugs and devices | $0/prescription | $0/prescription | $0/prescription | Applicable Tier 1, Tier 2, or Tier 3 Copayment |
Value Based Tier drugs or HDHP preventative drugs | $0/prescription | $0/prescription | $0/prescription | Not covered |
Tier 1 drugs | $10/prescription | $10/prescription | $10/prescription Deductible applies | 25% plus $10/prescription Deductible applies |
Tier 2 drugs | $25/prescription | $25/prescription | $25/prescription Deductible applies | 25% plus $25/prescription Deductible applies |
Tier 3 drugs | $40/prescription | $40/prescription | $40/prescription Deductible applies | 25% plus $40/prescription Deductible applies |
Tier 4 drugs | $40/prescription | $40/prescription | $40/prescription Deductible applies | 25% plus $40/prescription Deductible applies |
Mail-service prescriptions (up to 90-day supply) | ||||
Contraceptive drugs and devices | $0/prescription | $0/prescription | $0/prescription | Not covered |
Value Based Tier drugs or HDHP preventative drugs | $0/prescription | $0/prescription | $0/prescription | Not covered |
Tier 1 drugs | $20/prescription | $20/prescription | $20/prescription Deductible applies | Not covered |
Tier 2 drugs | $50/prescription | $50/prescription | $50/prescription Deductible applies | Not covered |
Tier 3 drugs | $80/prescription | $80/prescription | $80/prescription Deductible applies | Not covered |
Tier 4 drugs | $80/prescription | $80/prescription | $80/prescription Deductible applies | Not covered |