Summaries of Benefits for large group plans — 2017
EPO plans
- EPO $20 $40 $250
- EPO $20/$40 $1,500/80%
- EPO $30 $50 $1500 Ded 70% Coins
- EPO $30 $50 $2500 Ded 80% Coins $100 ER
- EPO $30 $50 $2500 Ded 80% Coins 80% ER
- EPO $30 $50 $500
- EPO $30 50% $2500 Ded 50% Coins
- EPO $50/$75 $2,500/50%
- EPO $2,000/100%
- EPO HSA $1300 Ded 50% Coins w INT $7 50% $125 max RX
- EPO HSA $1300 Ded 80% Coins w INT $7 50% $125 max RX
- EPO HSA $1300 Ded 50% Coins w INT $10 $40 $60 RX
- EPO HSA $1300 Ded 80% Coins w INT $10 $40 $60 RX
- EPO HSA $1500 Ded 70% Coins w INT $10 $40 $60 RX
- EPO HSA $1500 Ded 70% Coins w INT $7 50% $125 max RX
- EPO HSA $2,500/100% w/ $25/$50/$75 Int RX
EPO Advantage plans
- AmeriHealth Advantage $15/$25
- AmeriHealth Advantage High Option $1000 Ded
- AmeriHealth Advantage Medium Option $2000 Ded
- AmeriHealth Advantage Low Option $2500 Ded
- AmeriHealth Advantage Economy Option $2500 Ded
- AmeriHealth Advantage Economy HSA Option
- Tier 1 Advantage High Option $1500 Ded
- Tier 1 Advantage Low Option $2500 Ded
- Tier 1 Advantage Low HSA Option
HMO plans
- HMO $15 $30 $0 Day
- HMO $20 $40 $0 Day
- HMO $20 $40 $1000 Ded 80% Coins Option 1
- HMO $20 $40 $300 Day
- HMO $25 $50 $1000 Ded 80% Coins Option 2
- HMO $30 $50 $0 Day
- HMO $30 $50 $1500 Ded 70% Coins Option 3
- HMO $30 $50 $400 Day
- HMO Public Sector $2
- HMO Select $10
- HMO Select $20
- HMO Select $30
HMO Plus plans
- HMO Plus $20 $40 $1000 Ded 80% Coins Option 1
- HMO Plus $20 $40 $300 Day
- HMO Plus $25 $50 $1000 Ded 80% Coins Option 2
- HMO Plus $30 $50 $1500 Ded 70% Coins Option 3
- HMO Plus $30 $50 $400 Day
POS plans
- POS $15 $30 $0 Day
- POS $15 $30 $200 Day
- POS $20 $40 $0 Day
- POS $20 $40 $1000 Ded 90% Coins
- POS $20 $40 $300 Day
- POS $30 $50 $1500 Ded 80% Coins
- POS $30 $50 $2000 Ded 70% Coins
- POS $30 $50 $400 Day
- POS Premium Select $15 H
- POS Premium Select $30 E
- POS Public Sector $5
- POS Select $20 H
POS Plus plans
- POS Plus $10 $20 $0 Day
- POS Plus $15 $30 $0 Day
- POS Plus $15 $30 $200 Day
- POS Plus $20 $40 $0 Day
- POS Plus $20 $40 $1000 Ded 90% Coins
- POS Plus $20 $40 $250 Day
- POS Plus $30 $40 $300 Day
- POS Plus $30 $50 $1500 Ded 80% Coins
- POS Plus $30 $50 $2000 Ded 70% Coins
- POS Plus $40 $50 $300 Day
PPO plans
- PPO $10
- PPO $10 $20
- PPO $15
- PPO $15 $25
- PPO $20
- PPO $20 $20 $300 Ded 90% Coins
- PPO $20 $30
- PPO $5
- PPO HDHP $2500 Ded 70% Coins
- PPO HSA $1,300 Ded 80% Coins w INT RX $10 $40 $60
- PPO HSA $1,300 Ded 100% Coins w INT RX $10 $40 $60
- PPO HSA $2000 Ded 90% Coins w INT RX $7 $35 $50
- PPO HSA $2500 Ded 70% Coins w INT RX $7 $35 $50
- PPO Public Sector $10
Vision
- Vision Care 100: 12/12/12*
- Vision Care 100: 12/12/24*
- Vision Care 100: 24/24/24
- Vision Care 100: 12/12/12 $25 Copay — Voluntary
- Vision Care 130: 12/12/12*
- Vision Care 130: 12/12/24*
- Vision Care 130: 12/12/24 $25 Copay*
- Vision Care 150: 12/12/12*
- Vision Care 150: 12/12/24 — Voluntary
- $35 Vision Program
Benefits Available Every Two Calendar Years
- $100 Vision Program
Benefits Available Once Every Calendar Year
- $100 Vision Program
Benefits Available Every Two Calendar Years
- $200 Vision Program
Benefits Available Once Every Calendar Year
- $200 Vision Program
Benefits Available Every Two Calendar Years
- $35 Corrective Eyewear
Benefits Available Every Two Calendar Years
- $100 Corrective Eyewear
Benefits Available Every Two Calendar Years
Prescription benefits at a glance
- Standard Prescription Drug Program $7/50%
- Standard Prescription Drug Program 50%/50%
- Select Drug Program $7/$35/$50
- Select Drug Program $10/$40/$60
- Select Drug Program $15/$35/$50
*Voluntary option available.