Please let us know who you intend to cover

Note: embedded family deductible assumes two people contributed to claims.
Please select desired coverage level from the menu.
  • - select a option -
  • Employee Only
  • Employee + Child
  • Employee + Spouse
  • Employee + Family

Plan A

Plan B

Plan C

Monthly Premium
$0
$0
$0

Prescription Drug Costs

Note: you should enter actual costs and copay amount to compare
Prescription Costs
Prescription Copayments

Doctor's Office and Emergency Visits

Examples: primary care, specialists, urgent care, therapy and chiropractors.
Actual Office, UC, ER, other costs (allowable charge)
Office, UC, ER, other Copayments

In-Patient / Out-Patient and Other Services

Please enter all other costs subject to deductible and coinsurance:
All other expenses subject to Deductible and Coinsurance
$0
$0

Summary

Plan A

Plan B

Plan C

Deductible
$0
$0
$0
Coinsurance Maximum
$0
$0
$0
Out of Pocket Maximum
$0
$0
$0
Total expenses subject to Deductible and Coinsurance
$0
$0
$0
Deductible
$0
$0
$0
$0.00
$0.00
$0.00
Balance after Deductible
$0
$0
$0
Coinsurance (your share)
0%
0%
0%
Actual Coinsurance
$0
$0
$0
Coinsurance Maximum
$0
$0
$0
Copay Cost

NA

$0
$0
Deductible Cost
$0
$0
$0
Coinsurance Cost
$0
$0
$0
Total Out-of-Pocket Cost
$0
$0
$0
$0
$0
$0
Annual Premium
$0
$0
$0
Total Plan Cost (employee)
$0
$0
$0
You are under no obligation to choose the least expensive plan as illustrated above. Be sure to choose the plan that you feel will best meet your needs. You must finalize your 2019 enrollment elections in Ultipro no later than November 8th (5:00pm).

Please let us know who you intend to cover

Note: embedded family deductible assumes two people contributed to claims.
Please select desired coverage level from the menu.
  • - select a option -
  • Employee Only
  • Employee + Child
  • Employee + Spouse
  • Employee + Family

Plan A

Plan B

Plan C

Monthly Premium
$0
$0
$0

Prescription Drug Costs

Note: you should enter actual costs and copay amount to compare
Prescription Costs
Prescription Copayments

Doctor's Office and Emergency Visits

Examples: primary care, specialists, urgent care, therapy and chiropractors.
Actual Office, UC, ER, other costs (allowable charge)
Office, UC, ER, other Copayments

In-Patient / Out-Patient and Other Services

Please enter all other costs subject to deductible and coinsurance:
All other expenses subject to Deductible and Coinsurance
$0
$0

Summary

Plan A

Plan B

Plan C

Deductible
$0
$0
$0
Coinsurance Maximum
$0
$0
$0
Out of Pocket Maximum
$0
$0
$0
Total expenses subject to Deductible and Coinsurance
$0
$0
$0
Deductible
$0
$0
$0
$0.00
$0.00
$0.00
Balance after Deductible
$0
$0
$0
Coinsurance (your share)
0%
0%
0%
Actual Coinsurance
$0
$0
$0
Coinsurance Maximum
$0
$0
$0
Copay Cost

NA

$0
$0
Deductible Cost
$0
$0
$0
Coinsurance Cost
$0
$0
$0
Total Out-of-Pocket Cost
$0
$0
$0
$0
$0
$0
Annual Premium
$0
$0
$0
Total Plan Cost (employee)
$0
$0
$0
You are under no obligation to choose the least expensive plan as illustrated above. Be sure to choose the plan that you feel will best meet your needs. You must finalize your 2019 enrollment elections in Ultipro no later than November 8th (5:00pm).