It’s never been easier to choose Independent Health
The lowest rates. New and enhanced product options.
And the RedShirt® Treatment.

Since 1980, our mission has been to provide affordable access to quality coverage while enhancing the health and well-being of the communities we serve. We do this by working collaboratively with physicians, hospital systems and other community partners. The trusted relationships we've built over the last 40+ years have helped us bring you the lowest rates for 2022.

Lower Premiums

Lowest rates for 2022

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Product Options

New and unique plans for 2022.

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Better Care

Better care and outcomes for employees

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Locally Owned

Locally owned
health plan

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Satisfaction across all audiences

Satisfied
Recommended
Preferred

*2020 Employer Stakeholder Survey

**2020 Physician and Office Manager Stakeholder Survey

Independent Health has the lowest rates in 2022.

The plans shown below represent our 2022 Q3 Small Group plans. Download a printable version here.

To view our 2022 Q2 plans and rates, click here.

Show Plans By Metal Tier:

FlexFit Platinum

2022 Q3

Employee Rate
$633.86
Employee and Child(ren) Rate
$1,077.56
Employee and Spouse Rate
$1,267.72
Family Rate
$1,806.50
First Dollar Coverage
N/A
In-Network Deductible
$0
In-Network Coinsurance
0%
Primary Care/Specialist Office Visit
$10/$40
Telemedicine - General Medical and Behavioral Health Services
(participating Teladoc® providers only)
For Dermatology telemedicine, refer to the plan's benefit summary

$0
Inpatient Hospital Services
(per admission)

$500
Emergency Room Services
$150
Pharmacy1
$5/$30/50%

Show Benefits +

FlexFit Platinum Option 2

2022 Q3 New

Employee Rate
$648.97
Employee and Child(ren) Rate
$1,103.25
Employee and Spouse Rate
$1,297.94
Family Rate
$1,849.56
First Dollar Coverage
N/A
In-Network Deductible
$0
In-Network Coinsurance
0%
Primary Care/Specialist Office Visit
$5/$25
Telemedicine - General Medical and Behavioral Health Services
(participating Teladoc® providers only)
For Dermatology telemedicine, refer to the plan's benefit summary

$0
Inpatient Hospital Services
(per admission)

$500
Emergency Room Services
$150
Pharmacy1
$5/$30/$100

Show Benefits +

Choice Plus Platinum2

2022 Q3

Employee Rate
$600.19
Employee and Child(ren) Rate
$1,020.32
Employee and Spouse Rate
$1,200.38
Family Rate
$1,710.54
First Dollar Coverage
N/A
In-Network Deductible
A: $0
B: $1,500/$3,000 (T)
In-Network Coinsurance
A: 0%
B: Deductible then 50%
Primary Care/Specialist Office Visit
A: $10/$40
B: Deductible then 50%
Telemedicine - General Medical and Behavioral Health Services
(participating Teladoc® providers only)
For Dermatology telemedicine, refer to the plan's benefit summary

$0
Inpatient Hospital Services
(per admission)

A: $500
B: Deductible then 50%
Emergency Room Services
A: $150
B: $150
Pharmacy1
$5/$30/50%

Show Benefits +

Passport Plan National Platinum

2022 Q3

Employee Rate
$697.10
Employee and Child(ren) Rate
$1,185.07
Employee and Spouse Rate
$1,394.20
Family Rate
$1,986.74
First Dollar Coverage
N/A
In-Network Deductible
$0
In-Network Coinsurance
0%
Primary Care/Specialist Office Visit
$10/$40
Telemedicine - General Medical and Behavioral Health Services
(participating Teladoc® providers only)
For Dermatology telemedicine, refer to the plan's benefit summary

$0
Inpatient Hospital Services
(per admission)

$500
Emergency Room Services
$150
Pharmacy1
$5/$30/50%

Show Benefits +

Passport Plan Local Platinum4

2022 Q3

Employee Rate
$662.98
Employee and Child(ren) Rate
$1,127.07
Employee and Spouse Rate
$1,325.96
Family Rate
$1,889.49
First Dollar Coverage
N/A
In-Network Deductible
$0
In-Network Coinsurance
0%
Primary Care/Specialist Office Visit
$10/$40
Telemedicine - General Medical and Behavioral Health Services
(participating Teladoc® providers only)
For Dermatology telemedicine, refer to the plan's benefit summary

$0
Inpatient Hospital Services
(per admission)

$500
Emergency Room Services
$150
Pharmacy1
$5/$30/50%

Show Benefits +

thRed Platinum5

2022 Q3 New

Employee Rate
$578.11
Employee and Child(ren) Rate
$982.79
Employee and Spouse Rate
$1,156.22
Family Rate
$1,647.61
First Dollar Coverage
N/A
In-Network Deductible
$0
In-Network Coinsurance
0%
Primary Care/Specialist Office Visit
$0/$40
Telemedicine - General Medical and Behavioral Health Services
(participating Teladoc® providers only)
For Dermatology telemedicine, refer to the plan's benefit summary

$0
Inpatient Hospital Services
(per admission)

$500
Emergency Room Services
$150
Pharmacy1
$5/$30/50%

Show Benefits +

Activate Gold

2022 Q3

Employee Rate
$519.38
Employee and Child(ren) Rate
$882.95
Employee and Spouse Rate
$1,038.76
Family Rate
$1,480.23
First Dollar Coverage
$750/$1,500
In-Network Deductible
$1,500/$3,000 (E)
In-Network Coinsurance
25% Coinsurance after first dollar and deductible
Primary Care/Specialist Office Visit
$20/$50 Copayment after first dollar and deductible
Telemedicine - General Medical and Behavioral Health Services
(participating Teladoc® providers only)
For Dermatology telemedicine, refer to the plan's benefit summary

$0
Inpatient Hospital Services
(per admission)

25% Coinsurance after first dollar and deductible
Emergency Room Services
25% Coinsurance after first dollar and deductible
Pharmacy1
$10/25%/50% after first dollar and deductible

Show Benefits +

thRed Gold5

2022 Q3

Employee Rate
$493.17
Employee and Child(ren) Rate
$838.39
Employee and Spouse Rate
$986.34
Family Rate
$1,405.53
First Dollar Coverage
N/A
In-Network Deductible
$1,500/$3,000 (T)
In-Network Coinsurance
0%
Primary Care/Specialist Office Visit
$0/Deductible then $50
Telemedicine - General Medical and Behavioral Health Services
(participating Teladoc® providers only)
For Dermatology telemedicine, refer to the plan's benefit summary

$0
Inpatient Hospital Services
(per admission)

Deductible then $1,000
Emergency Room Services
Deductible then $150
Pharmacy1
$10/$40/50%

Show Benefits +

Standard Healthy NY Gold3

2022 Q3

Employee Rate
$483.91
Employee and Child(ren) Rate
$822.65
Employee and Spouse Rate
$967.82
Family Rate
$1,379.14
First Dollar Coverage
N/A
In-Network Deductible
$600/$1,200 (E)
In-Network Coinsurance
0%
Primary Care/Specialist Office Visit
Deductible then $25/Deductible then $40
Telemedicine - General Medical and Behavioral Health Services
(participating Teladoc® providers only)
For Dermatology telemedicine, refer to the plan's benefit summary

$0
Inpatient Hospital Services
(per admission)

Deductible then $1,000
Emergency Room Services
Deductible then $150
Pharmacy1
$10/$35/$70

Show Benefits +

iDirect Gold Copay

2022 Q3

Employee Rate
$547.72
Employee and Child(ren) Rate
$931.12
Employee and Spouse Rate
$1,095.44
Family Rate
$1,561.00
First Dollar Coverage
N/A
In-Network Deductible
$1,250/$2,500 (T)
In-Network Coinsurance
0%
Primary Care/Specialist Office Visit
$20/Deductible then $50
Telemedicine - General Medical and Behavioral Health Services
(participating Teladoc® providers only)
For Dermatology telemedicine, refer to the plan's benefit summary

$0
Inpatient Hospital Services
(per admission)

Deductible then $1,000
Emergency Room Services
$150
Pharmacy1
$10/$40/50%

Show Benefits +

iDirect Gold Copay Option 2

2022 Q3 New

Employee Rate
$552.08
Employee and Child(ren) Rate
$938.54
Employee and Spouse Rate
$1,104.16
Family Rate
$1,573.43
First Dollar Coverage
N/A
In-Network Deductible
$1,250/$2,500 (T)
In-Network Coinsurance
0%
Primary Care/Specialist Office Visit
$20/Deductible then $50
Telemedicine - General Medical and Behavioral Health Services
(participating Teladoc® providers only)
For Dermatology telemedicine, refer to the plan's benefit summary

$0
Inpatient Hospital Services
(per admission)

Deductible then $750
Emergency Room Services
Deductible then $150
Pharmacy1
$10/$40/$100

Show Benefits +

iDirect Gold Copay HSAQ
HealthEquity

2022 Q3

Employee Rate
$528.28
Employee and Child(ren) Rate
$898.08
Employee and Spouse Rate
$1,056.56
Family Rate
$1,505.60
First Dollar Coverage
N/A
In-Network Deductible
$1,400/$2,800 (T)
In-Network Coinsurance
0%
Primary Care/Specialist Office Visit
Deductible then $20/Deductible then $50
Telemedicine - General Medical and Behavioral Health Services
(participating Teladoc® providers only)
For Dermatology telemedicine, refer to the plan's benefit summary

Deductible then $0
Inpatient Hospital Services
(per admission)

Deductible then $750
Emergency Room Services
Deductible then $150
Pharmacy1
Deductible then $10/$40/50%

Show Benefits +

iDirect Gold Coinsurance HSAQ
HealthEquity

2022 Q3

Employee Rate
$502.83
Employee and Child(ren) Rate
$854.81
Employee and Spouse Rate
$1,005.66
Family Rate
$1,433.07
First Dollar Coverage
N/A
In-Network Deductible
$1,400/$2,800 (T)
In-Network Coinsurance
Deductible then 20%
Primary Care/Specialist Office Visit
Deductible then 20%
Telemedicine - General Medical and Behavioral Health Services
(participating Teladoc® providers only)
For Dermatology telemedicine, refer to the plan's benefit summary

Deductible then $0
Inpatient Hospital Services
(per admission)

Deductible then 20%
Emergency Room Services
Deductible then 20%
Pharmacy1
Deductible then 20%/20%/50%

Show Benefits +

Choice Plus Gold2

2022 Q3

Employee Rate
$522.12
Employee and Child(ren) Rate
$887.60
Employee and Spouse Rate
$1,044.24
Family Rate
$1,488.04
First Dollar Coverage
N/A
In-Network Deductible
A: $1,250/$2,500 (T)
B: $2,750/$5,500 (T)
In-Network Coinsurance
A: 0%
B: Deductible then 50%
Primary Care/Specialist Office Visit
A: $20/Deductible then $50
B: Deductible then 50%
Telemedicine - General Medical and Behavioral Health Services
(participating Teladoc® providers only)
For Dermatology telemedicine, refer to the plan's benefit summary

$0
Inpatient Hospital Services
(per admission)

Deductible then
A: $1,000
B: 50%
Emergency Room Services
A: $150
B: $150
Pharmacy1
$10/$40/50%

Show Benefits +

Passport Plan National Gold HSAQ
HealthEquity

2022 Q3

Employee Rate
$551.81
Employee and Child(ren) Rate
$938.08
Employee and Spouse Rate
$1,103.62
Family Rate
$1,572.66
First Dollar Coverage
N/A
In-Network Deductible
$1,400/$2,800 (T)
In-Network Coinsurance
Deductible then 20%
Primary Care/Specialist Office Visit
Deductible then 20%
Telemedicine - General Medical and Behavioral Health Services
(participating Teladoc® providers only)
For Dermatology telemedicine, refer to the plan's benefit summary

Deductible then $0
Inpatient Hospital Services
(per admission)

Deductible then 20%
Emergency Room Services
Deductible then 20%
Pharmacy1
Deductible then 20%/20%/50%

Show Benefits +

Passport Plan Local Gold HSAQ4
HealthEquity

2022 Q3

Employee Rate
$526.99
Employee and Child(ren) Rate
$895.88
Employee and Spouse Rate
$1,053.98
Family Rate
$1,501.92
First Dollar Coverage
N/A
In-Network Deductible
$1,400/$2,800 (T)
In-Network Coinsurance
Deductible then 20%
Primary Care/Specialist Office Visit
Deductible then 20%
Telemedicine - General Medical and Behavioral Health Services
(participating Teladoc® providers only)
For Dermatology telemedicine, refer to the plan's benefit summary

Deductible then $0
Inpatient Hospital Services
(per admission)

Deductible then 20%
Emergency Room Services
Deductible then 20%
Pharmacy1
Deductible then 20%/20%/50%

Show Benefits +

Standard Silver

2022 Q3

Employee Rate
$508.45
Employee and Child(ren) Rate
$864.37
Employee and Spouse Rate
$1,016.90
Family Rate
$1,449.08
First Dollar Coverage
N/A
In-Network Deductible
$1,300/$2,600 (E)
In-Network Coinsurance
0%
Primary Care/Specialist Office Visit
Deductible then $30/Deductible then $50
Telemedicine - General Medical and Behavioral Health Services
(participating Teladoc® providers only)
For Dermatology telemedicine, refer to the plan's benefit summary

$0
Inpatient Hospital Services
(per admission)

Deductible then $1,500
Emergency Room Services
Deductible then $300
Pharmacy1
$10/$35/$70

Show Benefits +

Activate Silver

2022 Q3

Employee Rate
$453.62
Employee and Child(ren) Rate
$771.15
Employee and Spouse Rate
$907.24
Family Rate
$1,292.82
First Dollar Coverage
$500/$1,000
In-Network Deductible
$3,000/$6,000 (E)
In-Network Coinsurance
40% Coinsurance after first dollar and deductible
Primary Care/Specialist Office Visit
$35/$60 Copayment after first dollar and deductible
Telemedicine - General Medical and Behavioral Health Services
(participating Teladoc® providers only)
For Dermatology telemedicine, refer to the plan's benefit summary

$0
Inpatient Hospital Services
(per admission)

40% Coinsurance after first dollar and deductible
Emergency Room Services
40% Coinsurance after first dollar and deductible
Pharmacy1
$15/40%/50% after first dollar and deductible

Show Benefits +

thRed Silver5

2022 Q3

Employee Rate
$437.28
Employee and Child(ren) Rate
$743.38
Employee and Spouse Rate
$874.56
Family Rate
$1,246.25
First Dollar Coverage
N/A
In-Network Deductible
$3,500/$7,000 (T)
In-Network Coinsurance
0%
Primary Care/Specialist Office Visit
$0/Deductible then $60
Telemedicine - General Medical and Behavioral Health Services
(participating Teladoc® providers only)
For Dermatology telemedicine, refer to the plan's benefit summary

$0
Inpatient Hospital Services
(per admission)

Deductible then $1,500
Emergency Room Services
Deductible then $250
Pharmacy1
$15/$50/50%

Show Benefits +

thRed Silver HSAQ5
HealthEquity

2022 Q3

Employee Rate
$399.90
Employee and Child(ren) Rate
$679.83
Employee and Spouse Rate
$799.80
Family Rate
$1,139.72
First Dollar Coverage
N/A
In-Network Deductible
$3,500/$7,000 (T)
In-Network Coinsurance
0%
Primary Care/Specialist Office Visit
Deductible then $0/Deductible then $60
Telemedicine - General Medical and Behavioral Health Services
(participating Teladoc® providers only)
For Dermatology telemedicine, refer to the plan's benefit summary

Deductible then $0
Inpatient Hospital Services
(per admission)

Deductible then $1,500
Emergency Room Services
Deductible then $250
Pharmacy1
Deductible then $15/$50/50%

Show Benefits +

iDirect Silver Copay

2022 Q3

Employee Rate
$481.16
Employee and Child(ren) Rate
$817.97
Employee and Spouse Rate
$962.32
Family Rate
$1,371.31
First Dollar Coverage
N/A
In-Network Deductible
$2,000/$4,000 (T)
In-Network Coinsurance
0%
Primary Care/Specialist Office Visit
Deductible then $35/Deductible then $60
Telemedicine - General Medical and Behavioral Health Services
(participating Teladoc® providers only)
For Dermatology telemedicine, refer to the plan's benefit summary

$0
Inpatient Hospital Services
(per admission)

Deductible then $1,000
Emergency Room Services
Deductible then $250
Pharmacy1
$15/$50/50%

Show Benefits +

iDirect Silver Copay HSAQ
HealthEquity

2022 Q3

Employee Rate
$472.17
Employee and Child(ren) Rate
$802.69
Employee and Spouse Rate
$944.34
Family Rate
$1,345.68
First Dollar Coverage
N/A
In-Network Deductible
$2,000/$4,000 (T)
In-Network Coinsurance
0%
Primary Care/Specialist Office Visit
Deductible then $35/Deductible then $60
Telemedicine - General Medical and Behavioral Health Services
(participating Teladoc® providers only)
For Dermatology telemedicine, refer to the plan's benefit summary

Deductible then $0
Inpatient Hospital Services
(per admission)

Deductible then $1,000
Emergency Room Services
Deductible then $250
Pharmacy1
Deductible then $15/$50/50%

Show Benefits +

iDirect Silver Coinsurance HSAQ
HealthEquity

2022 Q3

Employee Rate
$441.01
Employee and Child(ren) Rate
$749.72
Employee and Spouse Rate
$882.02
Family Rate
$1,256.88
First Dollar Coverage
N/A
In-Network Deductible
$3,000/$6,000 (T)
In-Network Coinsurance
Deductible then 20%
Primary Care/Specialist Office Visit
Deductible then 20%
Telemedicine - General Medical and Behavioral Health Services
(participating Teladoc® providers only)
For Dermatology telemedicine, refer to the plan's benefit summary

Deductible then $0
Inpatient Hospital Services
(per admission)

Deductible then 20%
Emergency Room Services
Deductible then 20%
Pharmacy1
Deductible then 20%/20%/50%

Show Benefits +

Max Silver

2022 Q3

Employee Rate
$472.88
Employee and Child(ren) Rate
$803.90
Employee and Spouse Rate
$945.76
Family Rate
$1,347.71
First Dollar Coverage
N/A
In-Network Deductible
$2,800/$5,600 (T)
In-Network Coinsurance
0%
Primary Care/Specialist Office Visit
$35/Deductible then $60
Telemedicine - General Medical and Behavioral Health Services
(participating Teladoc® providers only)
For Dermatology telemedicine, refer to the plan's benefit summary

$0
Inpatient Hospital Services
(per admission)

Deductible then $1,000
Emergency Room Services
Deductible then $250
Pharmacy1
$15/Deductible then $50/Deductible then 50%

Show Benefits +

Choice Plus Silver HSAQ2
HealthEquity

2022 Q3

Employee Rate
$451.04
Employee and Child(ren) Rate
$766.77
Employee and Spouse Rate
$902.08
Family Rate
$1,285.46
First Dollar Coverage
N/A
In-Network Deductible
A: $2,000/$4,000 (T)
B: $3,500/$7,000 (T)
In-Network Coinsurance
A: 0%
B: Deductible then 50%
Primary Care/Specialist Office Visit
Deductible then
A: $35/$60
B: 50%
Telemedicine - General Medical and Behavioral Health Services
(participating Teladoc® providers only)
For Dermatology telemedicine, refer to the plan's benefit summary

Deductible then $0
Inpatient Hospital Services
(per admission)

Deductible then
A: $1,000
B: 50%
Emergency Room Services
Deductible then
A: $250
B: $250
Pharmacy1
Deductible then
$15/$50/50%

Show Benefits +

Passport Plan National Silver HSAQ
HealthEquity

2022 Q3

Employee Rate
$484.30
Employee and Child(ren) Rate
$823.31
Employee and Spouse Rate
$968.60
Family Rate
$1,380.26
First Dollar Coverage
N/A
In-Network Deductible
$3,000/$6,000 (E)
In-Network Coinsurance
Deductible then 20%
Primary Care/Specialist Office Visit
Deductible then 20%
Telemedicine - General Medical and Behavioral Health Services
(participating Teladoc® providers only)
For Dermatology telemedicine, refer to the plan's benefit summary

Deductible then $0
Inpatient Hospital Services
(per admission)

Deductible then 20%
Emergency Room Services
Deductible then 20%
Pharmacy1
Deductible then 20%/20%/50%

Show Benefits +

Passport Plan Local Silver HSAQ4
HealthEquity

2022 Q3

Employee Rate
$463.17
Employee and Child(ren) Rate
$787.39
Employee and Spouse Rate
$926.34
Family Rate
$1,320.03
First Dollar Coverage
N/A
In-Network Deductible
$3,000/$6,000 (E)
In-Network Coinsurance
Deductible then 20%
Primary Care/Specialist Office Visit
Deductible then 20%
Telemedicine - General Medical and Behavioral Health Services
(participating Teladoc® providers only)
For Dermatology telemedicine, refer to the plan's benefit summary

Deductible then $0
Inpatient Hospital Services
(per admission)

Deductible then 20%
Emergency Room Services
Deductible then 20%
Pharmacy1
Deductible then 20%/20%/50%

Show Benefits +

thRed Bronze5

2022 Q3

Employee Rate
$346.30
Employee and Child(ren) Rate
$588.71
Employee and Spouse Rate
$692.60
Family Rate
$986.96
First Dollar Coverage
N/A
In-Network Deductible
$8,550/$17,100 (E)
In-Network Coinsurance
0%
Primary Care/Specialist Office Visit
Deductible then $0
Telemedicine - General Medical and Behavioral Health Services
(participating Teladoc® providers only)
For Dermatology telemedicine, refer to the plan's benefit summary

$0
Inpatient Hospital Services
(per admission)

Deductible then $0
Emergency Room Services
Deductible then $0
Pharmacy1
Deductible then $0

Show Benefits +

iDirect Bronze Blended HSAQ
HealthEquity

2022 Q3

Employee Rate
$402.76
Employee and Child(ren) Rate
$684.69
Employee and Spouse Rate
$805.52
Family Rate
$1,147.87
First Dollar Coverage
N/A
In-Network Deductible
$6,000/$12,000 (E)
In-Network Coinsurance
Deductible then 30%
Primary Care/Specialist Office Visit
Deductible then $40/Deductible then $60
Telemedicine - General Medical and Behavioral Health Services
(participating Teladoc® providers only)
For Dermatology telemedicine, refer to the plan's benefit summary

Deductible then $0
Inpatient Hospital Services
(per admission)

Deductible then 30%
Emergency Room Services
Deductible then 30%
Pharmacy1
Deductible then $20/30%/50%

Show Benefits +

iDirect Bronze Coinsurance HSAQ
HealthEquity

2022 Q3

Employee Rate
$402.71
Employee and Child(ren) Rate
$684.61
Employee and Spouse Rate
$805.42
Family Rate
$1,147.72
First Dollar Coverage
N/A
In-Network Deductible
$5,600/$11,200 (E)
In-Network Coinsurance
Deductible then 50%
Primary Care/Specialist Office Visit
Deductible then 50%
Telemedicine - General Medical and Behavioral Health Services
(participating Teladoc® providers only)
For Dermatology telemedicine, refer to the plan's benefit summary

Deductible then $0
Inpatient Hospital Services
(per admission)

Deductible then 50%
Emergency Room Services
Deductible then 50%
Pharmacy1
Deductible then 50%

Show Benefits +

iDirect Bronze MV HSAQ
HealthEquity

2022 Q3

Employee Rate
$401.25
Employee and Child(ren) Rate
$682.13
Employee and Spouse Rate
$802.50
Family Rate
$1,143.56
First Dollar Coverage
N/A
In-Network Deductible
$6,950/$13,900 (E)
In-Network Coinsurance
0%
Primary Care/Specialist Office Visit
Deductible then $0
Telemedicine - General Medical and Behavioral Health Services
(participating Teladoc® providers only)
For Dermatology telemedicine, refer to the plan's benefit summary

Deductible then $0
Inpatient Hospital Services
(per admission)

Deductible then $0
Emergency Room Services
Deductible then $0
Pharmacy1
Deductible then $0

Show Benefits +

Passport Plan National Bronze HSAQ
HealthEquity

2022 Q3

Employee Rate
$441.97
Employee and Child(ren) Rate
$751.35
Employee and Spouse Rate
$883.94
Family Rate
$1,259.61
First Dollar Coverage
N/A
In-Network Deductible
$5,600/$11,200 (E)
In-Network Coinsurance
Deductible then 50%
Primary Care/Specialist Office Visit
Deductible then 50%
Telemedicine - General Medical and Behavioral Health Services
(participating Teladoc® providers only)
For Dermatology telemedicine, refer to the plan's benefit summary

Deductible then $0
Inpatient Hospital Services
(per admission)

Deductible then 50%
Emergency Room Services
Deductible then 50%
Pharmacy1
Deductible then 50%

Show Benefits +

Passport Plan Local Bronze HSAQ4
HealthEquity

2022 Q3

Employee Rate
$423.08
Employee and Child(ren) Rate
$719.24
Employee and Spouse Rate
$846.16
Family Rate
$1,205.78
First Dollar Coverage
N/A
In-Network Deductible
$5,600/$11,200 (E)
In-Network Coinsurance
Deductible then 50%
Primary Care/Specialist Office Visit
Deductible then 50%
Telemedicine - General Medical and Behavioral Health Services
(participating Teladoc® providers only)
For Dermatology telemedicine, refer to the plan's benefit summary

Deductible then $0
Inpatient Hospital Services
(per admission)

Deductible then 50%
Emergency Room Services
Deductible then 50%
Pharmacy1
Deductible then 50%

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