Plans and benefits for FY22
For FY22 (July 1, 2021 – June 30, 2022), our plans—Direct Care and Select Care—have different networks and levels of benefits to best fit your health care needs. To determine which plans works best for you, compare the two differences: network and benefits.
Network
| Direct Care | Select Care |
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List of network providers and hospitals »
Benefits and copayments
The chart below shows your copayments for some of the most commonly used benefits.
| Direct Care | Select Care | |||||
|
Medical deductible |
$400 Individual |
$500 Individual |
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|
Rx deductible |
$100 Individual |
$100 Individual |
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Out-of-pocket maximum |
$5,000/$10,000 |
$5,000/$10,000 |
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|
PCP wellness exams |
$0 per visit |
$0 per visit |
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|
Other PCP office visits |
$15 per visit |
$20 per visit |
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|
Telemedicine |
$15 per consult |
$15 per consult |
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|
Tele-Behavioral Health - Beacon Network Providers |
$0 per visit (visits 1-3); $15 per visit (visits 4 and after) |
$0 per visit (visits 1-3); $15 per visit (visits 4 and after) |
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|
Tele-Behavioral Health - Teladoc |
$15 copay |
$15 copay |
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|
Urgent care center/Retail clinic |
$15 per visit |
$20 per visit |
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|
Ob/Gyn visits |
Tier 1: |
Tier 2: |
Tier 3: |
Tier 1: |
Tier 2: |
Tier 3: |
|
Specialist visits |
Tier 1: |
Tier 2: |
Tier 3: |
Tier 1: |
Tier 2: |
Tier 3: |
|
Prescriptions |
Drug coverage provided by Express Scripts |
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|
$10/30/65 Retail |
$10/30/65 Retail |
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|
Routine eye exams |
$15 per visit |
$20 per visit |
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|
Outpatient mental health and substance abuse |
$15 per visit |
$20 per visit |
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|
Preventive services** |
Covered in full |
Covered in full |
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|
Diagnostic services*** |
Subject to deductible then covered in full |
Subject to deductible then covered in full |
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|
Imaging (CAT, PET, MRI scans) (max. of one copayment per day) |
$100 copayment (then subject to deductible) |
$100 copayment (then subject to deductible) |
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|
Chiropractic care |
$15 per visit |
$20 per visit |
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|
Emergency services |
$100 copayment (then subject to deductible) |
$100 copayment (then subject to deductible) |
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|
Inpatient hospital |
$275 copayment per admission |
Tier 1: |
Tier 2: |
Tier 3: |
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|
Copayment, then subject to deductible |
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Outpatient surgery |
|
|
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|
Non-hospital setting |
$150 copayment then subject to deductible |
$150 copayment then subject to deductible |
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|
Hospital setting |
$250 copayment then subject to deductible |
$250 copayment then subject to deductible |
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|
Outpatient surgery |
$250 copayment then subject to deductible |
$250 copayment then subject to deductible |
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Healthy extras
With either Direct Care or Select Care, you'll get:
- It Fits!, one of the most flexible fitness reimbursements in the state
- Direct Care members - $400/family, $200/individual
- Select Care members - $100/family, $100/individual - Eyewear discounts – save up to 35% on frames and get additional discounts on contact lenses, laser vision correction and nonprescription sunglasses
- Quit to Win – smokers have access to this free counseling program with tobacco cessation experts who will work with you by telephone
- And other healthy extras that you won't find with any other plan
Learn more about healthy extras
Additional information about our health plan benefits and policies
Find out about our Case Management, Disease Management, Behavioral Health, and more.
Download information about your benefits and policies (pdf)
** Preventive services are tests, immunizations and services geared to help screen for diseases and improve early detection when symptoms or diagnosis are not present.
*** Diagnostic services are tests, immunizations and services that are intended to diagnose, check the status of, or treat a disease or condition.
