Health plan options for large groups

Here is a summary of coverage options available for groups with 51 or more eligible members. This is a reference only, and it is important to note:

• Some deductibles and copays are not available in all plan designs. Your Priority Health representative can help you determine which combinations will work for your group.
  
• Additional plan riders can add specific coverages to health plans. Review plan riders here.
• All of this information is subject to change at any time.
• All large group quotes must be completed by Priority Health.
• These options are primarily for groups with 51-99 eligible members. More coverage options are available for groups with 100+ eligible members.
  

Contact your Priority Health representative to get a quote or discuss available coverage options for your large group.

Options for groups with 51 or more Eligible Employees
	PriorityHMOSM	PriorityPOSSM	PriorityPPOSM
Associated consumer engaged health care (CEH) product	PriorityHRASM PriorityHSASM HealthbyChoice IncentivesSM    View HBCI plan designs.	PriorityHRA PriorityHSA HealthbyChoice Incentives    View HBCI plan designs.	PriorityHRA PriorityHSA HealthbyChoice Incentives    View HBCI plan designs.
Base plans (all include a $10 office visit copay)	100% hospital services 90% hospital services 80% hospital services	100% preferred/80% alternate 100% preferred/70% alternate 100% preferred/50% alternate 90% preferred/70% alternate 80% preferred/60% alternate	Premier 100% in-network/80% out-of-network 100% in-network/70% out-of-network 90% in-network/70% out-of-network 80% in-network/60% out-of-network Basic 100% in-network/80% out-of-network 100% in-network/70% out-of-network 90% in-network/70% out-of-network 80% in-network/60% out-of-network
Deductibles (individual/family)	$100/$200 $250/$500 $500/$1,000 $750/$1,500 $1,000/$2,000 $2,000/$4,000 $3,000/$6,000	Preferred benefit level $100/$200 $250/$500 $500/$1,000 $750/$1,500 $1,000/$2,000 $2,000/$4,000 $3,000/$6,000 Alternate benefit level $250/$500 $500/$1,000 $1,000/$2,000 $2,000/$4,000 $2,500/$5,000 $3,500/$7,500	In-network $100/$200 $100/$300 $250/$500 $250/$750 $500/$1,000 $500/$1,500 $1,000/$2,000 $1,000/$3,000 $2,000/$4,000 $3,000/$6,000 $3,000/$9,000 Out-of-network $250/$500 $250/$750 $500/$1,000 $500/$1,500 $1,000/$2,000 $1,000/$3,000 $2,000/$4,000 $2,000/$6,000 $4,000/$8,000 $4,000/$12,000 $6,000/$12,000 $6,000/$18,000
Standard office visit/urgent care copay (Non-copay alignment)	$10/$20 (included in base plans) $15/$25 $20/$30 $25/$35 $30/$40	$10/$20 (included in base plans) $15/$25 $20/$30 $25/$35 $30/$40	$10/$30 (included in base plans) $15/$35 $20/$40 $30/$50
Copay alignment (primary/specialist/urgent care)	$10/$25/$40 $15/$30/$45 $20/$35/$50 $25/$40/$55 $30/$45/$60	$10/$25/$40 $15/$30/$45 $20/$35/$50 $25/$40/$55 $30/$45/$60	$10/$25/$40 $15/$30/$45 $20/$35/$50 $25/$40/$55 $30/$45/$60
ER copay	$75 $100 (required for copay alignment) $150	$75 $100 (required for copay alignment) $150	$75 $100 (required for copay alignment) $150
Ambulance copay	$100	$100	$100
Prescription drug copay	With contraceptives or mail-order 2X copay $10 $15 $20 $25 50% Percentage 25% copay w/$50 max per script 50% copay w/$50 max per script 25% copay w/$1,000 OOP max per member Generic/Brand $10/$20 $10/$25 $10/$30 $10/$40 $10/$50 $15/$25 $15/$30 $15/$50 Third Tier 50% third tier non-formulary $50 third tier non-formulary	With contraceptives or mail-order 2X copay $10 $15 $20 $25 50% Percentage 25% copay w/$50 max per script 50% copay w/$50 max per script 25% copay w/$1,000 OOP max per member Generic/Brand $10/$20 $10/$25 $10/$30 $10/$40 $10/$50 $15/$25 $15/$30 $15/$50 Third Tier 50% third tier non-formulary $50 third tier non-formulary	With contraceptives or mail-order 2X copay $10 $15 $20 $25 50% Percentage 25% copay w/$50 max per script 50% copay w/$50 max per script 25% copay w/$1,000 OOP max per member Generic/Brand $10/$20 $10/$25 $10/$30 $10/$40 $10/$50 $15/$25 $15/$30 $15/$50 Third Tier 50% third tier non-formulary $50 third tier non-formulary
Contraceptive medications	Include or exclude	Include or exclude	Include or exclude
Rx deductible	$100/$200 on prescription drugs $200/$400 on prescription drugs $100/$200 on brand prescription drugs $200/$400 on brand prescription drugs	$100/$200 on prescription drugs $200/$400 on prescription drugs $100/$200 on brand prescription drugs $200/$400 on brand prescription drugs	$100/$200 on prescription drugs $200/$400 on prescription drugs $100/$200 on brand prescription drugs $200/$400 on brand prescription drugs
Out-of-pocket (OOP) maximums	In-network benefit With HMO 90%: $1,500/$3,000 $2,000/$4,000 $2,500/$5,000 With HMO 80%: $2,000/$4,000 $2,500/$5,000	In-network benefit With 90%/70%: $1,500/$3,000 $2,000/$4,000 $2,500/$5,000 With 80%/60%: $2,000/$4,000 $2,500/$5,000 Out-of-network benefit All POS plans: $3,500/$7,000 $5,000/$5,000 $5,000/$10,000 With 100%/80%, 100%/70%, 90%/70%: $3,000/$6,000	In-network benefit With 90%/70% coverage: $1,000/$3,000 $1,500/$3,000 $1,500/$4,500 $2,000/$4,000 $2,000/$6,000 With 80%/60% coverage: $1,500/$4,500 $2,000/$4,000 $2,000/$6,000 Out-of-network benefit All PPO plans: $3,000/$9,000 $3,500/$7,000 $3,500/$10,500 With 100%/80%, 100%/70%, 90%/70%: $2,500/$7,500 $3,000/$6,000