Plan benefits and coverage
Our plans come with added-value benefits and features, including: access to leading doctors and community hospitals across the state, dental exams, eye exams, chiropractic care, and mental health and substance abuse counseling. This chart shows only some of the plans we offer.
| Plan |
Monthly premium |
Routine physical exams |
Primary care visits |
Specialist visits |
Prescriptions |
Emergency room |
Inpatient hospital |
Deductible |
|
Premium Saver 2000/500 I |
$ Direct Care network
$ Select Care network
$$$ Preferred Care network |
$0 |
$25 |
$40 |
$15 tier 1
$50 tier 2
$100 tier 3 |
$200 |
$500 after deductible |
$2000 individual/
$4000 family |
|
Premium Saver 1000 |
$$ Direct Care network
$$$ Select Care network
$$$$ Preferred Care network |
$0 |
$25 |
$25 |
$15 tier 1
$40 tier 2
$75 tier 3 |
$150 after deductible |
$500 after deductible |
$1000 individual/
$2000 family |
|
Premium Saver Basic II |
$$ Direct Care network
$$$ Select Care network
$$$$ Preferred Care network |
$0 |
$25 |
$40 |
$15 tier 1
$50 tier 2
$100 tier 3 |
$150 |
$1200 |
Not applicable |
|
Premium Saver 500 |
$$ Direct Care network
$$$$ Select Care network
$$$$ Preferred Care network |
$0 |
$25 |
$25 |
$15 tier 1
$40 tier 2
$75 tier 3 |
$100 |
$250 after deductible |
$500 individual/
$1000 family |
|
Premium Saver Basic I |
$$ Direct Care network
$$$$ Select Care network
$$$$ Preferred Care network |
$0 |
$25 |
$40 |
$15 tier 1
$30 tier 2
$50 tier 3 |
$150 |
$1200 |
Not applicable |
|
Premium Saver Value I |
$$$ Direct Care network
$$$$ Select Care network
$$$$$ Preferred Care network |
$0 |
$20 |
$35 |
$15 tier 1
$30 tier 2
$50 tier 3 |
$150 |
$600 |
Not applicable |
|
Premium Saver I |
$$$ Direct Care network
$$$$ Select Care network
$$$$$ Preferred Care network |
$0 |
$15 |
$15 |
$15 tier 1
$30 tier 2
$50 tier 3 |
$100 |
$350 |
Not applicable | |