When you want MORE choices, you can access care with Plus Network providers using your Plus benefit. This benefit has an annual deductible and coinsurance.
$250 Deductible Per Person | $500 Deductible Per Family
20% coinsurance after deductible is met
What is a deductible? The amount of money that you must pay before health plan coverage will begin for the year. Network Plus has an embedded deductible for services provided on the Plus benefit tier only. The deductible does not apply to the EPO benefit or to the pharmacy benefit.
What does this mean? When you choose to use a doctor or facility listed in the Plus Network Provider Directory (PDF) for health care services, the deductible must be met before the Plus benefit coverage will begin.
For a family: An individual member doesn't have to meet the full family deductible. Once an individual meets the per person deductible, coverage for that member will begin; however, at least one (1) other covered individual will have to meet the per person deductible before Plus benefit coverage for the entire family will begin.
An example of this would be a family a five (5) in which two (2) of the family members use the Plus benefit and meet their $250 per person deductible also satisfying the $500 family deductible;
therefore, the other three (3) family members will not have to meet a deductible to use the Plus benefit for the year.
What expenses are applied toward the deductible? Medical expenses that are covered benefits on the Plus benefit tier, provided by a Plus Network provider, and authorized by the Plan will be applied toward your Plus benefit deductible.
Do I pay my deductible to the Plan? No, expenses that are applied toward the deductible will be owed to the Provider.
What is a coinsurance? Your share of the cost for medical services.
What does this mean? When you choose to use a doctor or facility listed in the Plus Network Provider Directory (PDF) for health care services, and your deductible has been satisfied, you will begin to share 20% of the contracted rate for covered services using the Plus benefit tier. The Plan will cover the remaining 80%.
See the Plus Network Provider Directory (PDF) to see the most current listing of Plus Network providers.