Employer group health plans
Your plan documents
Certificate of Coverage
The Certificate of Coverage is your official policy. It outlines the covered and non-covered benefits, information on how to access benefits and details any exclusions/limitations associated with benefits. The Certificate of Coverage also includes term definitions, enrollment and disenrollment issues, coordination of benefit information, member rights/responsibilities and complaints/appeals procedures. If you can’t find the information you need in your certificate or if you need a copy of your certificate, please contact your human resources department or call Health Tradition at 1-877-832-1823.
Summary of Benefits and Coverage (SBC)
The Summary provides information on some covered and non-covered services, including some exclusions. It indicates your out-of-pocket maximums for annual deductible and coinsurance per member and per family, defines office copays, confinement fees and emergency room co-payments.
The summary provides a quick reference for many benefit questions but does not include everything and does not replace your Certificate of Coverage. Health Tradition sends a copy of your Summary of Benefits annually to your employer. To clarify which plan you have, or if you need additional information, please call us at 1-888-459-3020.
See the Summary of Benefits for your plan below:
2020 plans
HMO plans
Plan
Annual Deductible
Coinsurance
Out-of-pocket maximum
Platinum Level
Health Tradition Platinum 500 w/copay
$500 / $1,000
80%
$1,500 / $3,000
What will I pay after meeting my deductible? [ See more + ] [ See less - ]
- Preventive Care 100% coverage
- Routine Eye Exam Covered under preventive care
- Routine Hearing Exam Covered under preventive care
- Office Visits $25 primary $50 specialist
- Chiropractic $25 copay
- Urgent Care $75 copay
- Emergency Room Services $150 copay and 20% coinsurance
- Ambulance 20%
- Hospitalization 20%
- Outpatient Lab/Radiology 20%
- Durable Medical Equipment 20%
- Skilled Nursing Facilities 20%
- Home Health Care 20%
- Rehabilitation Services 20%
- Prenatal/Postnatal Care 20%
- Delivery and all Inpatient Services 20%
- Mental/Behavioral Health, Outpatient 20%
- Mental/Behavioral Health, Inpatient $25 copay
- Prescription Drug Deductible $5 G $30 B $60 N $120 S
- Out-of-network services Out-of-network medical emergencies, urgent care and plan prior-approved referrals are covered as in-network benefit. See Certificate of Coverage for plan detail.
Health Tradition Platinum 1000 w/copay
$1,000 / $2,000
80%
$3,000 / $6,000
What will I pay after meeting my deductible? [ See more + ] [ See less - ]
- Preventive Care 100% coverage
- Routine Eye Exam Covered under preventive care
- Routine Hearing Exam Covered under preventive care
- Office Visits $20 primary $40 specialist
- Chiropractic $20 copay
- Urgent Care $75 copay
- Emergency Room Services $175 copay and 20% coinsurance
- Ambulance 20%
- Hospitalization 20%
- Outpatient Lab/Radiology 20%
- Durable Medical Equipment 20%
- Skilled Nursing Facilities 20%
- Home Health Care 20%
- Rehabilitation Services 20%
- Prenatal/Postnatal Care 20%
- Delivery and all Inpatient Services 20%
- Mental/Behavioral Health, Outpatient $20 copay
- Mental/Behavioral Health, Inpatient 20%
- Prescription Drugs $5 G $30 B $60 N $120 S
- Out-of-network services Out-of-network medical emergencies, urgent care and plan prior-approved referrals are covered as in-network benefit. See Certificate of Coverage for plan detail.
Gold Level
Health Tradition Gold 1000/80 w/copay
$1,000 / $2,000
80%
$4,500 / $9,000
What will I pay after meeting my deductible? [ See more + ] [ See less - ]
- Preventive Care 100% coverage
- Routine Eye Exam Covered under preventive care
- Routine Hearing Exam Covered under preventive care
- Office Visits $40 primary $90 specialist
- Chiropractic $40 copay
- Urgent Care $125 copay
- Emergency Room Services $250 copay and 20% coinsurance
- Ambulance 20%
- Hospitalization 20%
- Outpatient Lab/Radiology 20%
- Durable Medical Equipment 20%
- Skilled Nursing Facilities 20%
- Home Health Care 20%
- Rehabilitation Services 20%
- Prenatal/Postnatal Care 20%
- Delivery and all Inpatient Services 20%
- Mental/Behavioral Health, Outpatient $40 copay
- Mental/Behavioral Health, Inpatient 20%
- Prescription Drugs $10 G $50 B 40% N 20% S
- Out-of-network services Out-of-network medical emergencies, urgent care and plan prior-approved referrals are covered as in-network benefit. See Certificate of Coverage for plan detail.
Health Tradition Gold 1500/80
$1,500 / $3,000
80%
$4,000 / $8,000
What will I pay after meeting my deductible? [ See more + ] [ See less - ]
- Preventive Care 100% coverage
- Routine Eye Exam Covered under preventive care
- Routine Hearing Exam Covered under preventive care
- Office Visits 20%
- Chiropractic 20%
- Urgent Care 20%
- Emergency Room Services $250 copay and 20% coinsurance
- Ambulance 20%
- Hospitalization 20%
- Outpatient Lab/Radiology 20%
- Durable Medical Equipment 20%
- Skilled Nursing Facilities 20%
- Home Health Care 20%
- Rehabilitation Services 20%
- Prenatal/Postnatal Care 20%
- Delivery and all Inpatient Services 20%
- Mental/Behavioral Health, Outpatient 20%
- Mental/Behavioral Health, Inpatient 20%
- Prescription Drugs $10 G $50 B 40% N 20% S
- Out-of-network services Out-of-network medical emergencies, urgent care and plan prior-approved referrals are covered as in-network benefit. See Certificate of Coverage for plan detail.
Health Tradition Gold 2500/70 w/copay
$2,500 / $5,000
70%
$5,500 / $11,000
What will I pay after meeting my deductible? [ See more + ] [ See less - ]
- Preventive Care 100% coverage
- Routine Eye Exam Covered under preventive care
- Routine Hearing Exam Covered under preventive care
- Office Visits $45 primary $90 specialist
- Chiropractic $45 copay
- Urgent Care $150 copay
- Emergency Room Services $300 copay and 30% insurance
- Ambulance 30%
- Hospitalization 30%
- Outpatient Lab/Radiology 30%
- Durable Medical Equipment 30%
- Skilled Nursing Facilities 30%
- Home Health Care 30%
- Rehabilitation Services 30%
- Prenatal/Postnatal Care 30%
- Delivery and all Inpatient Services 30%
- Mental/Behavioral Health, Outpatient $45 copay
- Mental/Behavioral Health, Inpatient 30%
- Prescription Drugs $10 G $50 B 40% N 20% S
- Out-of-network services Out-of-network medical emergencies, urgent care and plan prior-approved referrals are covered as in-network benefit. See Certificate of Coverage for plan detail.
Health Tradition Gold HDHP 100
$3,000 / $6,000
100%
$3,000 / $6,000
What will I pay after meeting my deductible? [ See more + ] [ See less - ]
- Preventive Care 100% coverage
- Routine Eye Exam Covered under preventive care
- Routine Hearing Exam Covered under preventive care
- Office Visits 0%
- Chiropractic 0%
- Urgent Care 0%
- Emergency Room Services 0%
- Ambulance 0%
- Hospitalization 0%
- Outpatient Lab/Radiology 0%
- Durable Medical Equipment 0%
- Skilled Nursing Facilities 0%
- Home Health Care 0%
- Rehabilitation Services 0%
- Prenatal/Postnatal Care 0%
- Delivery and all Inpatient Services 0%
- Mental/Behavioral Health, Outpatient 0%
- Mental/Behavioral Health, Inpatient 0%
- Prescription Drugs 0% after deductible is met
- Out-of-network services Out-of-network medical emergencies, urgent care and plan prior-approved referrals are covered as in-network benefit. See Certificate of Coverage for plan detail.
Silver Level
Health Tradition Silver 2000/70 w/copay
$2,000 / $4,000
70%
$8,150 / $16,300
What will I pay after meeting my deductible? [ See more + ] [ See less - ]
- Preventive Care 100% coverage
- Routine Eye Exam Covered under preventive care
- Routine Hearing Exam Covered under preventive care
- Office Visits $70 primary $150 specialist
- Chiropractic $70 copay
- Urgent Care $200 copay
- Emergency Room Services $300 copay and 30% coinsurance
- Ambulance 30%
- Hospitalization 30%
- Outpatient Lab/Radiology 30%
- Durable Medical Equipment 30%
- Skilled Nursing Facilities 30%
- Home Health Care 30%
- Rehabilitation Services 30%
- Prenatal/Postnatal Care 30%
- Delivery and all Inpatient Services 30%
- Mental/Behavioral Health, Outpatient $70 copay
- Mental/Behavioral Health, Inpatient 30%
- Prescription Drugs $15 G $70 B 40% N 40% S
- Out-of-network services Out-of-network medical emergencies, urgent care and plan prior-approved referrals are covered as in-network benefit. See Certificate of Coverage for plan detail.
Health Tradition Silver 2000/70
$2,000 / $4,000
70%
$8,150 / $16,300
What will I pay after meeting my deductible? [ See more + ] [ See less - ]
- Preventive Care 100% coverage
- Routine Eye Exam Covered under preventive care
- Routine Hearing Exam Covered under preventive care
- Office Visits 30%
- Chiropractic 30%
- Urgent Care 30%
- Emergency Room Services $250 copay and 30% coinsurance
- Ambulance 30%
- Hospitalization 30%
- Outpatient Lab/Radiology 30%
- Durable Medical Equipment 30%
- Skilled Nursing Facilities 30%
- Home Health Care 30%
- Rehabilitation Services 30%
- Prenatal/Postnatal Care 30%
- Delivery and all Inpatient Services 30%
- Mental/Behavioral Health, Outpatient 30%
- Mental/Behavioral Health, Inpatient 30%
- Prescription Drugs $15 G $70 B 40% N 20% S
- Out-of-network services Out-of-network medical emergencies, urgent care and plan prior-approved referrals are covered as in-network benefit. See Certificate of Coverage for plan detail.
Health Tradition Silver 3000/80 w/copay
$3,000 / $6,000
80%
$8,150 / $16,300
What will I pay after meeting my deductible? [ See more + ] [ See less - ]
- Preventive Care 100% coverage
- Routine Eye Exam Covered under preventive care
- Routine Hearing Exam Covered under preventive care
- Office Visits $65 primary $150 specialist
- Chiropractic $65 copay
- Urgent Care $200 copay
- Emergency Room Services $300 copay and 20% coinsurance
- Ambulance 20%
- Hospitalization 20%
- Outpatient Lab/Radiology 20%
- Durable Medical Equipment 20%
- Skilled Nursing Facilities 20%
- Home Health Care 20%
- Rehabilitation Services 20%
- Prenatal/Postnatal Care 20%
- Delivery and all Inpatient Services 20%
- Mental/Behavioral Health, Outpatient $65 copay
- Mental/Behavioral Health, Inpatient 20%
- Prescription Drugs $15 G $70 B 40% N 20% S
- Out-of-network services Out-of-network medical emergencies, urgent care and plan prior-approved referrals are covered as in-network benefit. See Certificate of Coverage for plan detail.
Health Tradition Silver 5000/80 w/copay
$5,000 / $10,000
80%
$8,150 / $16,300
What will I pay after meeting my deductible? [ See more + ] [ See less - ]
- Preventive Care 100% coverage
- Routine Eye Exam Covered under preventive care
- Routine Hearing Exam Covered under preventive care
- Office Visits $60 primary $150 specialist
- Chiropractic $60 copay
- Urgent Care $200 copay
- Emergency Room Services $300 copay and 20% coinsurance
- Ambulance 20%
- Hospitalization 20%
- Outpatient Lab/Radiology 20%
- Durable Medical Equipment 20%
- Skilled Nursing Facilities 20%
- Home Health Care 20%
- Rehabilitation Services 20%
- Prenatal/Postnatal Care 20%
- Delivery and all Inpatient Services 20%
- Mental/Behavioral Health, Outpatient $60 copay
- Mental/Behavioral Health, Inpatient 20%
- Prescription Drugs $15 G $70 B 40% N 20% S
- Out-of-network services Out-of-network medical emergencies, urgent care and plan prior-approved referrals are covered as in-network benefit. See Certificate of Coverage for plan detail.
Health Tradition Silver HDHP 100
$5,500 / $11,000
100%
$5,500 / $11,000
What will I pay after meeting my deductible? [ See more + ] [ See less - ]
- Preventive Care 100% coverage
- Routine Eye Exam Covered under preventive care
- Routine Hearing Exam Covered under preventive care
- Office Visits 0%
- Chiropractic 0%
- Urgent Care 0%
- Emergency Room Services 0%
- Ambulance 0%
- Hospitalization 0%
- Outpatient Lab/Radiology 0%
- Durable Medical Equipment 0%
- Skilled Nursing Facilities 0%
- Home Health Care 0%
- Rehabilitation Services 0%
- Prenatal/Postnatal Care 0%
- Delivery and all Inpatient Services 0%
- Mental/Behavioral Health, Outpatient 0%
- Mental/Behavioral Health, Inpatient 0%
- Prescription Drugs 0% after deductible is met
- Out-of-network services Out-of-network medical emergencies, urgent care and plan prior-approved referrals are covered as in-network benefit. See Certificate of Coverage for plan detail.
Bronze Level
Health Tradition Bronze 7750/60 w/copay
$7,750 / $15,500
60%
$8,150 / $16,300
What will I pay after meeting my deductible? [ See more + ] [ See less - ]
- Preventive Care 100% coverage
- Routine Eye Exam Covered under preventive care
- Routine Hearing Exam Covered under preventive care
- Office Visits $75 primary $150 specialist
- Chiropractic $75 copay
- Urgent Care 40%
- Emergency Room Services 40%
- Ambulance 40%
- Hospitalization 40%
- Outpatient Lab/Radiology 40%
- Durable Medical Equipment 40%
- Skilled Nursing Facilities 40%
- Home Health Care 40%
- Rehabilitation Services 40%
- Prenatal/Postnatal Care 40%
- Delivery and all Inpatient Services 40%
- Mental/Behavioral Health, Outpatient $75 copay
- Mental/Behavioral Health, Inpatient 40%
- Prescription Drugs $15 G $70 B $150 N $200 S
- Out-of-network services Out-of-network medical emergencies, urgent care and plan prior-approved referrals are covered as in-network benefit. See Certificate of Coverage for plan detail.
Health Tradition Bronze HDHP 100
$6,900 / $13,800
100%
$6,900 / $13,800
What will I pay after meeting my deductible? [ See more + ] [ See less - ]
- Preventive Care 100% coverage
- Routine Eye Exam Covered under preventive care
- Routine Hearing Exam Covered under preventive care
- Office Visits 0%
- Chiropractic 0%
- Urgent Care 0%
- Emergency Room Services 0%
- Ambulance 0%
- Hospitalization 0%
- Outpatient Lab/Radiology 0%
- Durable Medical Equipment 0%
- Skilled Nursing Facilities 0%
- Home Health Care 0%
- Rehabilitation Services 0%
- Prenatal/Postnatal Care 0%
- Delivery and all Inpatient Services 0%
- Mental/Behavioral Health, Outpatient 0%
- Mental/Behavioral Health, Inpatient 0%
- Prescription Drugs 0% after deductible is met
- Out-of-network services Out-of-network medical emergencies, urgent care and plan prior-approved referrals are covered as in-network benefit. See Certificate of Coverage for plan detail.
Point of service plans
Plan
Annual Deductible
Coinsurance
Out-of-pocket maximum
Platinum Level
Health Tradition Platinum 500 w/copay POS
$500 / $1,000
80%
$1,500 / $3,000
What will I pay after meeting my deductible? [ See more + ] [ See less - ]
- Preventive Care 100% coverage
- Routine Eye Exam Covered under preventive care
- Routine Hearing Exam Covered under preventive care
- Office Visits $25 primary $50 specialist
- Chiropractic $25 copay
- Urgent Care $75 copay
- Emergency Room Services $150 copay and 20% coinsurance
- Ambulance 20%
- Hospitalization 20%
- Outpatient Lab/Radiology 20%
- Durable Medical Equipment 20%
- Skilled Nursing Facilities 20%
- Home Health Care 20%
- Rehabilitation Services 20%
- Prenatal/Postnatal Care 20%
- Delivery and all Inpatient Services 20%
- Mental/Behavioral Health, Outpatient $25 copay
- Mental/Behavioral Health, Inpatient 20%
- Prescription Drugs $5 G $30 B $60 N $120 S
- Out-of-network services Out-of-network medical emergencies, urgent care and plan prior-approved referrals are covered as in-network benefit. See Certificate of Coverage for plan detail.
Health Tradition Platinum 1000 w/copay POS
$1,000 / $2,000
80%
$3,000 / $6,000
What will I pay after meeting my deductible? [ See more + ] [ See less - ]
- Preventive Care 100% coverage
- Routine Eye Exam Covered under preventive care
- Routine Hearing Exam Covered under preventive care
- Office Visits $20 primary $40 specialist
- Chiropractic $20 copay
- Urgent Care $75 copay
- Emergency Room Services $175 copay and 20% coinsurance
- Ambulance 20%
- Hospitalization 20%
- Outpatient Lab/Radiology 20%
- Durable Medical Equipment 20%
- Skilled Nursing Facilities 20%
- Home Health Care 20%
- Rehabilitation Services 20%
- Prenatal/Postnatal Care 20%
- Delivery and all Inpatient Services 20%
- Mental/Behavioral Health, Outpatient $20 copay
- Mental/Behavioral Health, Inpatient 20%
- Prescription Drugs $5 G $30 B $60 N $120 S
- Out-of-network services Out-of-network medical emergencies, urgent care and plan prior-approved referrals are covered as in-network benefit. See Certificate of Coverage for plan detail.
Gold Level
Health Tradition Gold 1000/80 w/copay POS
$1,000 / $2,000
80%
$4,500 / $9,000
What will I pay after meeting my deductible? [ See more + ] [ See less - ]
- Preventive Care 100% coverage
- Routine Eye Exam Covered under preventive care
- Routine Hearing Exam Covered under preventive care
- Office Visits $40 primary $90 specialist
- Chiropractic $40 copay
- Urgent Care $125 copay
- Emergency Room Services $250 copay and 20% coinsurance
- Ambulance 20%
- Hospitalization 20%
- Outpatient Lab/Radiology 20%
- Durable Medical Equipment 20%
- Skilled Nursing Facilities 20%
- Home Health Care 20%
- Rehabilitation Services 20%
- Prenatal/Postnatal Care 20%
- Delivery and all Inpatient Services 20%
- Mental/Behavioral Health, Outpatient $40 copay
- Mental/Behavioral Health, Inpatient 20%
- Prescription Drugs $10 G $50 B 40% N 20% S
- Out-of-network services Out-of-network medical emergencies, urgent care and plan prior-approved referrals are covered as in-network benefit. See Certificate of Coverage for plan detail.
Health Tradition Gold 1500/80 POS
$1,500 / $3,000
80%
$4,000 / $8,000
What will I pay after meeting my deductible? [ See more + ] [ See less - ]
- Preventive Care 100% coverage
- Routine Eye Exam Covered under preventive care
- Routine Hearing Exam Covered under preventive care
- Office Visits 20%
- Chiropractic 20%
- Urgent Care 20%
- Emergency Room Services $250 copay and 20% coinsurance
- Ambulance 20%
- Hospitalization 20%
- Outpatient Lab/Radiology 20%
- Durable Medical Equipment 20%
- Skilled Nursing Facilities 20%
- Home Health Care 20%
- Rehabilitation Services 20%
- Prenatal/Postnatal Care 20%
- Delivery and all Inpatient Services 20%
- Mental/Behavioral Health, Outpatient 20%
- Mental/Behavioral Health, Inpatient 20%
- Prescription Drugs $10 G $50 B 40% N 20% S
- Out-of-network services Out-of-network medical emergencies, urgent care and plan prior-approved referrals are covered as in-network benefit. See Certificate of Coverage for plan detail.
Health Tradition Gold 2500/70 w/copay POS
$2,500 / $5,000
70%
$5,500 / $11,000
What will I pay after meeting my deductible? [ See more + ] [ See less - ]
- Preventive Care 100% coverage
- Routine Eye Exam Covered under preventive care
- Routine Hearing Exam Covered under preventive care
- Office Visits $45 primary $90 specialist
- Chiropractic $45 copay
- Urgent Care $150 copay
- Emergency Room Services $300 copay and 30% coinsurance
- Ambulance 30%
- Hospitalization 30%
- Outpatient Lab/Radiology 30%
- Durable Medical Equipment 30%
- Skilled Nursing Facilities 30%
- Home Health Care 30%
- Rehabilitation Services 30%
- Prenatal/Postnatal Care 30%
- Delivery and all Inpatient Services 30%
- Mental/Behavioral Health, Outpatient $45 copay
- Mental/Behavioral Health, Inpatient 30%
- Prescription Drugs $10 G $50 B 40% N 20% S
- Out-of-network services Out-of-network medical emergencies, urgent care and plan prior-approved referrals are covered as in-network benefit. See Certificate of Coverage for plan detail.
Health Tradition Gold HDHP 100 POS
$3,000 / $6,000
100%
$3,000 / $6,000
What will I pay after meeting my deductible? [ See more + ] [ See less - ]
- Preventive Care 100% coverage
- Routine Eye Exam Covered under preventive care
- Routine Hearing Exam Covered under preventive care
- Office Visits 0%
- Chiropractic 0%
- Urgent Care 0%
- Emergency Room Services 0%
- Ambulance 0%
- Hospitalization 0%
- Outpatient Lab/Radiology 0%
- Durable Medical Equipment 0%
- Skilled Nursing Facilities 0%
- Home Health Care 0%
- Rehabilitation Services 0%
- Prenatal/Postnatal Care 0%
- Delivery and all Inpatient Services 0%
- Mental/Behavioral Health, Outpatient 0%
- Mental/Behavioral Health, Inpatient 0%
- Prescription Drugs 0% after deductible is met
- Out-of-network services Out-of-network medical emergencies, urgent care and plan prior-approved referrals are covered as in-network benefit. See Certificate of Coverage for plan detail.
Silver Level
Health Tradition Silver 2000/70 w/copay POS
$2,000 / $4,000
70%
$8,150 / $16,300
What will I pay after meeting my deductible? [ See more + ] [ See less - ]
- Preventive Care 100% coverage
- Routine Eye Exam Covered under preventive care
- Routine Hearing Exam Covered under preventive care
- Office Visits $70 primary $150 specialist
- Chiropractic $70 copay
- Urgent Care $200 copay
- Emergency Room Services $300 copay and 30% coinsurance
- Ambulance 30%
- Hospitalization 30%
- Outpatient Lab/Radiology 30%
- Durable Medical Equipment 30%
- Skilled Nursing Facilities 30%
- Home Health Care 30%
- Rehabilitation Services 30%
- Prenatal/Postnatal Care 30%
- Delivery and all Inpatient Services 30%
- Mental/Behavioral Health, Outpatient $70 copay
- Mental/Behavioral Health, Inpatient 30%
- Prescription Drugs $15 G $70 B 40% N 40% S
- Out-of-network services Out-of-network medical emergencies, urgent care and plan prior-approved referrals are covered as in-network benefit. See Certificate of Coverage for plan detail.
Health Tradition Silver 2000/70 POS
$2,000 / $4,000
70%
$8,150 / $16,300
What will I pay after meeting my deductible? [ See more + ] [ See less - ]
- Preventive Care 100% coverage
- Routine Eye Exam Covered under preventive care
- Routine Hearing Exam Covered under preventive care
- Office Visits 30%
- Chiropractic 30%
- Urgent Care 30%
- Emergency Room Services $250 copay and 30% coinsurance
- Ambulance 30%
- Hospitalization 30%
- Outpatient Lab/Radiology 30%
- Durable Medical Equipment 30%
- Skilled Nursing Facilities 30%
- Home Health Care 30%
- Rehabilitation Services 30%
- Prenatal/Postnatal Care 30%
- Delivery and all Inpatient Services 30%
- Mental/Behavioral Health, Outpatient 30%
- Mental/Behavioral Health, Inpatient 30%
- Prescription Drugs $15 G $70 B 40% N 20% S
- Out-of-network services Out-of-network medical emergencies, urgent care and plan prior-approved referrals are covered as in-network benefit. See Certificate of Coverage for plan detail.
Health Tradition Silver 3000/80 w/copay POS
$3,000 / $6,000
80%
$8,150 / $16,300
What will I pay after meeting my deductible? [ See more + ] [ See less - ]
- Preventive Care 100% coverage
- Routine Eye Exam Covered under preventive care
- Routine Hearing Exam Covered under preventive care
- Office Visits $65 primary $150 specialist
- Chiropractic $65 copay
- Urgent Care $200 copay
- Emergency Room Services $300 copay and 20% coinsurance
- Ambulance 20%
- Hospitalization 20%
- Outpatient Lab/Radiology 20%
- Durable Medical Equipment 20%
- Skilled Nursing Facilities 20%
- Home Health Care 20%
- Rehabilitation Services 20%
- Prenatal/Postnatal Care 20%
- Delivery and all Inpatient Services 20%
- Mental/Behavioral Health, Outpatient $65 copay
- Mental/Behavioral Health, Inpatient 20%
- Prescription Drugs $15 G $70 B 40% N 20% S
- Out-of-network services Out-of-network medical emergencies, urgent care and plan prior-approved referrals are covered as in-network benefit. See Certificate of Coverage for plan detail.
Health Tradition Silver 5000/80 w/copay POS
$5,000 / $10,000
80%
$8,150 / $16,300
What will I pay after meeting my deductible? [ See more + ] [ See less - ]
- Preventive Care 100% coverage
- Routine Eye Exam Covered under preventive care
- Routine Hearing Exam Covered under preventive care
- Office Visits $60 primary and $150 specialist
- Chiropractic $60 copay
- Urgent Care $200 copay
- Emergency Room Services $300 copay and 20% coinsurance
- Ambulance 20%
- Hospitalization 20%
- Outpatient Lab/Radiology 20%
- Durable Medical Equipment 20%
- Skilled Nursing Facilities 20%
- Home Health Care 20%
- Rehabilitation Services 20%
- Prenatal/Postnatal Care 20%
- Delivery and all Inpatient Services 20%
- Mental/Behavioral Health, Outpatient $60 copay
- Mental/Behavioral Health, Inpatient 20%
- Prescription Drugs $15 G $70 B 40% N 20% S
- Out-of-network services Out-of-network medical emergencies, urgent care and plan prior-approved referrals are covered as in-network benefit. See Certificate of Coverage for plan detail.
Health Tradition Silver HDHP 100 POS
$5,500 / $11,000
100%
$5,500 / $11,000
What will I pay after meeting my deductible? [ See more + ] [ See less - ]
- Preventive Care 100% coverage
- Routine Eye Exam Covered under preventive care
- Routine Hearing Exam Covered under preventive care
- Office Visits 0%
- Chiropractic 0%
- Urgent Care 0%
- Emergency Room Services 0%
- Ambulance 0%
- Hospitalization 0%
- Outpatient Lab/Radiology 0%
- Durable Medical Equipment 0%
- Skilled Nursing Facilities 0%
- Home Health Care 0%
- Rehabilitation Services 0%
- Prenatal/Postnatal Care 0%
- Delivery and all Inpatient Services 0%
- Mental/Behavioral Health, Outpatient 0%
- Mental/Behavioral Health, Inpatient 0%
- Prescription Drugs 0% after deductible is met
- Out-of-network services Out-of-network medical emergencies, urgent care and plan prior-approved referrals are covered as in-network benefit. See Certificate of Coverage for plan detail.
Bronze Level
Health Tradition Bronze 7750/60 w/copay POS
$7,750 / $15,500
60%
$8,150 / $16,300
What will I pay after meeting my deductible? [ See more + ] [ See less - ]
- Preventive Care 100% coverage
- Routine Eye Exam Covered under preventive care
- Routine Hearing Exam Covered under preventive care
- Office Visits $75 primary $150 specialist
- Chiropractic $75 copay
- Urgent Care 40%
- Emergency Room Services 40%
- Ambulance 40%
- Hospitalization 40%
- Outpatient Lab/Radiology 40%
- Durable Medical Equipment 40%
- Skilled Nursing Facilities 40%
- Home Health Care 40%
- Rehabilitation Services 40%
- Prenatal/Postnatal Care 40%
- Delivery and all Inpatient Services 40%
- Mental/Behavioral Health, Outpatient $75 copay
- Mental/Behavioral Health, Inpatient 40%
- Prescription Drugs $15 G $70 B $150 N $200 S
- Out-of-network services Out-of-network medical emergencies, urgent care and plan prior-approved referrals are covered as in-network benefit. See Certificate of Coverage for plan detail.
Health Tradition Bronze HDHP 100 POS
$6,900 / $13,800
100%
$6,900 / $13,800
What will I pay after meeting my deductible? [ See more + ] [ See less - ]
- Preventive Care 100% coverage
- Routine Eye Exam Covered under preventive care
- Routine Hearing Exam Covered under preventive care
- Office Visits 0%
- Chiropractic 0%
- Urgent Care 0%
- Emergency Room Services 0%
- Ambulance 0%
- Hospitalization 0%
- Outpatient Lab/Radiology 0%
- Durable Medical Equipment 0%
- Skilled Nursing Facilities 0%
- Home Health Care 0%
- Rehabilitation Services 0%
- Prenatal/Postnatal Care 0%
- Delivery and all Inpatient Services 0%
- Mental/Behavioral Health, Outpatient 0%
- Mental/Behavioral Health, Inpatient 0%
- Prescription Drugs 0% after deductible is met
- Out-of-network services Out-of-network medical emergencies, urgent care and plan prior-approved referrals are covered as in-network benefit. See Certificate of Coverage for plan detail.
* This Benefit Plan provides 100% coverage for preventive health services. Coverage may be subject to reasonable medical management techniques to determine the frequency, method, treatment, or setting for receipt of preventive health services and as defined in Section 1001 of the Patient Protection and Affordable Care Act, with no cost sharing.
** Out-of-network medical emergencies, urgent care and prior plan-approved referrals are covered as in-network benefit. See Certificate of Coverage for plan detail.
*** Once a member of a family plan meets the individual deductible or maximum out-of-pocket, Health Tradition begins paying for covered services for that person, regardless of whether the family deductible or out-of-pocket maximum has been met.