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← Back to All Plans EPO, HSA-Compatible, with Dental – In-Network Only

2000 HSA EPO

Our highest-deductible EPO plan, HSA-eligible, and the only plan in the lineup with a built-in dental benefit.

Annual Deductible (Ind / Family)
$2,000 / $4,000
Out-of-Pocket Max (Ind / Family)
$8,500 / $17,000
Network
In-network only (except true emergencies)
BenefitWhat You Pay
Primary Care Visit$50 copay after deductible
Specialist Visit$75 copay after deductible
Urgent Care$100 copay after deductible
Telemedicine (MYMDNOW)$0 copay, unlimited visits
Emergency Room$1,000 copay after deductible
HSA ContributionPlan contributes $25/month; employer contribution amount is employer-determined
Dental Benefit$50 deductible, $1,000 annual maximum (100% preventive / 80% basic / 50% major)

Prescription Drug Benefits

Drug TierWhat You Pay
Rx Preventive / Maintenance$0 copay
Retail Generic Rx$0 copay
Preferred Brand Name DrugsNot covered (patient assistance programs may be available)
Non-Preferred Brand Name DrugsNot covered (patient assistance programs may be available)
Specialty DrugsNot covered (patient assistance programs may be available)
This is an in-network-only plan. Brand-name and specialty drugs are not covered on this plan; patient assistance programs may be available.

Want the Full Plan Details?

This page summarizes the key benefits only. For the complete Summary of Benefits, exclusions, and plan documentation, return to your plan overview page and schedule time with the benefits advisor affiliated with your association.

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