AMT has established The AMT Agency, LLC to provide employers and brokers access to a full suite of benefit programs.

Read our notice to learn more.

Horizon Employer Choice, an Individual Coverage Health Reimbursement Arrangement is now available.

Read our notice to learn more.

New voluntary benefits are now available to AMT employer groups through The AMT Agency and MetLife. Learn more:

https://theamtagency.com/voluntary-benefits-from-metlife

Your Plan Options

Review Plan Package
star Affordable
Monthly Rate (Employee Only) download
$
952 - OMNIA 55/45
Deductible
T1 $2,500/$5,000 / T2 $5,000/$10,000
Coinsurance
T1 55% / T2 45%
Max Out-of-Pocket
T1 $9,200/$18,400 / T2 $9,200/$18,400
Prescription Drugs
Rx Ded $350/$700 then $25/50%/50%
star Essential Value
Monthly Rate (Employee Only) download
$
866 - EPO 50%
Deductible
$2,500/$5,000
Coinsurance
50%
Max Out-of-Pocket
$6,250/$12,500
Prescription Drugs
$15/$35/$50
star Preferred Value
Monthly Rate (Employee Only) download
$
913 - OMNIA 100/60
Deductible
T1 $0 / T2 $2,500/$5,000
Coinsurance
T1 100% / T2 60%
Max Out-of-Pocket
T1 $3,500/$7,000 / T2 $5,000/$10,000
Prescription Drugs
$10/$50/$75
star Tax Savings
Monthly Rate (Employee Only) download
$
949 - OMNIA 90/70 HSA
Deductible
T1 $1,700/$3,400 / T2 $2,500/$5,000
Coinsurance
T1 90% / T2 70%
Max Out-of-Pocket
T1 $3,500/$7,000 / T2 $6,450/$12,900
Prescription Drugs
60% after T1 ded
Monthly Rate (Employee Only) download
$
406 - PPO 80/60
Deductible
$0
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
411 - DA 100/60
Deductible
$0
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$25
Monthly Rate (Employee Only) download
$
415 - DA 100/60
Deductible
$0
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
70%/30%
Monthly Rate (Employee Only) download
$
416 - DA 100/60
Deductible
$0
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
436 - DA 90/60
Deductible
$0
Coinsurance
90%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
446 - DA 80/60
Deductible
$0
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
447 - DA 80/60
Deductible
$0
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
50%/50%
Monthly Rate (Employee Only) download
$
456 - DA 100/60
Deductible
$0
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
461 - DA 80/60
Deductible
$0
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$25
Monthly Rate (Employee Only) download
$
466 - DA 80/60
Deductible
$0
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
476 - DA 80/60
Deductible
$1,500/$3,000
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
486 - DA 80/60
Deductible
$2,500/$5,000
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
487 - DA 80/60
Deductible
$2,500/$5,000
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
50%/50%
Monthly Rate (Employee Only) download
$
496 - DA 100/60
Deductible
$1,500/$3,000
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
509 - PPO 100/80/60 HSA
Deductible
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
Monthly Rate (Employee Only) download
$
611 - DA 50% HSA
Deductible
$2,500/$5,000
Coinsurance
50%
Max Out-of-Pocket
$6,750/$13,500
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
613 - DA 50% HSA (611 W/O BANKING)
Deductible
$2,500/$5,000
Coinsurance
50%
Max Out-of-Pocket
$6,750/$13,500
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
621 - DA 100% HSA
Deductible
$2,500/$5,000
Coinsurance
100%
Max Out-of-Pocket
$5,500/$11,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
623 - DA 70% HSA
Deductible
$2,500/$5,000
Coinsurance
70%
Max Out-of-Pocket
$6,750/$13,500
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
631 - DA 100% HSA (621 W/O BANKING)
Deductible
$2,500/$5,000
Coinsurance
100%
Max Out-of-Pocket
$5,500/$11,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
633 - DA 70% HSA (623 W/O BANKING)
Deductible
$2,500/$5,000
Coinsurance
70%
Max Out-of-Pocket
$6,750/$13,500
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
816 - EPO 100%
Deductible
$0
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
825 - EPO 80%
Deductible
$0
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
70%/30%
Monthly Rate (Employee Only) download
$
826 - EPO 80%
Deductible
$0
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
836 - EPO 80%
Deductible
$1,500/$3,000
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
837 - EPO 80%
Deductible
$1,500/$3,000
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
50%/50%
Monthly Rate (Employee Only) download
$
841 - EPO 80%
Deductible
$2,500/$5,000
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$25
Monthly Rate (Employee Only) download
$
846 - EPO 80%
Deductible
$2,500/$5,000
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
847 - EPO 80%
Deductible
$2,500/$5,000
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
50%/50%
Monthly Rate (Employee Only) download
$
856 - EPO 100%
Deductible
$2,500/$5,000
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
857 - EPO 100%
Deductible
$2,500/$5,000
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
50%/50%
Monthly Rate (Employee Only) download
$
873 - EPO 50%
Deductible
$3,500/$7,000
Coinsurance
50%
Max Out-of-Pocket
$7,900/$15,800
Prescription Drugs
$10/$50/$75
Monthly Rate (Employee Only) download
$
886 - EPO 50%
Deductible
$5,000/$10,000
Coinsurance
50%
Max Out-of-Pocket
$9,200/$18,400
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
893 - EPO 90%
Deductible
$1,000/$2,000
Coinsurance
90%
Max Out-of-Pocket
$3,500/$7,000
Prescription Drugs
$10/$50/$75
Monthly Rate (Employee Only) download
$
934 - OMNIA 100/50
Deductible
T1 ER only $500/$1,000 / T2 $2,500/$5,000
Coinsurance
T1 100% / T2 50%
Max Out-of-Pocket
T1 $6,600/$13,200 / T2 $6,600/$13,200
Prescription Drugs
$15/60%/50%/50%
Monthly Rate (Employee Only) download
$
950 - OMNIA 65/55
Deductible
T1 $1,750/$3,500 / T2 $2,250/$4,500
Coinsurance
T1 65% / T2 55%
Max Out-of-Pocket
T1 $8,150/$16,300 / T2 $8,150/$16,300
Prescription Drugs
Rx Ded $350/$700 then $25/50%/50%
Monthly Rate (Employee Only) download
$
958 - OMNIA 50/50
Deductible
T1 $3,000/$6,000 / T2 $3,000/$6,000
Coinsurance
T1 50% / T2 50%
Max Out-of-Pocket
T1 $6,850/$13,700 / T2 $6,850/$13,700
Prescription Drugs
50% after ded
Monthly Rate (Employee Only) download
$
968 - OMNIA 50/50
Deductible
T1 $5,000/$10,000 / T2 $5,000/$10,000
Coinsurance
T1 50% / T2 50%
Max Out-of-Pocket
T1 $9,200/$18,400 / T2 $9,200/$18,400
Prescription Drugs
50% after ded
Monthly Rate (Employee Only) download
$
979 - OMNIA 50/50 HSA
Deductible
T1 $5,000/$10,000 / T2 $7,000/$14,000
Coinsurance
T1 50% / T2 50%
Max Out-of-Pocket
T1 $8,050/$16,100 / T2 $8,050/$16,100
Prescription Drugs
$25/50%/50% after T1 ded
Monthly Rate (Employee Only) download
$
989 – OMNIA 50/50 HSA (979 W/O BANKING)
Deductible
T1 $5,000/$10,000 / T2 $7,000/$14,000
Coinsurance
T1 50% / T2 50%
Max Out-of-Pocket
T1 $8,050/$16,100 / T2 $8,050/$16,100
Prescription Drugs
$25/50%/50% after T1 ded
Monthly Rate (Employee Only) download
$
609 - DA 100/80/60 HSA
Deductible
$2,500/$5,000
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
619 - DA 100/70 HSA
Deductible
$2,500/$5,000
Coinsurance
100%
Max Out-of-Pocket
$5,000/$10,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
629 - DA 100/70 HSA (619 W/O BANKING)
Deductible
$2,500/$5,000
Coinsurance
100%
Max Out-of-Pocket
$5,000/$10,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
639 - DA 100/80/60 HSA (609 W/O BANKING)
Deductible
$2,500/$5,000
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
811 - EPO 100%
Deductible
$0
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$25
Monthly Rate (Employee Only) download
$
815 - EPO 100%
Deductible
$0
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
70%/30%
Monthly Rate (Employee Only) download
$
821 - EPO 80%
Deductible
$0
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$25
Monthly Rate (Employee Only) download
$
851 - EPO 100%
Deductible
$2,500/$5,000
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$25
Monthly Rate (Employee Only) download
$
867 - EPO 50%
Deductible
$2,500/$5,000
Coinsurance
50%
Max Out-of-Pocket
$6,250/$12,500
Prescription Drugs
50%/50%
Monthly Rate (Employee Only) download
$
256 - PPO 80/60
Deductible
$0
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
620 - DA 100% HSA
Deductible
$1,700/$3,400
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
630 - DA 100% HSA (620 W/O BANKING)
Deductible
$1,700/$3,400
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
959 - OMNIA 90/70 HSA (949 W/O BANKING)
Deductible
T1 $1,700/$3,400 / T2 $2,500/$5,000
Coinsurance
T1 90% / T2 70%
Max Out-of-Pocket
T1 $3,500/$7,000 / T2 $6,450/$12,900
Prescription Drugs
60% after T1 ded
Monthly Rate (Employee Only) download
$
929 - OMNIA 80/50 HSA
Deductible
T1 $1,700/$3,400 / T2 $2,500/$5,000
Coinsurance
T1 80% / T2 50%
Max Out-of-Pocket
T1 $3,000/$6,000 / T2 $6,000/$12,000
Prescription Drugs
60% after T1 ded
Monthly Rate (Employee Only) download
$
939 - OMNIA 80/50 HSA (929 W/O BANKING)
Deductible
T1 $1,700/$3,400 / T2 $2,500/$5,000
Coinsurance
T1 80% / T2 50%
Max Out-of-Pocket
T1 $3,000/$6,000 / T2 $6,000/$12,000
Prescription Drugs
60% after T1 ded
Monthly Rate (Employee Only) download
$
508 - PPO 100/80/60 HSA
Deductible
Coinsurance
80%
Max Out-of-Pocket
$3,500/$7,000
Prescription Drugs
Monthly Rate (Employee Only) download
$
608 - DA 100/80/60 HSA
Deductible
$1,700/$3,400
Coinsurance
80%
Max Out-of-Pocket
$3,500/$7,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
638 - DA 100/80/60 HSA (608 W/O BANKING)
Deductible
$1,700/$3,400
Coinsurance
80%
Max Out-of-Pocket
$3,500/$7,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
618 - DA 100/70 HSA
Deductible
$1,700/$3,400
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
628 - DA 100/70 HSA (618 W/O BANKING)
Deductible
$1,700/$3,400
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
919 - OMNIA 90/70
Deductible
T1 $1,000/$2,000 / T2 $2,500/$5,000
Coinsurance
T1 90% / T2 70%
Max Out-of-Pocket
T1 $3,500/$7,000 / T2 $6,500/$13,000
Prescription Drugs
$20/$40/$60
star Affordable
Monthly Rate (Employee Only) download
$
952 - OMNIA 55/45
Deductible
T1 $2,500/$5,000 / T2 $5,000/$10,000
Coinsurance
T1 55% / T2 45%
Max Out-of-Pocket
T1 $9,200/$18,400 / T2 $9,200/$18,400
Prescription Drugs
Rx Ded $350/$700 then $25/50%/50%
star Essential Value
Monthly Rate (Employee Only) download
$
866 - EPO 50%
Deductible
$2,500/$5,000
Coinsurance
50%
Max Out-of-Pocket
$6,250/$12,500
Prescription Drugs
$15/$35/$50
star Preferred Value
Monthly Rate (Employee Only) download
$
913 - OMNIA 100/60
Deductible
T1 $0 / T2 $2,500/$5,000
Coinsurance
T1 100% / T2 60%
Max Out-of-Pocket
T1 $3,500/$7,000 / T2 $5,000/$10,000
Prescription Drugs
$10/$50/$75
star Tax Savings
Monthly Rate (Employee Only) download
$
949 - OMNIA 90/70 HSA
Deductible
T1 $1,700/$3,400 / T2 $2,500/$5,000
Coinsurance
T1 90% / T2 70%
Max Out-of-Pocket
T1 $3,500/$7,000 / T2 $6,450/$12,900
Prescription Drugs
60% after T1 ded
Monthly Rate (Employee Only) download
$
406 - PPO 80/60
Deductible
$0
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
411 - DA 100/60
Deductible
$0
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$25
Monthly Rate (Employee Only) download
$
415 - DA 100/60
Deductible
$0
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
70%/30%
Monthly Rate (Employee Only) download
$
416 - DA 100/60
Deductible
$0
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
436 - DA 90/60
Deductible
$0
Coinsurance
90%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
446 - DA 80/60
Deductible
$0
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
447 - DA 80/60
Deductible
$0
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
50%/50%
Monthly Rate (Employee Only) download
$
456 - DA 100/60
Deductible
$0
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
461 - DA 80/60
Deductible
$0
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$25
Monthly Rate (Employee Only) download
$
466 - DA 80/60
Deductible
$0
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
476 - DA 80/60
Deductible
$1,500/$3,000
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
486 - DA 80/60
Deductible
$2,500/$5,000
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
487 - DA 80/60
Deductible
$2,500/$5,000
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
50%/50%
Monthly Rate (Employee Only) download
$
496 - DA 100/60
Deductible
$1,500/$3,000
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
509 - PPO 100/80/60 HSA
Deductible
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
Monthly Rate (Employee Only) download
$
611 - DA 50% HSA
Deductible
$2,500/$5,000
Coinsurance
50%
Max Out-of-Pocket
$6,750/$13,500
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
613 - DA 50% HSA (611 W/O BANKING)
Deductible
$2,500/$5,000
Coinsurance
50%
Max Out-of-Pocket
$6,750/$13,500
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
621 - DA 100% HSA
Deductible
$2,500/$5,000
Coinsurance
100%
Max Out-of-Pocket
$5,500/$11,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
623 - DA 70% HSA
Deductible
$2,500/$5,000
Coinsurance
70%
Max Out-of-Pocket
$6,750/$13,500
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
631 - DA 100% HSA (621 W/O BANKING)
Deductible
$2,500/$5,000
Coinsurance
100%
Max Out-of-Pocket
$5,500/$11,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
633 - DA 70% HSA (623 W/O BANKING)
Deductible
$2,500/$5,000
Coinsurance
70%
Max Out-of-Pocket
$6,750/$13,500
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
816 - EPO 100%
Deductible
$0
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
825 - EPO 80%
Deductible
$0
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
70%/30%
Monthly Rate (Employee Only) download
$
826 - EPO 80%
Deductible
$0
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
836 - EPO 80%
Deductible
$1,500/$3,000
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
837 - EPO 80%
Deductible
$1,500/$3,000
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
50%/50%
Monthly Rate (Employee Only) download
$
841 - EPO 80%
Deductible
$2,500/$5,000
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$25
Monthly Rate (Employee Only) download
$
846 - EPO 80%
Deductible
$2,500/$5,000
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
847 - EPO 80%
Deductible
$2,500/$5,000
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
50%/50%
Monthly Rate (Employee Only) download
$
856 - EPO 100%
Deductible
$2,500/$5,000
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
857 - EPO 100%
Deductible
$2,500/$5,000
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
50%/50%
Monthly Rate (Employee Only) download
$
873 - EPO 50%
Deductible
$3,500/$7,000
Coinsurance
50%
Max Out-of-Pocket
$7,900/$15,800
Prescription Drugs
$10/$50/$75
Monthly Rate (Employee Only) download
$
886 - EPO 50%
Deductible
$5,000/$10,000
Coinsurance
50%
Max Out-of-Pocket
$9,200/$18,400
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
893 - EPO 90%
Deductible
$1,000/$2,000
Coinsurance
90%
Max Out-of-Pocket
$3,500/$7,000
Prescription Drugs
$10/$50/$75
Monthly Rate (Employee Only) download
$
934 - OMNIA 100/50
Deductible
T1 ER only $500/$1,000 / T2 $2,500/$5,000
Coinsurance
T1 100% / T2 50%
Max Out-of-Pocket
T1 $6,600/$13,200 / T2 $6,600/$13,200
Prescription Drugs
$15/60%/50%/50%
Monthly Rate (Employee Only) download
$
950 - OMNIA 65/55
Deductible
T1 $1,750/$3,500 / T2 $2,250/$4,500
Coinsurance
T1 65% / T2 55%
Max Out-of-Pocket
T1 $8,150/$16,300 / T2 $8,150/$16,300
Prescription Drugs
Rx Ded $350/$700 then $25/50%/50%
Monthly Rate (Employee Only) download
$
958 - OMNIA 50/50
Deductible
T1 $3,000/$6,000 / T2 $3,000/$6,000
Coinsurance
T1 50% / T2 50%
Max Out-of-Pocket
T1 $6,850/$13,700 / T2 $6,850/$13,700
Prescription Drugs
50% after ded
Monthly Rate (Employee Only) download
$
968 - OMNIA 50/50
Deductible
T1 $5,000/$10,000 / T2 $5,000/$10,000
Coinsurance
T1 50% / T2 50%
Max Out-of-Pocket
T1 $9,200/$18,400 / T2 $9,200/$18,400
Prescription Drugs
50% after ded
Monthly Rate (Employee Only) download
$
979 - OMNIA 50/50 HSA
Deductible
T1 $5,000/$10,000 / T2 $7,000/$14,000
Coinsurance
T1 50% / T2 50%
Max Out-of-Pocket
T1 $8,050/$16,100 / T2 $8,050/$16,100
Prescription Drugs
$25/50%/50% after T1 ded
Monthly Rate (Employee Only) download
$
989 – OMNIA 50/50 HSA (979 W/O BANKING)
Deductible
T1 $5,000/$10,000 / T2 $7,000/$14,000
Coinsurance
T1 50% / T2 50%
Max Out-of-Pocket
T1 $8,050/$16,100 / T2 $8,050/$16,100
Prescription Drugs
$25/50%/50% after T1 ded
Monthly Rate (Employee Only) download
$
609 - DA 100/80/60 HSA
Deductible
$2,500/$5,000
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
619 - DA 100/70 HSA
Deductible
$2,500/$5,000
Coinsurance
100%
Max Out-of-Pocket
$5,000/$10,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
629 - DA 100/70 HSA (619 W/O BANKING)
Deductible
$2,500/$5,000
Coinsurance
100%
Max Out-of-Pocket
$5,000/$10,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
639 - DA 100/80/60 HSA (609 W/O BANKING)
Deductible
$2,500/$5,000
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
811 - EPO 100%
Deductible
$0
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$25
Monthly Rate (Employee Only) download
$
815 - EPO 100%
Deductible
$0
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
70%/30%
Monthly Rate (Employee Only) download
$
821 - EPO 80%
Deductible
$0
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$25
Monthly Rate (Employee Only) download
$
851 - EPO 100%
Deductible
$2,500/$5,000
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$25
Monthly Rate (Employee Only) download
$
867 - EPO 50%
Deductible
$2,500/$5,000
Coinsurance
50%
Max Out-of-Pocket
$6,250/$12,500
Prescription Drugs
50%/50%
Monthly Rate (Employee Only) download
$
256 - PPO 80/60
Deductible
$0
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
620 - DA 100% HSA
Deductible
$1,700/$3,400
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
630 - DA 100% HSA (620 W/O BANKING)
Deductible
$1,700/$3,400
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
959 - OMNIA 90/70 HSA (949 W/O BANKING)
Deductible
T1 $1,700/$3,400 / T2 $2,500/$5,000
Coinsurance
T1 90% / T2 70%
Max Out-of-Pocket
T1 $3,500/$7,000 / T2 $6,450/$12,900
Prescription Drugs
60% after T1 ded
Monthly Rate (Employee Only) download
$
929 - OMNIA 80/50 HSA
Deductible
T1 $1,700/$3,400 / T2 $2,500/$5,000
Coinsurance
T1 80% / T2 50%
Max Out-of-Pocket
T1 $3,000/$6,000 / T2 $6,000/$12,000
Prescription Drugs
60% after T1 ded
Monthly Rate (Employee Only) download
$
939 - OMNIA 80/50 HSA (929 W/O BANKING)
Deductible
T1 $1,700/$3,400 / T2 $2,500/$5,000
Coinsurance
T1 80% / T2 50%
Max Out-of-Pocket
T1 $3,000/$6,000 / T2 $6,000/$12,000
Prescription Drugs
60% after T1 ded
Monthly Rate (Employee Only) download
$
508 - PPO 100/80/60 HSA
Deductible
Coinsurance
80%
Max Out-of-Pocket
$3,500/$7,000
Prescription Drugs
Monthly Rate (Employee Only) download
$
608 - DA 100/80/60 HSA
Deductible
$1,700/$3,400
Coinsurance
80%
Max Out-of-Pocket
$3,500/$7,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
638 - DA 100/80/60 HSA (608 W/O BANKING)
Deductible
$1,700/$3,400
Coinsurance
80%
Max Out-of-Pocket
$3,500/$7,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
618 - DA 100/70 HSA
Deductible
$1,700/$3,400
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
628 - DA 100/70 HSA (618 W/O BANKING)
Deductible
$1,700/$3,400
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
919 - OMNIA 90/70
Deductible
T1 $1,000/$2,000 / T2 $2,500/$5,000
Coinsurance
T1 90% / T2 70%
Max Out-of-Pocket
T1 $3,500/$7,000 / T2 $6,500/$13,000
Prescription Drugs
$20/$40/$60
star Affordable
Monthly Rate (Employee Only) download
$
952 - OMNIA 55/45
Deductible
T1 $2,500/$5,000 / T2 $5,000/$10,000
Coinsurance
T1 55% / T2 45%
Max Out-of-Pocket
T1 $9,200/$18,400 / T2 $9,200/$18,400
Prescription Drugs
Rx Ded $350/$700 then $25/50%/50%
star Essential Value
Monthly Rate (Employee Only) download
$
866 - EPO 50%
Deductible
$2,500/$5,000
Coinsurance
50%
Max Out-of-Pocket
$6,250/$12,500
Prescription Drugs
$15/$35/$50
star Preferred Value
Monthly Rate (Employee Only) download
$
913 - OMNIA 100/60
Deductible
T1 $0 / T2 $2,500/$5,000
Coinsurance
T1 100% / T2 60%
Max Out-of-Pocket
T1 $3,500/$7,000 / T2 $5,000/$10,000
Prescription Drugs
$10/$50/$75
star Tax Savings
Monthly Rate (Employee Only) download
$
949 - OMNIA 90/70 HSA
Deductible
T1 $1,700/$3,400 / T2 $2,500/$5,000
Coinsurance
T1 90% / T2 70%
Max Out-of-Pocket
T1 $3,500/$7,000 / T2 $6,450/$12,900
Prescription Drugs
60% after T1 ded
Monthly Rate (Employee Only) download
$
406 - PPO 80/60
Deductible
$0
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
411 - DA 100/60
Deductible
$0
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$25
Monthly Rate (Employee Only) download
$
415 - DA 100/60
Deductible
$0
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
70%/30%
Monthly Rate (Employee Only) download
$
416 - DA 100/60
Deductible
$0
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
436 - DA 90/60
Deductible
$0
Coinsurance
90%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
446 - DA 80/60
Deductible
$0
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
447 - DA 80/60
Deductible
$0
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
50%/50%
Monthly Rate (Employee Only) download
$
456 - DA 100/60
Deductible
$0
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
461 - DA 80/60
Deductible
$0
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$25
Monthly Rate (Employee Only) download
$
466 - DA 80/60
Deductible
$0
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
476 - DA 80/60
Deductible
$1,500/$3,000
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
486 - DA 80/60
Deductible
$2,500/$5,000
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
487 - DA 80/60
Deductible
$2,500/$5,000
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
50%/50%
Monthly Rate (Employee Only) download
$
496 - DA 100/60
Deductible
$1,500/$3,000
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
509 - PPO 100/80/60 HSA
Deductible
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
Monthly Rate (Employee Only) download
$
611 - DA 50% HSA
Deductible
$2,500/$5,000
Coinsurance
50%
Max Out-of-Pocket
$6,750/$13,500
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
613 - DA 50% HSA (611 W/O BANKING)
Deductible
$2,500/$5,000
Coinsurance
50%
Max Out-of-Pocket
$6,750/$13,500
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
621 - DA 100% HSA
Deductible
$2,500/$5,000
Coinsurance
100%
Max Out-of-Pocket
$5,500/$11,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
623 - DA 70% HSA
Deductible
$2,500/$5,000
Coinsurance
70%
Max Out-of-Pocket
$6,750/$13,500
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
631 - DA 100% HSA (621 W/O BANKING)
Deductible
$2,500/$5,000
Coinsurance
100%
Max Out-of-Pocket
$5,500/$11,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
633 - DA 70% HSA (623 W/O BANKING)
Deductible
$2,500/$5,000
Coinsurance
70%
Max Out-of-Pocket
$6,750/$13,500
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
816 - EPO 100%
Deductible
$0
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
825 - EPO 80%
Deductible
$0
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
70%/30%
Monthly Rate (Employee Only) download
$
826 - EPO 80%
Deductible
$0
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
836 - EPO 80%
Deductible
$1,500/$3,000
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
837 - EPO 80%
Deductible
$1,500/$3,000
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
50%/50%
Monthly Rate (Employee Only) download
$
841 - EPO 80%
Deductible
$2,500/$5,000
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$25
Monthly Rate (Employee Only) download
$
846 - EPO 80%
Deductible
$2,500/$5,000
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
847 - EPO 80%
Deductible
$2,500/$5,000
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
50%/50%
Monthly Rate (Employee Only) download
$
856 - EPO 100%
Deductible
$2,500/$5,000
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
857 - EPO 100%
Deductible
$2,500/$5,000
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
50%/50%
Monthly Rate (Employee Only) download
$
873 - EPO 50%
Deductible
$3,500/$7,000
Coinsurance
50%
Max Out-of-Pocket
$7,900/$15,800
Prescription Drugs
$10/$50/$75
Monthly Rate (Employee Only) download
$
886 - EPO 50%
Deductible
$5,000/$10,000
Coinsurance
50%
Max Out-of-Pocket
$9,200/$18,400
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
893 - EPO 90%
Deductible
$1,000/$2,000
Coinsurance
90%
Max Out-of-Pocket
$3,500/$7,000
Prescription Drugs
$10/$50/$75
Monthly Rate (Employee Only) download
$
934 - OMNIA 100/50
Deductible
T1 ER only $500/$1,000 / T2 $2,500/$5,000
Coinsurance
T1 100% / T2 50%
Max Out-of-Pocket
T1 $6,600/$13,200 / T2 $6,600/$13,200
Prescription Drugs
$15/60%/50%/50%
Monthly Rate (Employee Only) download
$
950 - OMNIA 65/55
Deductible
T1 $1,750/$3,500 / T2 $2,250/$4,500
Coinsurance
T1 65% / T2 55%
Max Out-of-Pocket
T1 $8,150/$16,300 / T2 $8,150/$16,300
Prescription Drugs
Rx Ded $350/$700 then $25/50%/50%
Monthly Rate (Employee Only) download
$
958 - OMNIA 50/50
Deductible
T1 $3,000/$6,000 / T2 $3,000/$6,000
Coinsurance
T1 50% / T2 50%
Max Out-of-Pocket
T1 $6,850/$13,700 / T2 $6,850/$13,700
Prescription Drugs
50% after ded
Monthly Rate (Employee Only) download
$
968 - OMNIA 50/50
Deductible
T1 $5,000/$10,000 / T2 $5,000/$10,000
Coinsurance
T1 50% / T2 50%
Max Out-of-Pocket
T1 $9,200/$18,400 / T2 $9,200/$18,400
Prescription Drugs
50% after ded
Monthly Rate (Employee Only) download
$
979 - OMNIA 50/50 HSA
Deductible
T1 $5,000/$10,000 / T2 $7,000/$14,000
Coinsurance
T1 50% / T2 50%
Max Out-of-Pocket
T1 $8,050/$16,100 / T2 $8,050/$16,100
Prescription Drugs
$25/50%/50% after T1 ded
Monthly Rate (Employee Only) download
$
989 – OMNIA 50/50 HSA (979 W/O BANKING)
Deductible
T1 $5,000/$10,000 / T2 $7,000/$14,000
Coinsurance
T1 50% / T2 50%
Max Out-of-Pocket
T1 $8,050/$16,100 / T2 $8,050/$16,100
Prescription Drugs
$25/50%/50% after T1 ded
Monthly Rate (Employee Only) download
$
609 - DA 100/80/60 HSA
Deductible
$2,500/$5,000
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
619 - DA 100/70 HSA
Deductible
$2,500/$5,000
Coinsurance
100%
Max Out-of-Pocket
$5,000/$10,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
629 - DA 100/70 HSA (619 W/O BANKING)
Deductible
$2,500/$5,000
Coinsurance
100%
Max Out-of-Pocket
$5,000/$10,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
639 - DA 100/80/60 HSA (609 W/O BANKING)
Deductible
$2,500/$5,000
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
811 - EPO 100%
Deductible
$0
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$25
Monthly Rate (Employee Only) download
$
815 - EPO 100%
Deductible
$0
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
70%/30%
Monthly Rate (Employee Only) download
$
821 - EPO 80%
Deductible
$0
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$25
Monthly Rate (Employee Only) download
$
851 - EPO 100%
Deductible
$2,500/$5,000
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$25
Monthly Rate (Employee Only) download
$
867 - EPO 50%
Deductible
$2,500/$5,000
Coinsurance
50%
Max Out-of-Pocket
$6,250/$12,500
Prescription Drugs
50%/50%
Monthly Rate (Employee Only) download
$
256 - PPO 80/60
Deductible
$0
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
620 - DA 100% HSA
Deductible
$1,700/$3,400
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
630 - DA 100% HSA (620 W/O BANKING)
Deductible
$1,700/$3,400
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
959 - OMNIA 90/70 HSA (949 W/O BANKING)
Deductible
T1 $1,700/$3,400 / T2 $2,500/$5,000
Coinsurance
T1 90% / T2 70%
Max Out-of-Pocket
T1 $3,500/$7,000 / T2 $6,450/$12,900
Prescription Drugs
60% after T1 ded
Monthly Rate (Employee Only) download
$
929 - OMNIA 80/50 HSA
Deductible
T1 $1,700/$3,400 / T2 $2,500/$5,000
Coinsurance
T1 80% / T2 50%
Max Out-of-Pocket
T1 $3,000/$6,000 / T2 $6,000/$12,000
Prescription Drugs
60% after T1 ded
Monthly Rate (Employee Only) download
$
939 - OMNIA 80/50 HSA (929 W/O BANKING)
Deductible
T1 $1,700/$3,400 / T2 $2,500/$5,000
Coinsurance
T1 80% / T2 50%
Max Out-of-Pocket
T1 $3,000/$6,000 / T2 $6,000/$12,000
Prescription Drugs
60% after T1 ded
Monthly Rate (Employee Only) download
$
508 - PPO 100/80/60 HSA
Deductible
Coinsurance
80%
Max Out-of-Pocket
$3,500/$7,000
Prescription Drugs
Monthly Rate (Employee Only) download
$
608 - DA 100/80/60 HSA
Deductible
$1,700/$3,400
Coinsurance
80%
Max Out-of-Pocket
$3,500/$7,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
638 - DA 100/80/60 HSA (608 W/O BANKING)
Deductible
$1,700/$3,400
Coinsurance
80%
Max Out-of-Pocket
$3,500/$7,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
618 - DA 100/70 HSA
Deductible
$1,700/$3,400
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
628 - DA 100/70 HSA (618 W/O BANKING)
Deductible
$1,700/$3,400
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
919 - OMNIA 90/70
Deductible
T1 $1,000/$2,000 / T2 $2,500/$5,000
Coinsurance
T1 90% / T2 70%
Max Out-of-Pocket
T1 $3,500/$7,000 / T2 $6,500/$13,000
Prescription Drugs
$20/$40/$60
star Affordable
Monthly Rate (Employee Only) download
$
952 - OMNIA 55/45
Deductible
T1 $2,500/$5,000 / T2 $5,000/$10,000
Coinsurance
T1 55% / T2 45%
Max Out-of-Pocket
T1 $9,200/$18,400 / T2 $9,200/$18,400
Prescription Drugs
Rx Ded $350/$700 then $25/50%/50%
star Essential Value
Monthly Rate (Employee Only) download
$
866 - EPO 50%
Deductible
$2,500/$5,000
Coinsurance
50%
Max Out-of-Pocket
$6,250/$12,500
Prescription Drugs
$15/$35/$50
star Preferred Value
Monthly Rate (Employee Only) download
$
913 - OMNIA 100/60
Deductible
T1 $0 / T2 $2,500/$5,000
Coinsurance
T1 100% / T2 60%
Max Out-of-Pocket
T1 $3,500/$7,000 / T2 $5,000/$10,000
Prescription Drugs
$10/$50/$75
star Tax Savings
Monthly Rate (Employee Only) download
$
949 - OMNIA 90/70 HSA
Deductible
T1 $1,700/$3,400 / T2 $2,500/$5,000
Coinsurance
T1 90% / T2 70%
Max Out-of-Pocket
T1 $3,500/$7,000 / T2 $6,450/$12,900
Prescription Drugs
60% after T1 ded
Monthly Rate (Employee Only) download
$
406 - PPO 80/60
Deductible
$0
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
411 - DA 100/60
Deductible
$0
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$25
Monthly Rate (Employee Only) download
$
415 - DA 100/60
Deductible
$0
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
70%/30%
Monthly Rate (Employee Only) download
$
416 - DA 100/60
Deductible
$0
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
436 - DA 90/60
Deductible
$0
Coinsurance
90%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
446 - DA 80/60
Deductible
$0
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
447 - DA 80/60
Deductible
$0
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
50%/50%
Monthly Rate (Employee Only) download
$
456 - DA 100/60
Deductible
$0
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
461 - DA 80/60
Deductible
$0
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$25
Monthly Rate (Employee Only) download
$
466 - DA 80/60
Deductible
$0
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
476 - DA 80/60
Deductible
$1,500/$3,000
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
486 - DA 80/60
Deductible
$2,500/$5,000
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
487 - DA 80/60
Deductible
$2,500/$5,000
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
50%/50%
Monthly Rate (Employee Only) download
$
496 - DA 100/60
Deductible
$1,500/$3,000
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
509 - PPO 100/80/60 HSA
Deductible
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
Monthly Rate (Employee Only) download
$
611 - DA 50% HSA
Deductible
$2,500/$5,000
Coinsurance
50%
Max Out-of-Pocket
$6,750/$13,500
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
613 - DA 50% HSA (611 W/O BANKING)
Deductible
$2,500/$5,000
Coinsurance
50%
Max Out-of-Pocket
$6,750/$13,500
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
621 - DA 100% HSA
Deductible
$2,500/$5,000
Coinsurance
100%
Max Out-of-Pocket
$5,500/$11,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
623 - DA 70% HSA
Deductible
$2,500/$5,000
Coinsurance
70%
Max Out-of-Pocket
$6,750/$13,500
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
631 - DA 100% HSA (621 W/O BANKING)
Deductible
$2,500/$5,000
Coinsurance
100%
Max Out-of-Pocket
$5,500/$11,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
633 - DA 70% HSA (623 W/O BANKING)
Deductible
$2,500/$5,000
Coinsurance
70%
Max Out-of-Pocket
$6,750/$13,500
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
816 - EPO 100%
Deductible
$0
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
825 - EPO 80%
Deductible
$0
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
70%/30%
Monthly Rate (Employee Only) download
$
826 - EPO 80%
Deductible
$0
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
836 - EPO 80%
Deductible
$1,500/$3,000
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
837 - EPO 80%
Deductible
$1,500/$3,000
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
50%/50%
Monthly Rate (Employee Only) download
$
841 - EPO 80%
Deductible
$2,500/$5,000
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$25
Monthly Rate (Employee Only) download
$
846 - EPO 80%
Deductible
$2,500/$5,000
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
847 - EPO 80%
Deductible
$2,500/$5,000
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
50%/50%
Monthly Rate (Employee Only) download
$
856 - EPO 100%
Deductible
$2,500/$5,000
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
857 - EPO 100%
Deductible
$2,500/$5,000
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
50%/50%
Monthly Rate (Employee Only) download
$
873 - EPO 50%
Deductible
$3,500/$7,000
Coinsurance
50%
Max Out-of-Pocket
$7,900/$15,800
Prescription Drugs
$10/$50/$75
Monthly Rate (Employee Only) download
$
886 - EPO 50%
Deductible
$5,000/$10,000
Coinsurance
50%
Max Out-of-Pocket
$9,200/$18,400
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
893 - EPO 90%
Deductible
$1,000/$2,000
Coinsurance
90%
Max Out-of-Pocket
$3,500/$7,000
Prescription Drugs
$10/$50/$75
Monthly Rate (Employee Only) download
$
934 - OMNIA 100/50
Deductible
T1 ER only $500/$1,000 / T2 $2,500/$5,000
Coinsurance
T1 100% / T2 50%
Max Out-of-Pocket
T1 $6,600/$13,200 / T2 $6,600/$13,200
Prescription Drugs
$15/60%/50%/50%
Monthly Rate (Employee Only) download
$
950 - OMNIA 65/55
Deductible
T1 $1,750/$3,500 / T2 $2,250/$4,500
Coinsurance
T1 65% / T2 55%
Max Out-of-Pocket
T1 $8,150/$16,300 / T2 $8,150/$16,300
Prescription Drugs
Rx Ded $350/$700 then $25/50%/50%
Monthly Rate (Employee Only) download
$
958 - OMNIA 50/50
Deductible
T1 $3,000/$6,000 / T2 $3,000/$6,000
Coinsurance
T1 50% / T2 50%
Max Out-of-Pocket
T1 $6,850/$13,700 / T2 $6,850/$13,700
Prescription Drugs
50% after ded
Monthly Rate (Employee Only) download
$
968 - OMNIA 50/50
Deductible
T1 $5,000/$10,000 / T2 $5,000/$10,000
Coinsurance
T1 50% / T2 50%
Max Out-of-Pocket
T1 $9,200/$18,400 / T2 $9,200/$18,400
Prescription Drugs
50% after ded
Monthly Rate (Employee Only) download
$
979 - OMNIA 50/50 HSA
Deductible
T1 $5,000/$10,000 / T2 $7,000/$14,000
Coinsurance
T1 50% / T2 50%
Max Out-of-Pocket
T1 $8,050/$16,100 / T2 $8,050/$16,100
Prescription Drugs
$25/50%/50% after T1 ded
Monthly Rate (Employee Only) download
$
989 – OMNIA 50/50 HSA (979 W/O BANKING)
Deductible
T1 $5,000/$10,000 / T2 $7,000/$14,000
Coinsurance
T1 50% / T2 50%
Max Out-of-Pocket
T1 $8,050/$16,100 / T2 $8,050/$16,100
Prescription Drugs
$25/50%/50% after T1 ded
Monthly Rate (Employee Only) download
$
609 - DA 100/80/60 HSA
Deductible
$2,500/$5,000
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
619 - DA 100/70 HSA
Deductible
$2,500/$5,000
Coinsurance
100%
Max Out-of-Pocket
$5,000/$10,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
629 - DA 100/70 HSA (619 W/O BANKING)
Deductible
$2,500/$5,000
Coinsurance
100%
Max Out-of-Pocket
$5,000/$10,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
639 - DA 100/80/60 HSA (609 W/O BANKING)
Deductible
$2,500/$5,000
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
811 - EPO 100%
Deductible
$0
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$25
Monthly Rate (Employee Only) download
$
815 - EPO 100%
Deductible
$0
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
70%/30%
Monthly Rate (Employee Only) download
$
821 - EPO 80%
Deductible
$0
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$25
Monthly Rate (Employee Only) download
$
851 - EPO 100%
Deductible
$2,500/$5,000
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$25
Monthly Rate (Employee Only) download
$
867 - EPO 50%
Deductible
$2,500/$5,000
Coinsurance
50%
Max Out-of-Pocket
$6,250/$12,500
Prescription Drugs
50%/50%
Monthly Rate (Employee Only) download
$
256 - PPO 80/60
Deductible
$0
Coinsurance
80%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50
Monthly Rate (Employee Only) download
$
620 - DA 100% HSA
Deductible
$1,700/$3,400
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
630 - DA 100% HSA (620 W/O BANKING)
Deductible
$1,700/$3,400
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
959 - OMNIA 90/70 HSA (949 W/O BANKING)
Deductible
T1 $1,700/$3,400 / T2 $2,500/$5,000
Coinsurance
T1 90% / T2 70%
Max Out-of-Pocket
T1 $3,500/$7,000 / T2 $6,450/$12,900
Prescription Drugs
60% after T1 ded
Monthly Rate (Employee Only) download
$
929 - OMNIA 80/50 HSA
Deductible
T1 $1,700/$3,400 / T2 $2,500/$5,000
Coinsurance
T1 80% / T2 50%
Max Out-of-Pocket
T1 $3,000/$6,000 / T2 $6,000/$12,000
Prescription Drugs
60% after T1 ded
Monthly Rate (Employee Only) download
$
939 - OMNIA 80/50 HSA (929 W/O BANKING)
Deductible
T1 $1,700/$3,400 / T2 $2,500/$5,000
Coinsurance
T1 80% / T2 50%
Max Out-of-Pocket
T1 $3,000/$6,000 / T2 $6,000/$12,000
Prescription Drugs
60% after T1 ded
Monthly Rate (Employee Only) download
$
508 - PPO 100/80/60 HSA
Deductible
Coinsurance
80%
Max Out-of-Pocket
$3,500/$7,000
Prescription Drugs
Monthly Rate (Employee Only) download
$
608 - DA 100/80/60 HSA
Deductible
$1,700/$3,400
Coinsurance
80%
Max Out-of-Pocket
$3,500/$7,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
638 - DA 100/80/60 HSA (608 W/O BANKING)
Deductible
$1,700/$3,400
Coinsurance
80%
Max Out-of-Pocket
$3,500/$7,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
618 - DA 100/70 HSA
Deductible
$1,700/$3,400
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
628 - DA 100/70 HSA (618 W/O BANKING)
Deductible
$1,700/$3,400
Coinsurance
100%
Max Out-of-Pocket
$4,500/$9,000
Prescription Drugs
$15/$35/$50 after deductible
Monthly Rate (Employee Only) download
$
919 - OMNIA 90/70
Deductible
T1 $1,000/$2,000 / T2 $2,500/$5,000
Coinsurance
T1 90% / T2 70%
Max Out-of-Pocket
T1 $3,500/$7,000 / T2 $6,500/$13,000
Prescription Drugs
$20/$40/$60