Medical Benefits
In-Network |
Out-of-Network |
|
|---|---|---|
Deductible |
$2,000/$4,000 |
$4,000/$8,000 |
Member Coinsurance |
20% |
50% |
Out-of-Pocket Max |
$5,000/$10,000 |
$12,000/$20,000 |
Primary Care Visit |
$35 Copay |
Deductible + 50% |
Routine Preventive |
Covered at 100% |
Deductible + 50% |
Specialist Visit |
$60 Copay |
Deductible + 50% |
Inpatient Hospitalization |
Deductible + 20% |
Deductible + 50% |
Office Visits |
Deductible + 20% |
Deductible + 50% |
Outpatient Surgery |
Deductible + 20% |
Deductible + 50% |
Outpatient Diagnostics |
Deductible + 20% |
Deductible + 50% |
Urgent Care |
$75 Copay |
Deductible + 50% |
Emergency Room |
$200 Copay + Deductible |
$200 Copay + Deductible |
Prescription Drugs |
|
|---|---|
Generic |
$15 Copay |
Preferred |
$70 Copay |
Non-Preferred |
$90 Copay |
Mail Order Drugs |
2.5 x Retail |
Full-Time |
Non-Tobacco |
Tobacco |
|---|---|---|
Employee Only |
$92.40 |
$117.40 |
Employee + Spouse |
$185.85 |
$210.85 |
Employee + Child(ren) |
$164.85 |
$189.85 |
Employee + Family |
$278.25 |
$303.25 |
Part-Time |
Non-Tobacco |
Tobacco |
|---|---|---|
Employee Only |
$135.45 |
$160.45 |
Employee + Spouse |
$277.20 |
$302.20 |
Employee + Child(ren) |
$250.95 |
$275.95 |
Employee + Family |
$394.80 |
$419.80 |
In-Network |
Out-of-Network |
|
|---|---|---|
Deductible |
$1,000/$2,000 |
$2,000/$4,000 |
Member Coinsurance |
20% |
40% |
Out-of-Pocket Max |
$3,000/$5,000 |
$5,000/$10,000 |
Primary Care Visit |
$25 Copay |
Deductible + 40% |
Routine Preventive |
Covered at 100% |
Deductible + 40% |
Specialist |
$50 Copay |
Deductible + 40% |
Inpatient Hospitalization |
Deductible + 20% |
Deductible + 40% |
Office Visits |
Deductible + 20% |
Deductible + 40% |
Outpatient Surgery |
Deductible + 20% |
Deductible + 40% |
Outpatient Diagnostics |
Deductible + 20% |
Deductible + 40% |
Urgent Care |
$75 Copay |
Deductible + 40% |
Emergency Room |
$200 Copay + Deductible |
$200 Copay + Deductible |
Prescription Drugs |
|
|---|---|
Generic |
$15 Copay |
Preferred |
$70 Copay |
Non-Preferred |
$90 Copay |
Mail Order Drugs |
2.5 x Retail |
Full-Time |
Non-Tobacco |
Tobacco |
|---|---|---|
Employee Only |
$123.90 |
$148.90 |
Employee + Spouse |
$257.25 |
$282.25 |
Employee + Child(ren) |
$231.00 |
$256.00 |
Employee + Family |
$366.45 |
$391.45 |
Part-Time |
Non-Tobacco |
Tobacco |
|---|---|---|
Employee Only |
$157.08 |
$182.08 |
Employee + Spouse |
$324.56 |
$349.56 |
Employee + Spouse |
$292.22 |
$317.22 |
Employee + Family |
$460.85 |
$485.85 |
Member Advantage Plan (MAP)
Imagine 100% Coverage…
The MAP offers employees who have access to alternate group medical and prescription drug coverage (usually through your spouse) 100% coverage. You will be reimbursed for ALL eligible co-pays, co-insurance and deductibles incurred through your alternate medical plan up to the maximum out of pocket limits under the Affordable Care Act ($8,550/single and $17,100/family per year).
This benefit is provided at no cost to the employee.
Eligibility
Current employees as of December 31, 2023: Must be enrolled in the Visiting Nurse Association (VNA) Medical Plan
New employees: Must satisfy the eligibility waiting period and be covered on a spouse’s employer sponsored plan
Not Eligible
• Spouses with current coverage available through an employer plan
• Spouses who become eligible for coverage through an employer plan
Opportunities for Enrollment
• VNA open enrollment
• Qualifying event: marriage, spouses change in employment status, birth of child, part time to full time, etc.
• Spouses open enrollment
• New employee
IRS Rules
You may be enrolled in an HRA or FSA. You CAN NOT be reimbursed from both the MAP and your HRA or FSA. Employees are NOT eligible for the MAP if their Alternate Coverage is:
• High Deductible Health Plan (HDHP) with active contributions to a Health Savings Account (HSA),
• Medicare, Tricare or Medicaid
• Healthcare Exchange Policy made available thru the Affordable Care Act
• Individual policy
• Limited Benefit Health Plan
If you have questions about the MAP benefit, please contact Human Resources or contact Catalize Health at (877) 872-4232.
HealthJoy Makes Using Your Benefits Simple!
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The Experts are In
Don’t try and navigate your benefits alone. HealthJoy’s healthcare concierge and online doctors are available LIVE. You can get a personalized recommendation for a local doctor, consult with a medical provider in the middle of the night, or have an expert review and negotiate your confusing medical bills.