Meriter Choice Reward Plan

Tiered Copay $25/$50, $500/$1,000D (surgery & services only)

Tiered Copay $35/$70, $500/$1,000D (surgery & services only)

HMO

Copay $35, $500/$1,000D (surgery & services only)

HealthShare

$1,000/$2,000D, 20% coinsurance

$2,000/$4,000D, 20% coinsurance

$5,000/$10,000D, 20% coinsurance

HealthShare Complete

$500/$1,000D, 20% coinsurance, $35 office visit copay

$1,000/$2,000D, 20% coinsurance, $35 office visit copay

High-Deductible Health Plans (HSA-Compatible) *

* If you purchase prescription drug or maternity coverage along with a High-Deductible Health Plan, please consult your accountant or financial institution to verify that your plan will meet Federal Tax Guidelines for Health Savings Accounts.

Single Plan $1,250D, 20% coinsurance

Family Plan $2,500D, 20% coinsurance

Single Plan $5,000D

Family Plan $10,000D

Riders

Prescription Drug

• $10 Generic Rx: The member pays a $10 copay for prescribed generics on the Physicians Plus drug formulary; P+ covers the balance. The member pays 100% for all other prescriptions.



• $10/30%/50%: The member pays a $10 copay for Physicians Plus formulary generics, 30% of total cost for brand name formulary medications and 50% of total cost for drugs not on the formulary.



• $10 Generic Rx/$50 Reverse Copay: The member pays a $10 copay for formulary generics; P+ pays up to $50 for brand name formulary prescriptions, the member pays the balance.

Maternity

• The member pays a $1,000 deductible, then the member pays 20% coinsurance; there is no maximum out of pocket.
• There is a 10-month waiting period before the benefit eligibility begins.
• If the benefit is not added when you enroll, it cannot be added at a later date unless a new application is submitted for underwriting review.

Behavioral Health & AODA

• Behavioral Health (BH) and Alcohol and Other Drug Abuse (AODA) services are covered according to policy copays, deductibles, coinsurance and maximums.