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Shared Pay Comprehensive

Affordable comprehensive protection without a deductible.

Basic plan summary
Plan type PPO (Preferred Provider Organization) – Allows you to choose to receive care from network providers of your choice.
Deductible individual $0
Deductible family $0
Coinsurance 50%
Individual out-of-pocket maximum $750 / $1,500 / $3,000
Family out-of-pocket maximum $1,500 / $3,000 / $6,000
Individual lifetime maximum Unlimited
Dependent coverage Eligible children covered to age 26
HSA eligibility No
Doctor office visits (illness and injury)
Office visit - history and exam 50% coinsurance
Office visit - specialist 50% coinsurance
How can I find a doctor in this plan's Network? Search for a doctor or hospital here
Do I need permission from my primary care doctor to see a specialist? No
Do I need authorization before seeing an out-of-network doctor? No
Hospital services Your cost sharing
Emergency room $100 copay, then subject to 50% coinsurance after deductible
Accident coverage 100% coverage up to $1,000 per person per benefit period
Outpatient Lab/X-ray 50% coinsurance
Outpatient surgery 50% coinsurance
Hospitalization 50% coinsurance
Preventive care
As part of the Affordable Care Act, preventive services are paid at 100% of the allowable charge for new enrollees after Sept. 23, 2010. This includes routine screenings, immunizations, checkups and counseling received to prevent illness or disease. Learn more.
Periodic health exam No charge
Periodic OB-GYN exam No charge
Well baby care No charge
Prescription drug
Generic $15 copay
Brand $30 copay
Non-formulary $45 copay
Prescription drug – Mail order
Generic $37.50 copay
Brand $75.00 copay
Non-formulary $112.50 copay
Maternity coverage
Pre and postnatal office visit 50% coinsurance
Labor and delivery hospital stay 50% coinsurance
Additional coverage
Mental health 50% coinsurance
Substance abuse 50% coinsurance
Optional benefits
Dental program Dental coverage options
Hospital Indemnity Plan (HIP) Cash benefits during hospitalization
Life insurance Life coverage options
LTC Blue Long-term care insurance
Plan 150 Cancer policy

Exclusions
See the Exclusions page for details.

Additional Program Information

Triple Option Plan
The Triple Option Plan is available to groups of 2 to 50 employees with this product. The plan offers employees one of three out-of-pocket choices annually within the Shared Pay Comprehensive benefit program. The employer must contribute at least 25 percent of the employee-only premium amount for the highest out-of-pocket option. This stabilizes the group's base and gives the employees the option to "buy up" to a better level of coverage, based on their personal insurance needs.

More Information