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:
HMO plans with coverage beginning after January 1, 2019
Plan
Annual Deductible
Coinsurance
Out-of-pocket maximum
Platinum Level
Health Tradition Platinum 1000
$1,000 / $2,000
100%
$2,000 / $4,000
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 $50 primary $75 specialist
- Chiropractic $50 copay
- Urgent Care $50 copay
- Emergency Room Services $150 copay
- 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 $50 copay
- Mental/Behavioral Health, Inpatient 0%
- Prescription Drugs $15 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.
Gold Level
Health Tradition Gold 1000/80 w/copay
$1,000 / $2,000
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 $50 primary $75 specialist
- Chiropractic $50 copay
- Urgent Care $50 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 $50 copay
- Mental/Behavioral Health, Inpatient 20%
- Prescription Drugs $15 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 $100 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 $15 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 2000/90
$2,000 / $4,000
90%
$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 10%
- Chiropractic 10%
- Urgent Care 10%
- Emergency Room Services $100 copay and 10% coinsurance
- Ambulance 10%
- Hospitalization 10%
- Outpatient Lab/Radiology 10%
- Durable Medical Equipment 10%
- Skilled Nursing Facilities 10%
- Home Health Care 10%
- Rehabilitation Services 10%
- Prenatal/Postnatal Care 10%
- Delivery and all Inpatient Services 10%
- Mental/Behavioral Health, Outpatient 10%
- Mental/Behavioral Health, Inpatient 10%
- Prescription Drugs $25 G $60 B $80 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 2600/80 w/copay
$2,600 / $5,200
80%
$7,500 / $15,000
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 $75 primary $150 specialist
- Chiropractic $75 copay
- Urgent Care $75 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 $75 copay
- Mental/Behavioral Health, Inpatient 20%
- Prescription Drugs $15 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 Silver 1500/70 w/copay
$1,500 / $3,000
70%
$7,000 / $14,000
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 $75 primary $150 specialist
- Chiropractic $75 copay
- Urgent Care $75 copay
- Emergency Room Services $200 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 $75 copay
- Mental/Behavioral Health, Inpatient 30%
- Prescription Drugs $30 G $70 B $150 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 2000/70
$2,000 / $4,000
70%
$7,500 / $15,000
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 30%
- Chiropractic 30%
- Urgent Care 30%
- Emergency Room Services $200 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 $30 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
$5,000 / $10,000
100%
$5,000 / $10,000
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.
Health Tradition Silver HDHP 90
$3,500 / $7,000
90%
$6,750 / $13,500
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 10%
- Chiropractic 10%
- Urgent Care 10%
- Emergency Room Services 10%
- Ambulance 10%
- Hospitalization 10%
- Outpatient Lab/Radiology 10%
- Durable Medical Equipment 10%
- Skilled Nursing Facilities 10%
- Home Health Care 10%
- Rehabilitation Services 10%
- Prenatal/Postnatal Care 10%
- Delivery and all Inpatient Services 10%
- Mental/Behavioral Health, Outpatient 10%
- Mental/Behavioral Health, Inpatient 10%
- Prescription Drugs 10% G 10% B 30% N 10% S 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 HDHP 80
$6,000 / $12,000
80%
$6,750 / $13,500
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 20%
- 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 20% G 20% B 40% N 20% S 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.
Health Tradition Bronze HDHP 60
$5,000 / $10,000
60%
$6,750 / $13,500
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%
- Chiropractic 40%
- 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 40%
- Mental/Behavioral Health, Inpatient 40%
- Prescription Drugs 40% G 40% B 60% N 20% S 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.
Health Tradition Bronze HDHP 50
$4,500 / $9,000
50%
$6,750 / $13,500
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 50%
- Chiropractic 50%
- Urgent Care 50%
- Emergency Room Services 50%
- Ambulance 50%
- Hospitalization 50%
- Outpatient Lab/Radiology 50%
- Durable Medical Equipment 50%
- Skilled Nursing Facilities 50%
- Home Health Care 50%
- Rehabilitation Services 50%
- Prenatal/Postnatal Care 50%
- Delivery and all Inpatient Services 50%
- Mental/Behavioral Health, Outpatient 50%
- Mental/Behavioral Health, Inpatient 50%
- Prescription Drugs 50% 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.
Health Tradition Bronze 6500/60
$6,500 / $13,000
60%
$7,500 / $15,000
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%
- Chiropractic 40%
- 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 40%
- Mental/Behavioral Health, Inpatient 40%
- Prescription Drugs $30 G $75 B $150 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 Bronze 7500/100
$7,500 / $15,000
100%
$7,500 / $15,000
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.
POS plans with coverage beginning after January 1, 2019
Plan
Annual Deductible
Coinsurance
Out-of-pocket maximum
Platinum Level
Health Tradition Platinum 1000 POS
$1,000 / $2,000
100%
$2,000 / $4,000
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 $50 primary $75 specialist
- Chiropractic $50 copay
- Urgent Care $50 copay
- Emergency Room Services $150 copay
- Ambulance 0%
- Hospitlization 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 $50 copay
- Mental/Behavioral Health, Inpatient 0%
- Prescription Drugs $15 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.
Gold Level
Health Tradition Gold 1000/80 w/copay POS
$1,000 / $2,000
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 $50 primary $75 specialist
- Chiropractic $50 copay
- Urgent Care $50 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 $50 copay
- Mental/Behavioral Health, Inpatient 20%
- Prescription Drugs $15 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 $100 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 $15 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 2000/90 POS
$2,000 / $4,000
90%
$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 10%
- Chiropractic 10%
- Urgent Care 10%
- Emergency Room Services $100 copay and 10% coinsurance
- Ambulance 10%
- Hospitalization 10%
- Outpatient Lab/Radiology 10%
- Durable Medical Equipment 10%
- Skilled Nursing Facilities 10%
- Home Health Care 10%
- Rehabilitation Services 10%
- Prenatal/Postnatal Care 10%
- Delivery and all Inpatient Services 10%
- Mental/Behavioral Health, Outpatient 10%
- Mental/Behavioral Health, Inpatient 10%
- Prescription Drugs $25 G $60 B $80 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 2600/80 w/copay POS
$2,600 / $5,200
80%
$7,500 / $15,000
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 $75 primary $150 specialist
- Chiropractic $75 copay
- Urgent Care $75 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 $75 copay
- Mental/Behavioral Health, Inpatient 20%
- Prescription Drugs $15 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 Silver 1500/70 w/copay POS
$1,500 / $3,000
70%
$7,000 / $14,000
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 $75 copay and $150 specialist
- Chiropractic $75 copay
- Urgent Care $75 copay
- Emergency Room Services $200 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 $75 copay
- Mental/Behavioral Health, Inpatient 30%
- Prescription Drugs $30 G $70 B $150 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 2000/70 POS
$2,000 / $4,000
70%
$7,500 / $15,000
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 30%
- Chiropractic 30%
- Urgent Care 30%
- Emergency Room Services $200 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 $30 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
$5,000 / $10,000
100%
$5,000 / $10,000
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.
Health Tradition Silver HDHP 90 POS
$3,500 / $7,000
90%
$6,750 / $13,500
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 10%
- Chiropractic 10%
- Urgent Care 10%
- Emergency Room Services 10%
- Ambulance 10%
- Hospitalization 10%
- Outpatient Lab/Radiology 10%
- Durable Medical Equipment 10%
- Skilled Nursing Facilities 10%
- Home Health Care 10%
- Rehabilitation Services 10%
- Prenatal/Postnatal Care 10%
- Delivery and all Inpatient Services 10%
- Mental/Behavioral Health, Outpatient 10%
- Mental/Behavioral Health, Inpatient 10%
- Prescription Drugs 10% G 10% B 30% N 10% S 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 HDHP 80 POS
$6,000 / $12,000
80%
$6,750 / $13,500
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 20%
- 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 20% G 20% B 40% N 20% S 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.
Health Tradition Bronze HDHP 60 POS
$5,000 / $10,000
60%
$6,750 / $13,500
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%
- Chiropractic 40%
- 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 40%
- Mental/Behavioral Health, Inpatient 40%
- Prescription Drugs 40% G 40% B 60% N 20% S 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.
Health Tradition Bronze HDHP 50 POS
$4,500 / $9,000
50%
$6,750 / $13,500
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 50%
- Chiropractic 50%
- Urgent Care 50%
- Emergency Room Services 50%
- Ambulance 50%
- Hospitalization 50%
- Outpatient Lab/Radiology 50%
- Durable Medical Equipment 50%
- Skilled Nursing Facilities 50%
- Home Health Care 50%
- Rehabilitation Services 50%
- Prenatal/Postnatal Care 50%
- Delivery and all Inpatient Services 50%
- Mental/Behavioral Health, Outpatient 50%
- Mental/Behavioral Health, Inpatient 50%
- Prescription Drugs 50% 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.
Health Tradition Bronze 6500/60 POS
$6,500 / $13,000
60%
$7,500 / $15,000
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%
- Chiropractic 40%
- 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 40%
- Mental/Behavioral Health, Inpatient 20%
- Prescription Drugs $30 G $75 B $150 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 Bronze 7500/100 POS
$7,500 / $15,000
100%
$7,500 / $15,000
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.
HMO plans with coverage beginning after January 1, 2018
Platinum Level
Gold Level
- Health Tradition Gold 1000/80 w/copay
- Health Tradition Gold 1500/80
- Health Tradition Gold 2000/90
- Health Tradition Gold HDHP 100
Silver Level
- Health Tradition Silver 2500/80 w/copay
- Health Tradition Silver 1500/70 w/copay
- Health Tradition Silver 2000/70
- Health Tradition Silver HDHP 100
- Health Tradition Silver HDHP 90
Bronze Level
- Health Tradition Bronze HDHP 80
- Health Tradition Bronze HDHP 60
- Health Tradition Bronze HDHP 50
- Health Tradition Bronze 6500/60
- Health Tradition Bronze 7350/100
POS plans with coverage beginning after January 1, 2018
Platinum Level
Gold Level
- Health Tradition Gold 1000/80 w/copay POS
- Health Tradition Gold 1500/80 POS
- Health Tradition Gold 2000/90 POS
- Health Tradition Gold HDHP 100 POS
Silver Level
- Health Tradition Silver 2500/80 w/copay POS
- Health Tradition Silver 1500/70 w/copay POS
- Health Tradition Silver 2000/70 POS
- Health Tradition Silver HDHP 100 POS
- Health Tradition Silver HDHP 90 POS