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 Q1 Small Group plans. Download a printable version here.

To view our 2021 Q4 plans and rates, click here.

Show Plans By Metal Tier:

FlexFit Platinum

2022 Q1

Employee Rate
$615.26
Employee and Child(ren) Rate
$1,045.94
Employee and Spouse Rate
$1,230.52
Family Rate
$1,753.49
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 +

FlexFit Platinum Option 2

2022 Q1 New

Employee Rate
$629.93
Employee and Child(ren) Rate
$1,070.88
Employee and Spouse Rate
$1,259.86
Family Rate
$1,795.30
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 Q1

Employee Rate
$582.58
Employee and Child(ren) Rate
$990.39
Employee and Spouse Rate
$1,165.16
Family Rate
$1,660.35
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 Q1

Employee Rate
$676.65
Employee and Child(ren) Rate
$1,150.31
Employee and Spouse Rate
$1,353.30
Family Rate
$1,928.45
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 Q1

Employee Rate
$643.53
Employee and Child(ren) Rate
$1,094.00
Employee and Spouse Rate
$1,287.06
Family Rate
$1,834.06
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 Q1 New

Employee Rate
$561.15
Employee and Child(ren) Rate
$953.96
Employee and Spouse Rate
$1,122.30
Family Rate
$1,599.28
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 Q1

Employee Rate
$504.14
Employee and Child(ren) Rate
$857.04
Employee and Spouse Rate
$1,008.28
Family Rate
$1,436.80
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 Q1

Employee Rate
$478.70
Employee and Child(ren) Rate
$813.79
Employee and Spouse Rate
$957.40
Family Rate
$1,364.30
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 Q1

Employee Rate
$469.71
Employee and Child(ren) Rate
$798.51
Employee and Spouse Rate
$939.42
Family Rate
$1,338.67
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 Q1

Employee Rate
$531.65
Employee and Child(ren) Rate
$903.81
Employee and Spouse Rate
$1,063.30
Family Rate
$1,515.20
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 Q1 New

Employee Rate
$535.88
Employee and Child(ren) Rate
$911.00
Employee and Spouse Rate
$1,071.76
Family Rate
$1,527.26
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 Q1

Employee Rate
$512.78
Employee and Child(ren) Rate
$871.73
Employee and Spouse Rate
$1,025.56
Family Rate
$1,461.42
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 Q1

Employee Rate
$488.08
Employee and Child(ren) Rate
$829.74
Employee and Spouse Rate
$976.16
Family Rate
$1,391.03
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 Q1

Employee Rate
$506.80
Employee and Child(ren) Rate
$861.56
Employee and Spouse Rate
$1,013.60
Family Rate
$1,444.38
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 Q1

Employee Rate
$535.62
Employee and Child(ren) Rate
$910.55
Employee and Spouse Rate
$1,071.24
Family Rate
$1,526.52
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 Q1

Employee Rate
$511.53
Employee and Child(ren) Rate
$869.60
Employee and Spouse Rate
$1,023.06
Family Rate
$1,457.86
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 Q1

Employee Rate
$493.53
Employee and Child(ren) Rate
$839.00
Employee and Spouse Rate
$987.06
Family Rate
$1,406.56
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 Q1

Employee Rate
$440.31
Employee and Child(ren) Rate
$748.53
Employee and Spouse Rate
$880.62
Family Rate
$1,254.88
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 Q1

Employee Rate
$424.45
Employee and Child(ren) Rate
$721.57
Employee and Spouse Rate
$848.90
Family Rate
$1,209.68
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 Q1

Employee Rate
$388.17
Employee and Child(ren) Rate
$659.89
Employee and Spouse Rate
$776.34
Family Rate
$1,106.28
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 Q1

Employee Rate
$467.04
Employee and Child(ren) Rate
$793.97
Employee and Spouse Rate
$934.08
Family Rate
$1,331.06
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 Q1

Employee Rate
$458.32
Employee and Child(ren) Rate
$779.14
Employee and Spouse Rate
$916.64
Family Rate
$1,306.21
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 Q1

Employee Rate
$428.07
Employee and Child(ren) Rate
$727.72
Employee and Spouse Rate
$856.14
Family Rate
$1,220.00
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 Q1

Employee Rate
$459.01
Employee and Child(ren) Rate
$780.32
Employee and Spouse Rate
$918.02
Family Rate
$1,308.18
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 Q1

Employee Rate
$437.81
Employee and Child(ren) Rate
$744.28
Employee and Spouse Rate
$875.62
Family Rate
$1,247.76
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 Q1

Employee Rate
$470.09
Employee and Child(ren) Rate
$799.15
Employee and Spouse Rate
$940.18
Family Rate
$1,339.76
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 Q1

Employee Rate
$449.58
Employee and Child(ren) Rate
$764.29
Employee and Spouse Rate
$899.16
Family Rate
$1,281.30
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 Q1

Employee Rate
$336.14
Employee and Child(ren) Rate
$571.44
Employee and Spouse Rate
$672.28
Family Rate
$958.00
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 Q1

Employee Rate
$390.94
Employee and Child(ren) Rate
$664.60
Employee and Spouse Rate
$781.88
Family Rate
$1,114.18
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 Q1

Employee Rate
$390.90
Employee and Child(ren) Rate
$664.53
Employee and Spouse Rate
$781.80
Family Rate
$1,114.07
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 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 Q1

Employee Rate
$389.48
Employee and Child(ren) Rate
$662.12
Employee and Spouse Rate
$778.96
Family Rate
$1,110.02
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 Q1

Employee Rate
$429.00
Employee and Child(ren) Rate
$729.30
Employee and Spouse Rate
$858.00
Family Rate
$1,222.65
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 Q1

Employee Rate
$410.67
Employee and Child(ren) Rate
$698.14
Employee and Spouse Rate
$821.34
Family Rate
$1,170.41
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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