You Deserve the RedShirt Treatment.®
You Deserve the RedShirt Treatment.®
Lower premiums for 2021
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At Independent Health, we’re bending the trend of rising health care and pharmacy costs. We’re wringing inefficiencies out of the system by leveraging dialogue, data and education with providers and our own members to make better decisions on where and when to get care.
You can also count on the lowest filed rate change for small groups in WNY for the second consecutive year.
New and enhanced product options
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For greater affordability and convenient access to care, we offer a deductible plan with first-dollar coverage and a roll-over option, competitively priced plan options to cover your employees and their family members who live or work out of the area, Health Savings Accounts with no monthly maintenance fees and more.
Better care and outcomes for employees
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We outperform the local competition in HEDIS measures for prevention, including prenatal care, colorectal cancer screening and flu shots, and chronic condition management measures such as diabetes HbA1c<8% and controlling high blood pressure*.
*Independent Health's Commercial HMO/POS Population compared to Local Competitors, 2019. The Healthcare Effectiveness Data and Information Set (HEDIS®) is a registered trademark of NCQA.
Locally owned
health plan
Western New York has been our home since 1980 and we understand how to keep this community healthy.
We’re dedicated to improving the health and well-being of all Western New Yorkers however we can. Over the last year through our many local initiatives, we’ve impacted nearly 150,000 people in a tangible way. While also creating opportunities to help our community become more educated, aware and involved in the decision making that leads to healthier choices and behaviors.
Satisfaction across all audiences
We are proud to be ranked #1 Member Satisfaction among Commercial Health Plans in New York by J.D. Power, scoring the highest in four of six categories, including customer service, coverage and benefits, information and communication, and provider choice.
For J.D.Power 2020 award information, visit jdpower.com/awards
*2020 Employer Stakeholder Survey
**2020 Physician and Office Manager Stakeholder Survey
You Deserve the RedShirt Treatment.® Before you choose a health plan, speak with a RedShirt® at 1-800-453-1910 or email us.
The plans shown below represent our 2021 Q4 Small Group plans. Download a printable version here.
To view our 2021 Q3 plans and rates, click here.
| FlexFit Platinum |
|---|
2021 Q4 |
| Employee Rate $643.20 |
| Employee and Child(ren) Rate $1,093.44 |
| Employee and Spouse Rate $1,286.40 |
| Family Rate $1,833.12 |
| First Dollar Coverage N/A |
| In-Network Deductible $0 |
| In-Network Coinsurance 0% |
| Primary Care/Specialist Office Visit $10/$40 |
| Telemedicine - General Medical Services (participating Teladoc® providers only) For Mental Health and Dermatology telemedicine, refer to the plan's benefit summary $10 |
| Inpatient Hospital Services (per admission) $500 |
| Emergency Room Services $150 |
| Pharmacy1 $5/$30/50% |
Show Benefits + |
| Choice Plus Platinum2 |
|---|
2021 Q4 |
| Employee Rate $607.59 |
| Employee and Child(ren) Rate $1,032.90 |
| Employee and Spouse Rate $1,215.18 |
| Family Rate $1,731.63 |
| 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 Services (participating Teladoc® providers only) For Mental Health and Dermatology telemedicine, refer to the plan's benefit summary $10 |
| 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 |
|---|
2021 Q4 |
| Employee Rate $783.93 |
| Employee and Child(ren) Rate $1,332.68 |
| Employee and Spouse Rate $1,567.86 |
| Family Rate $2,234.20 |
| First Dollar Coverage N/A |
| In-Network Deductible $0 |
| In-Network Coinsurance 0% |
| Primary Care/Specialist Office Visit $10/$40 |
| Telemedicine - General Medical Services (participating Teladoc® providers only) For Mental Health and Dermatology telemedicine, refer to the plan's benefit summary $10 |
| Inpatient Hospital Services (per admission) $500 |
| Emergency Room Services $150 |
| Pharmacy1 $5/$30/50% |
Show Benefits + |
| Passport Plan Local Platinum4 |
|---|
2021 Q4 |
| Employee Rate $654.11 |
| Employee and Child(ren) Rate $1,111.99 |
| Employee and Spouse Rate $1,308.22 |
| Family Rate $1,864.21 |
| First Dollar Coverage N/A |
| In-Network Deductible $0 |
| In-Network Coinsurance 0% |
| Primary Care/Specialist Office Visit $10/$40 |
| Telemedicine - General Medical Services (participating Teladoc® providers only) For Mental Health and Dermatology telemedicine, refer to the plan's benefit summary $10 |
| Inpatient Hospital Services (per admission) $500 |
| Emergency Room Services $150 |
| Pharmacy1 $5/$30/50% |
Show Benefits + |
| Activate Gold |
|---|
2021 Q4 |
| Employee Rate $519.01 |
| Employee and Child(ren) Rate $882.32 |
| Employee and Spouse Rate $1,038.02 |
| Family Rate $1,479.18 |
| 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 Services (participating Teladoc® providers only) For Mental Health and Dermatology telemedicine, refer to the plan's benefit summary $20 Copayment after first dollar and deductible |
| 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 |
|---|
2021 Q4 New |
| Employee Rate $507.56 |
| Employee and Child(ren) Rate $862.85 |
| Employee and Spouse Rate $1,015.12 |
| Family Rate $1,446.55 |
| 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 Services (participating Teladoc® providers only) For Mental Health and 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 |
|---|
2021 Q4 |
| Employee Rate $491.18 |
| Employee and Child(ren) Rate $835.01 |
| Employee and Spouse Rate $982.36 |
| Family Rate $1,399.86 |
| First Dollar Coverage N/A |
| In-Network Deductible $600/$1,200 (E) |
| In-Network Coinsurance 0% |
| Primary Care/Specialist Office Visit Deductible then $25/$40 |
| Telemedicine - General Medical Services (participating Teladoc® providers only) For Mental Health and Dermatology telemedicine, refer to the plan's benefit summary Deductible then $25 |
| Inpatient Hospital Services (per admission) Deductible then $1,000 |
| Emergency Room Services Deductible then $150 |
| Pharmacy1 $10/$35/$70 |
Show Benefits + |
| iDirect Gold Copay |
|---|
2021 Q4 |
| Employee Rate $562.64 |
| Employee and Child(ren) Rate $956.49 |
| Employee and Spouse Rate $1,125.28 |
| Family Rate $1,603.52 |
| 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 Services (participating Teladoc® providers only) For Mental Health and Dermatology telemedicine, refer to the plan's benefit summary $20 |
| Inpatient Hospital Services (per admission) Deductible then $1,000 |
| Emergency Room Services $150 |
| Pharmacy1 $10/$40/50% |
Show Benefits + |
iDirect Gold Copay HSAQ  |
|---|
2021 Q4 |
| Employee Rate $537.15 |
| Employee and Child(ren) Rate $913.16 |
| Employee and Spouse Rate $1,074.30 |
| Family Rate $1,530.88 |
| 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/$50 |
| Telemedicine - General Medical Services (participating Teladoc® providers only) For Mental Health and Dermatology telemedicine, refer to the plan's benefit summary Deductible then $20 |
| Inpatient Hospital Services (per admission) Deductible then $1,000 |
| Emergency Room Services Deductible then $150 |
| Pharmacy1 Deductible then $10/$40/50% |
Show Benefits + |
| Max Gold |
|---|
2021 Q4 |
| Employee Rate $548.21 |
| Employee and Child(ren) Rate $931.96 |
| Employee and Spouse Rate $1,096.42 |
| Family Rate $1,562.40 |
| First Dollar Coverage N/A |
| In-Network Deductible $1,500/$3,000 (T) |
| In-Network Coinsurance 0% |
| Primary Care/Specialist Office Visit $20/Deductible then $50 |
| Telemedicine - General Medical Services (participating Teladoc® providers only) For Mental Health and Dermatology telemedicine, refer to the plan's benefit summary $20 |
| Inpatient Hospital Services (per admission) Deductible then $1,000 |
| Emergency Room Services Deductible then $150 |
| Pharmacy1 $10/Deductible then $40/Deductible then 50% |
Show Benefits + |
|
iDirect Gold Coinsurance HSAQ |
|---|
2021 Q4 |
| 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 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 Services (participating Teladoc® providers only) For Mental Health and Dermatology telemedicine, refer to the plan's benefit summary Deductible then 20% |
| 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 |
|---|
2021 Q4 |
| Employee Rate $534.01 |
| Employee and Child(ren) Rate $907.82 |
| Employee and Spouse Rate $1,068.02 |
| Family Rate $1,521.93 |
| 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 Services (participating Teladoc® providers only) For Mental Health and Dermatology telemedicine, refer to the plan's benefit summary $20 |
| 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 |
|---|
2021 Q4 |
| Employee Rate $626.23 |
| Employee and Child(ren) Rate $1,064.59 |
| Employee and Spouse Rate $1,252.46 |
| Family Rate $1,784.76 |
| 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 Services (participating Teladoc® providers only) For Mental Health and Dermatology telemedicine, refer to the plan's benefit summary Deductible then 20% |
| 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 |
|---|
2021 Q4 |
| Employee Rate $527.82 |
| Employee and Child(ren) Rate $897.29 |
| Employee and Spouse Rate $1,055.64 |
| Family Rate $1,504.29 |
| 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 Services (participating Teladoc® providers only) For Mental Health and Dermatology telemedicine, refer to the plan's benefit summary Deductible then 20% |
| Inpatient Hospital Services (per admission) Deductible then 20% |
| Emergency Room Services Deductible then 20% |
| Pharmacy1 Deductible then 20%/20%/50% |
Show Benefits + |
| Standard Silver |
|---|
2021 Q4 |
| Employee Rate $515.56 |
| Employee and Child(ren) Rate $876.45 |
| Employee and Spouse Rate $1,031.12 |
| Family Rate $1,469.35 |
| 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/$50 |
| Telemedicine - General Medical Services (participating Teladoc® providers only) For Mental Health and Dermatology telemedicine, refer to the plan's benefit summary Deductible then $30 |
| Inpatient Hospital Services (per admission) Deductible then $1,500 |
| Emergency Room Services Deductible then $300 |
| Pharmacy1 $10/$35/$70 |
Show Benefits + |
| Activate Silver |
|---|
2021 Q4 New |
| Employee Rate $454.11 |
| Employee and Child(ren) Rate $771.99 |
| Employee and Spouse Rate $908.22 |
| Family Rate $1,294.21 |
| 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 Services (participating Teladoc® providers only) For Mental Health and Dermatology telemedicine, refer to the plan's benefit summary $35 Copayment after first dollar and deductible |
| 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 |
|---|
2021 Q4 New |
| Employee Rate $449.72 |
| Employee and Child(ren) Rate $764.52 |
| Employee and Spouse Rate $899.44 |
| Family Rate $1,281.70 |
| 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 Services (participating Teladoc® providers only) For Mental Health and 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 |
|---|
2021 Q4 New |
| Employee Rate $412.50 |
| Employee and Child(ren) Rate $701.25 |
| Employee and Spouse Rate $825.00 |
| Family Rate $1,175.63 |
| 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/$60 |
| Telemedicine - General Medical Services (participating Teladoc® providers only) For Mental Health and 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 |
|---|
2021 Q4 |
| Employee Rate $489.52 |
| Employee and Child(ren) Rate $832.18 |
| Employee and Spouse Rate $979.04 |
| Family Rate $1,395.13 |
| First Dollar Coverage N/A |
| In-Network Deductible $2,250/$4,500 (T) |
| In-Network Coinsurance 0% |
| Primary Care/Specialist Office Visit Deductible then $35/$60 |
| Telemedicine - General Medical Services (participating Teladoc® providers only) For Mental Health and Dermatology telemedicine, refer to the plan's benefit summary Deductible then $35 |
| 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 |
|---|
2021 Q4 |
| Employee Rate $480.02 |
| Employee and Child(ren) Rate $816.03 |
| Employee and Spouse Rate $960.04 |
| Family Rate $1,368.06 |
| First Dollar Coverage N/A |
| In-Network Deductible $2,250/$4,500 (T) |
| In-Network Coinsurance 0% |
| Primary Care/Specialist Office Visit Deductible then $35/$60 |
| Telemedicine - General Medical Services (participating Teladoc® providers only) For Mental Health and Dermatology telemedicine, refer to the plan's benefit summary Deductible then $35 |
| 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 |
|---|
2021 Q4 |
| Employee Rate $455.59 |
| Employee and Child(ren) Rate $774.50 |
| Employee and Spouse Rate $911.18 |
| Family Rate $1,298.43 |
| 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 Services (participating Teladoc® providers only) For Mental Health and Dermatology telemedicine, refer to the plan's benefit summary Deductible then 20% |
| Inpatient Hospital Services (per admission) Deductible then 20% |
| Emergency Room Services Deductible then 20% |
| Pharmacy1 Deductible then 20%/20%/50% |
Show Benefits + |
| Max Silver |
|---|
2021 Q4 |
| Employee Rate $486.65 |
| Employee and Child(ren) Rate $827.31 |
| Employee and Spouse Rate $973.30 |
| Family Rate $1,386.95 |
| 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 Services (participating Teladoc® providers only) For Mental Health and Dermatology telemedicine, refer to the plan's benefit summary $35 |
| 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 |
|---|
2021 Q4 |
| Employee Rate $456.97 |
| Employee and Child(ren) Rate $776.85 |
| Employee and Spouse Rate $913.94 |
| Family Rate $1,302.36 |
| First Dollar Coverage N/A |
| In-Network Deductible A: $2,250/$4,500 (T) B: $3,750/$7,500 (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 Services (participating Teladoc® providers only) For Mental Health and Dermatology telemedicine, refer to the plan's benefit summary Deductible then $35 |
| 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 |
|---|
2021 Q4 |
| Employee Rate $548.29 |
| Employee and Child(ren) Rate $932.09 |
| Employee and Spouse Rate $1,096.58 |
| Family Rate $1,562.63 |
| 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 Services (participating Teladoc® providers only) For Mental Health and Dermatology telemedicine, refer to the plan's benefit summary Deductible then 20% |
| 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 |
|---|
2021 Q4 |
| Employee Rate $462.98 |
| Employee and Child(ren) Rate $787.07 |
| Employee and Spouse Rate $925.96 |
| Family Rate $1,319.49 |
| 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 Services (participating Teladoc® providers only) For Mental Health and Dermatology telemedicine, refer to the plan's benefit summary Deductible then 20% |
| Inpatient Hospital Services (per admission) Deductible then 20% |
| Emergency Room Services Deductible then 20% |
| Pharmacy1 Deductible then 20%/20%/50% |
Show Benefits + |
| thRed Bronze5 |
|---|
2021 Q4 New |
| Employee Rate $352.18 |
| Employee and Child(ren) Rate $598.71 |
| Employee and Spouse Rate $704.36 |
| Family Rate $1,003.71 |
| 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 Services (participating Teladoc® providers only) For Mental Health and 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 + |
|
iDirect Bronze Blended HSAQ |
|---|
2021 Q4 |
| Employee Rate $409.06 |
| Employee and Child(ren) Rate $695.40 |
| Employee and Spouse Rate $818.12 |
| Family Rate $1,165.82 |
| 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/$60 |
| Telemedicine - General Medical Services (participating Teladoc® providers only) For Mental Health and Dermatology telemedicine, refer to the plan's benefit summary Deductible then $40 |
| 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 |
|---|
2021 Q4 |
| Employee Rate $409.13 |
| Employee and Child(ren) Rate $695.52 |
| Employee and Spouse Rate $818.26 |
| Family Rate $1,166.02 |
| 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 Services (participating Teladoc® providers only) For Mental Health and Dermatology telemedicine, refer to the plan's benefit summary Deductible then 50% |
| Inpatient Hospital Services (per admission) Deductible then 50% |
| Emergency Room Services Deductible then 50% |
| Pharmacy1 Deductible then 50% |
Show Benefits + |
|
iDirect Bronze MV HSAQ |
|---|
2021 Q4 |
| Employee Rate $407.22 |
| Employee and Child(ren) Rate $692.27 |
| Employee and Spouse Rate $814.44 |
| Family Rate $1,160.58 |
| 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 Services (participating Teladoc® providers only) For Mental Health and 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 |
|---|
2021 Q4 |
| Employee Rate $489.85 |
| Employee and Child(ren) Rate $832.75 |
| Employee and Spouse Rate $979.70 |
| Family Rate $1,396.07 |
| 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 Services (participating Teladoc® providers only) For Mental Health and Dermatology telemedicine, refer to the plan's benefit summary Deductible then 50% |
| 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 |
|---|
2021 Q4 |
| Employee Rate $415.62 |
| Employee and Child(ren) Rate $706.55 |
| Employee and Spouse Rate $831.24 |
| Family Rate $1,184.52 |
| 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 Services (participating Teladoc® providers only) For Mental Health and Dermatology telemedicine, refer to the plan's benefit summary Deductible then 50% |
| Inpatient Hospital Services (per admission) Deductible then 50% |
| Emergency Room Services Deductible then 50% |
| Pharmacy1 Deductible then 50% |
Show Benefits + |
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