Medical

We offer health plans to fit varying needs for different stages of life. For more information, please review the Summary of Benefits and Coverage provided or Plan Documents

The table below summarizes the key features of the medical coverage. The deductibles, copays, and coinsurance percentages in the following chart indicate the amounts you are responsible for.

In Network*
Benefit Highlights
Allied Base Copay Plan
Allied Buy Up Plan
Allied HDHP (HSA) Plan
Allied Low Cost (ACP) Plan
Type of Plan
EPO (In Network Only)
PPO
EPO (In Network Only)
Indemnity / Reference Based Pricing subject to Balance Billing
Name of Provider Network
Aetna Signature Administrators (EPO)
+USRx (pharmacy benefit manager)
Aetna Signature Administrators (PPO)
+USRx (pharmacy benefit manager)
Aetna Signature Administrators (EPO)
+USRx (pharmacy benefit manager)
*No provider network.
You may receive covered services from any provider – however, the Plan pays using the Maximum Allowable Amount. You may owe balance bills. Uses Caremark Rx.

Deductible (Individual/Family)

$3,000/$6,000
$1,500/$3,000
$6,000/$12,000
$2,000/$4,000

Deductible Explained

Embedded
(Per Person) Plan Year Deductible
Embedded
(Per Person) Plan Year Deductible
Embedded
(Per Person) Plan Year Deductible
Embedded (Per Person) Plan Year Deductible
Co-Insurance (Cost Share You Pay After Deductible)
50%
0%
0%
0% - 10%
(Note: The plan pays at a Maximum Allowable Charge (MAC); your provider may bill above MAC.
Out of Pocket Max/Year
Allied
Base Copay Plan
Allied Buy Up Plan
Allied HDHP (HSA) Plan
Allied Low Cost (ACP) Plan

Individual/Family

$5,000/$10,000
$4,000/$8,000
$6,400/$12,800

$6,450/$12,900

+ balance bills to providers

Office Visit
Primary
Specialist
$30
$60
$30
$30
0% after ded.
0% after ded.
0%
0%

Preventative

$0
$0
$0
$0

X-Ray & Lab

Doctors Office

MRI, CT, PET, etc.

N/C
50% after ded.
N/C
$500
0% after ded.
0% after ded.
0%
0%
10% after ded. for Outpatient Lab
Urgent Care
$100
$100
100% after ded.
10% after ded.
Acute/Sick Care via Teledoc®
No charge 24/7
No charge 24/7
No charge 24/7
No charge 24/7
Rx Deductible
Individual/Family
N/A
N/A
Included in deductible above
Included in deductible above
Rx Cost by Tier
1/2/3/4/Specialty
$15/50/100/350
$15/35/75/250
$15/35/75/250 after ded.
10% after ded.
(Specialty drugs are NOT covered)
Emergency Room
$300 + 50% after ded.
$300
0% after ded.
10% after ded.
Hospital
Inpatient
Out Patient
50% after ded.
50% after ded.
0% after ded.
0% after ded.
0% after ded.
0% after ded.
10% after ded.
10% after ded.

Important: If the Low Cost (ACP) health plan is not affordable, we will subsidize you cost to ensure you are made an affordable health plan coverage offer.

Healthplan Features

Base Copay Plan:

This is the lowest cost traditional health plan giving you first dollar (copay) coverage for day-to-day care such as doctor’s visits, urgent care and prescriptions, and emergency room visits. It provides free acute/sick visits via Teladoc®.

Features and Registration:

  • Free Teladoc® Telemedicine benefits are a great way to access free acute care 24/7 and can save you time and money.
  • In-network-only coverage. Life or limb-threatening emergencies are covered as in-network.
  • Use pharmacy resources with USRx and ScriptSourcing to keep your pharmacy costs down.
Register

Buy Up Plan:

This plan offers the lowest out-of-pocket limit giving you first-dollar (copay) coverage for day-to-day care such as doctor’s visits, urgent care, and prescriptions, and provides free acute/sick visits via Teladoc.

  • Free Teladoc® Telemedicine benefits are a great way to access free acute care 24/7 and can save you time and money.
  • Use pharmacy resources with USRx and ScriptSourcing to keep your pharmacy costs down
Register

HDHP (HSA) Plan:

This plan allows you to use establish a pre-tax Health Savings Account (HSA).

  • Free Teladoc® Telemedicine benefits are a great way to access free acute care 24/7 and can save you time and money.
  • In-network-only coverage. Life or limb-threatening emergencies are covered as in-network.
  • Use pharmacy resources with USRx and ScriptSourcing to keep your pharmacy costs down.
Register

Low Cost (ACP) Plan:

  • This Plan does not contain a network of Hospitals or Physicians.
  • The Plan’s liability for any covered service will be limited to the Maximum Allowable Amount.
  • The Plan will communicate with the provider(s) regarding the Maximum Allowable Amount; however, the provider(s) has the right to not accept the amount determined by the Plan as payment in full and may bill the member for the difference (called ‘balance billing’). If you are balance billed, contact Zelis Member Advocacy Team at 877-259-3194 for possible assistance within 90 days of the date of the claim.
  • Free Teladoc® Telemedicine benefits are a great way to access free acute care 24/7 and can save you time and money.
  • Our Option 5 Low-Cost health plan rate is calculated to be affordable to you.
Register

Health Plan Tips

Follow these tips to get the most from your health benefit plans.

  • All of our health deductibles and out-of-pockets reset as of December 1.
  • Access free preventative benefits – see www.healthcare.gov/coverage/preventive-care-benefits/.
  • Register with your health plan at https://www.alliedbenefit.com/ to access key information. Use group number: A23210.
  • Use Allied’s Teladoc® Telemedicine for free from anywhere 24/7/365.
  • Be proactive and informed about your health.
  • Make healthy choices (regular exercise, rest, nutrition, Etc.).
  • Utilize plan resources and discounts (login to your health plan to learn more).
  • Get the right care from the right place to access the lowest cost / highest quality providers.
  • Allied copay and HSA health plan options use the Aetna Signature Administrators PPO network. The Low Cost (ACP) health plan allows you to access care from any provider but you can be balanced billed. Pick good providers who can help you get well quicker and better. And, for our Allied copay and HSA health plan options pick a good network provider.
  • See ‘Prescription Tips’ for tips about our pharmacy benefits. Remember, Allied copay and HSA Health use USRx as our Pharmacy Benefit Manager whereas the Allied Low Cost (ACP) health plan uses Caremark as our Pharmacy Benefit Manager.
  • Make sure your claims are filed timely – most plans require the claim to be filed in whole within 90 days of the date the service was provided. If a claim is not filed timely, you may be responsible for all charges.
  • Our Allied copay and HSA health plans include a low-cost pharmacy locator. And, these plans also offer financial support for high-cost prescriptions
  • Our plans comply with the Patient Protection and Affordable Care Act requirements but may not comply with certain state mandates.

Important: If the Low Cost (ACP) health plan is not affordable, we will subsidize your cost to ensure you are made an affordable health plan coverage offer.

See plan details and SBCs provided for more information.

Dive deeper: Why Consider a HDHP?

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