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HEALTHCARE PLAN DESIGNS AND COSTS

You are viewing plans for:

HSA Eligible

OPTION 1

Primary Only

Total Monthly Premium

$696.60

Individual Deductible
$5,000
Individual Out-of-Pocket Max
$6,650
Family Deductible
$10,000
Family Out-of-Pocket Max
$13,300
Office Visit
30% Coinsurance
Specialist Visit
30% Coinsurance

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HSA Eligible

OPTION 2

Primary Only

Total Monthly Premium

$738.87

Individual Deductible
$3,500
Individual Out-of-Pocket Max
$6,000
Family Deductible
$7,000
Family Out-of-Pocket Max
$12,000
Office Visit
20% Coinsurance
Specialist Visit
20% Coinsurance

View Formulary

OPTION 3

Primary Only

Total Monthly Premium

$842.65

Individual Deductible
$2,500
Individual Out-of-Pocket Max
$7,350
Family Deductible
$5,000
Family Out-of-Pocket Max
$14,700
Office Visit
$0 copay / visit
Specialist Visit
$60 copay / visit

View Formulary

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MetLife Dental

Primary Only

Total Monthly Premium

$33.02

Preventive
100%
Basic
80%
Major
50%
Annual Maximum (Per Person)
$1,500
Annual Deductible (Per Person)
$50
Annual Deductible (Family Maximum)
$150

MetLife TX-MT-LA

MetLife Non TX-MT-LA

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MetLife Vision

Primary Only

Total Monthly Premium

$6.18

Eye Exams
$10 Copay
Lenses Benefit (Single Vision)
$25 Copay
Frame Benefits
$130 Allowance

Summary of Benefits

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Your employer wants to support you in being your best at work and in your personal life by providing the Employee Assistance Program (EAP). This program is run by First Sun EAP. Because First Sun is a separate company from BlueChoice HealthPlan, First Sun will be responsible for all services related to the employee assistance program. First Sun services are free to you and your household members. They include:

  • Counseling Sessions – Three free face-to-face sessions for you and your family members per person per contract year for individual, couples and family counseling.
  • Life Management Services – Three free life management services are available for you and your family members per person per contract year.
    • Financial Counseling
    • Legal Services
    • Adult Care Resources
    • Child Care Resources
    • College Consultation Resources
    • Parenting/Adoption Resources

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