Medical & Prescription Plans

Once again Pathfinder Services will be partnering with Leading Edge Administrators, using the Anthem National PPO network (Blue Card) and Carelon Rx to bring you your medical and prescription drug insurance for the upcoming year.

We offer two medical plans, one with copays, which are generally applied to office visits, urgent care visits, and prescription drugs. The second plan, is a high-deductible health plan that is HSA-eligible, where all services are subject to the deductible first, then coinsurance.

For both plans, if you have a service done in a facility or hospital, or if you go to the Emergency Room, then you will be responsible for your deductible and a coinsurance.

The below chart identifies the copays, coinsurance, and deductible that apply for the plan. If you have questions, please contact HR for assistance.

Medical Plans

Services	Traditional Copay Plan	HDHP with HSA
Deductible (Individual/Family)	$1,200 / $2,400	$3,400 / $6,000
Out-of-Pocket Maximum (Individual / Family)	$5,000 / $8,000	$5,000 / $8,000
Preventive Care	100% Covered	100% Covered
Physician Visits (Primary Care / Specialist)	$30 Copay / $50 Copay	Deductible, then 20% Coinsurance
Urgent Care	$30 Copay	Deductible, then 20% Coinsurance
Emergency Room	$500 Copay then 20% Coinsurance after deductible	Deductible, then 20% Coinsurance
Hospitalization	Deductible, then 20% Coinsurance	Deductible, then 20% Coinsurance

Prescription Drug Plans

	Copay Plan	HDHP with HSA
Tier 1: Generic	$15 copay l $37.50 copay	0% after deductible
Tier 2 : Preferred	$40 copay l $100 copay	0% after deductible
Tier 3 : Non Preferred	$60 copay l $150 copay	0% after deductible
Specialty	Not Covered	Not Covered

PER PAY PERIOD (26 pays)

Coverage Tier	Copay Plan	HDHP Plan
Employee Only	$74.57	$51.58
Employee / Child(ren)	$140.27	$102.74
Employee / Spouse	$201.53	$147.62
Family	$201.53	$147.62

Copay Plan SBC

HDHP Plan SBC

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