HealthbyChoice Incentives HMO plans

Healthy employees are not only more productive, but they also cost less. HealthbyChoice Incentives rewards employees for being, getting and staying engaged in their health. With HealthbyChoice, employees receive the same great benefits, but have different out-of-pocket costs depending on how engaged they choose to be in their health.

Smart idea:

If you’re looking to improve employee health and incentivize healthy behavior, HealthbyChoice is a smart choice.

How it works

Purpose of plan: reward employees for being, getting, and staying healthy

Requirements to participate: health assessment and qualification form

  • Priority Health sets the participation requirements and administers the rewards program
  • The plan has two levels of benefits: Choice and Standard. Choice benefits offer lower cost sharing
  • All new employees begin at the Choice level of benefits
  • Employees that complete the requirements will keep the Choice level of benefits
  • Employees that don’t meet the requirements will receive the Standard level benefits
  • At the next enrollment date, employees’ benefit statuses carry over for the first 90 days of the new plan year. During this 90-day period, employees and their spouses (if applicable) have the opportunity to quality or re-qualify for the Choice level of benefits
  • The same medical benefits are covered regardless of the benefits level

Plan highlights

  • $10 Virtual care services covered before deductible
  • Diabetic coverage – Certain diabetic supplies purchased through a participating DME provider are covered at 100% before deductible and preferred insulins are covered at the Tier 1b prescription drug copay
  • Chiropractic care – Covers up to 30 acute and/or maintenance care visits per contract year
  • Standard copayments for the benefits needed most – Primary care, specialist, urgent care, labs, standard radiology, and prescription drugs are covered with a copayment before deductible
  • Cash rewards – Our Cost Estimator tool lets members shop for high-quality care at lower-cost facilities. Best of all, when members receive care at a fair-price facility, we’ll send them a Visa® reward card
  • Hearing exams and discounts on high-quality hearing aids – Offered by our partner, TruHearing. Learn more
  • Adult vision coverage, powered by EyeMed – $15 annual eye exam and in-network discounts on frames, standard plastic lenses, lens options, select contact lenses, laser vision correction, and non-prescription sunglasses. Learn more
  • Optional dental coverage – Two Delta Dental PPO/Premier plans to choose from, both include annual exams and cleanings. Learn more
  • No referral needed – Our plans don't require a referral to see a specialist

Plan notes

We want you to know exactly what you're looking at, so here are explanations of the notes used in the plan pricing information.

  • (E) "Embedded" means the plan contains an individual limit (stop) within the family total. The embedded stop occurs when an individual's deductible or out-of-pocket limit has been satisfied, but the family deductible or out of pocket limit hasn't.
  • (A) "Aggregate" means the total deductible or out-of-pocket limit does not contain an individual limit. An individual is covered when the family deductible or out-of-pocket limit has been met.
  • Deductibles and out-of-pocket limits are listed as individual/family amounts.
  • HealthbyChoice Incentives

    Choice 250 90%

    Deductible: $250/$500 E
    Coinsurance: 90%
    Out-of-pocket-limit: $5000/$10000 E
    Primary/specialist/urgent care: $15/$35/$75

    Standard 3500

    Deductible: $3500/$7000 E
    Coinsurance: 70%
    Out-of-pocket-limit: $8150/$16300 E
    Primary/specialist/urgent care: $35/$65/$85

  • HealthbyChoice Incentives

    HMO Choice 1000

    Deductible: $1000/$2000 E
    Coinsurance: 80%
    Out-of-pocket-limit: $7950/$15900 E
    Primary/specialist/urgent care: $20/$50/$85

    HMO Standard 4500

    Deductible: $4500/$9000 E
    Coinsurance: 70%
    Out-of-pocket-limit: $8150/$16300 E
    Primary/specialist/urgent care: $35/$65/$85

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