Start with the network.
Confirm the doctors, specialists, hospitals and facilities that matter to you are available in the plan network.
EMPLOVA BENEFITS
Medical Plans
UNDERSTANDING YOUR MEDICAL COVERAGE
Choose with the whole picture in view.
Start with the doctors and facilities you want to use, then balance everyday copays with the protection provided by the deductible and maximum out-of-pocket amount.
11medical plan designs
Compare everyday costs.
Look at office visits, prescriptions, urgent care and the services you expect to use most often.
Understand your protection.
Review the deductible, coinsurance and maximum out-of-pocket amount for a higher-cost year.
MEDICAL PLAN DESIGNS
Every medical plan. One clear view.
Compare copays, deductibles, out-of-pocket limits and network coverage across all 11 Emplova medical options.
Benefit names
In-Network Only Plans
HSA Plans
In & Out of Network Plans
BenefitAll amounts shown per plan
EPOValue EPO
EPOBasic EPO
EPOComprehensive EPO
HSA · EPOHSA EPO 5000
HSA · PPOHSA PPO 3000
PPOFocus PPO
PPOEssential PPO
PPOSelect PPO
PPOEnhanced PPO
PPOPremier PPO
PPOExclusive PPO
In-Network plan highlights
Primary care visit
$30
$30
$25
D
D
$30
$30
$25
$20
$20
$20
Specialist visit
$50
$50
$50
D
D
$50
$50
$40
$40
$30
$20
DeductibleFamily is 2×
$2,500
$500
None
$5,000
$3,000
$3,000
$2,000
$1,000
None
None
None
Maximum out-of-pocketFamily is 2×
$6,350
$4,000
$4,000
$6,350
$3,500
$6,000
$4,000
$5,000
$4,000
$4,000
$2,500
Coinsurance
20%
10%
None
None
None
20%
20%
10%
None
None
None
Inpatient hospital
D&C
D&C
$500
D
D
D&C
D&C
D&C + $500
$500
$500
$500
Outpatient hospital
D&C
D&C
$250
D
D
D&C
D&C
D&C + $250
$250
$250
$250
Urgent care
$75
$50
$50
D
D
$75
$75
$75
$40
$30
$20
Emergency room visit
$300
$200
$100
D
D
C
$300
$300
$100
$100
$100
Prescription drugs
$10 / $35 / $75
$10 / $30 / $50
$10 / $30 / $50
$15 / $35 / $75 (AD)
$10 / $30 / $50 (AD)
$15 / $35 / $75
$15 / $35 / $75
$15 / $35 / $75
$10 / $30 / $50
$10 / $30 / $50
$10 / $30 / $50
Out-of-Network plan highlights
DeductibleFamily is 2×
N/A
N/A
N/A
N/A
$3,000
$6,000
$5,000
$3,000
$1,000
$500
$300
Maximum out-of-pocketFamily is 2×
N/A
N/A
N/A
N/A
$4,500
$12,000
$8,000
$10,000
$5,000
$4,000
$2,500
Coinsurance
N/A
N/A
N/A
N/A
30%
40%
40%
30%
30%
30%
20%
Reimbursement table
N/A
N/A
N/A
N/A
80th % UCR
150% Mdcr
150% Mdcr
150% Mdcr
80th % UCR
80th % UCR
90th % UCR
Value EPO
In-network
- Primary care visit
- $30
- Specialist visit
- $50
- DeductibleFamily is 2×
- $2,500
- Maximum out-of-pocketFamily is 2×
- $6,350
- Coinsurance
- 20%
- Inpatient hospital
- D&C
- Outpatient hospital
- D&C
- Urgent care
- $75
- Emergency room visit
- $300
- Prescription drugs
- $10 / $35 / $75
Out-of-network
No out-of-network coverage
Basic EPO
In-network
- Primary care visit
- $30
- Specialist visit
- $50
- DeductibleFamily is 2×
- $500
- Maximum out-of-pocketFamily is 2×
- $4,000
- Coinsurance
- 10%
- Inpatient hospital
- D&C
- Outpatient hospital
- D&C
- Urgent care
- $50
- Emergency room visit
- $200
- Prescription drugs
- $10 / $30 / $50
Out-of-network
No out-of-network coverage
Comprehensive EPO
In-network
- Primary care visit
- $25
- Specialist visit
- $50
- DeductibleFamily is 2×
- None
- Maximum out-of-pocketFamily is 2×
- $4,000
- Coinsurance
- None
- Inpatient hospital
- $500
- Outpatient hospital
- $250
- Urgent care
- $50
- Emergency room visit
- $100
- Prescription drugs
- $10 / $30 / $50
Out-of-network
No out-of-network coverage
HSA EPO 5000
In-network
- Primary care visit
- D
- Specialist visit
- D
- DeductibleFamily is 2×
- $5,000
- Maximum out-of-pocketFamily is 2×
- $6,350
- Coinsurance
- None
- Inpatient hospital
- D
- Outpatient hospital
- D
- Urgent care
- D
- Emergency room visit
- D
- Prescription drugs
- $15 / $35 / $75 (AD)
Out-of-network
No out-of-network coverage
HSA PPO 3000
In-network
- Primary care visit
- D
- Specialist visit
- D
- DeductibleFamily is 2×
- $3,000
- Maximum out-of-pocketFamily is 2×
- $3,500
- Coinsurance
- None
- Inpatient hospital
- D
- Outpatient hospital
- D
- Urgent care
- D
- Emergency room visit
- D
- Prescription drugs
- $10 / $30 / $50 (AD)
Out-of-network
- DeductibleFamily is 2×
- $3,000
- Maximum out-of-pocketFamily is 2×
- $4,500
- Coinsurance
- 30%
- Reimbursement table
- 80th % UCR
Focus PPO
In-network
- Primary care visit
- $30
- Specialist visit
- $50
- DeductibleFamily is 2×
- $3,000
- Maximum out-of-pocketFamily is 2×
- $6,000
- Coinsurance
- 20%
- Inpatient hospital
- D&C
- Outpatient hospital
- D&C
- Urgent care
- $75
- Emergency room visit
- C
- Prescription drugs
- $15 / $35 / $75
Out-of-network
- DeductibleFamily is 2×
- $6,000
- Maximum out-of-pocketFamily is 2×
- $12,000
- Coinsurance
- 40%
- Reimbursement table
- 150% Mdcr
Essential PPO
In-network
- Primary care visit
- $30
- Specialist visit
- $50
- DeductibleFamily is 2×
- $2,000
- Maximum out-of-pocketFamily is 2×
- $4,000
- Coinsurance
- 20%
- Inpatient hospital
- D&C
- Outpatient hospital
- D&C
- Urgent care
- $75
- Emergency room visit
- $300
- Prescription drugs
- $15 / $35 / $75
Out-of-network
- DeductibleFamily is 2×
- $5,000
- Maximum out-of-pocketFamily is 2×
- $8,000
- Coinsurance
- 40%
- Reimbursement table
- 150% Mdcr
Select PPO
In-network
- Primary care visit
- $25
- Specialist visit
- $40
- DeductibleFamily is 2×
- $1,000
- Maximum out-of-pocketFamily is 2×
- $5,000
- Coinsurance
- 10%
- Inpatient hospital
- D&C + $500
- Outpatient hospital
- D&C + $250
- Urgent care
- $75
- Emergency room visit
- $300
- Prescription drugs
- $15 / $35 / $75
Out-of-network
- DeductibleFamily is 2×
- $3,000
- Maximum out-of-pocketFamily is 2×
- $10,000
- Coinsurance
- 30%
- Reimbursement table
- 150% Mdcr
Enhanced PPO
In-network
- Primary care visit
- $20
- Specialist visit
- $40
- DeductibleFamily is 2×
- None
- Maximum out-of-pocketFamily is 2×
- $4,000
- Coinsurance
- None
- Inpatient hospital
- $500
- Outpatient hospital
- $250
- Urgent care
- $40
- Emergency room visit
- $100
- Prescription drugs
- $10 / $30 / $50
Out-of-network
- DeductibleFamily is 2×
- $1,000
- Maximum out-of-pocketFamily is 2×
- $5,000
- Coinsurance
- 30%
- Reimbursement table
- 80th % UCR
Premier PPO
In-network
- Primary care visit
- $20
- Specialist visit
- $30
- DeductibleFamily is 2×
- None
- Maximum out-of-pocketFamily is 2×
- $4,000
- Coinsurance
- None
- Inpatient hospital
- $500
- Outpatient hospital
- $250
- Urgent care
- $30
- Emergency room visit
- $100
- Prescription drugs
- $10 / $30 / $50
Out-of-network
- DeductibleFamily is 2×
- $500
- Maximum out-of-pocketFamily is 2×
- $4,000
- Coinsurance
- 30%
- Reimbursement table
- 80th % UCR
Exclusive PPO
In-network
- Primary care visit
- $20
- Specialist visit
- $20
- DeductibleFamily is 2×
- None
- Maximum out-of-pocketFamily is 2×
- $2,500
- Coinsurance
- None
- Inpatient hospital
- $500
- Outpatient hospital
- $250
- Urgent care
- $20
- Emergency room visit
- $100
- Prescription drugs
- $10 / $30 / $50
Out-of-network
- DeductibleFamily is 2×
- $300
- Maximum out-of-pocketFamily is 2×
- $2,500
- Coinsurance
- 20%
- Reimbursement table
- 90th % UCR
Table key
- D
- The deductible applies before the plan begins paying for the service.
- C
- Coinsurance applies to the service.
- D&C
- The deductible and coinsurance apply.
- AD
- The listed benefit applies after the deductible.
- OON
- Out-of-network. Costs and reimbursement may differ from in-network care.
- UCR
- Usual, customary and reasonable reimbursement methodology.
- Mdcr
- Reimbursement shown as a percentage of the Medicare rate.