PPO High-Deductible 3500 (HSA* Compatible)
- A lower monthly premium with a higher yearly deductible, then 10% for most visits and services
- The ability to open a tax-advantaged Health Savings Account (HSA)
- The freedom to see any licensed health care professional for covered services
- The option to visit a health care professional in our network or outside of our network
| Benefits | Member’s Responsibility |
|---|---|
| Premiums | Lower |
| Annual deductible | $3,500 individual; $7,000 family |
| Coinsurance | 10% after deductible up to out-of-pocket maximum |
| Out-of-pocket maximum | $5,950 individual; $11,900 family |
| Office visit copay | 10% after deductible** |
| Prescription drug copay | 10% after deductible*** |
| Hospitalization | 10% after deductible** |
| Skilled nursing | 10% after deductible** |
| Physical/occupational therapy | 10% after deductible** |
| Home health care | 10% after deductible** |
- Plan Design Options
- Dental Plan Design Options
- Plan Brochure
- Rates (for effective dates before 06/30/2012)
- Rates (for effective dates after 07/01/2012)
- Disclosure Information
Step 1 Application
Once you’ve gotten a price quote on this website or by calling 1-800-217-2386, you must submit an online application form. You can apply right now on this secure website. (You cannot apply by phone.)
Application Checklist
You’ll need this information for each person on the application:- Date of birth
- Social Security Number
- Height/weight
- Current/past health insurance plans
- Medical history (diagnosis, treatment, dates of service, status)
- Prescription drug information (name, dose, date prescribed)
- Contact information for doctors (primary care and specialists)
Please complete the application form. If you skip any questions, the review process will stop until we can get the missing information.
With your application, please submit payment for your first month of coverage (this is the amount indicated in your price quote). Without payment, the review process will be delayed. When you apply online you can use a credit card.
Important note: We will charge your credit card or deposit your check ONLY if your application is approved.
Step 2 Confirmation & Approval
We review your completed application as soon as we get it. This review process is called “medical underwriting”. We may call you to clarify information you’ve provided. The review process takes about 5 to 15 days.
After your application has been processed, one of three things can happen. You may be:
- Approved at the quoted rate (known as the standard premium charge)
- Approved at a higher rate (based on your medical history)
- Declined coverage (based on your medical history)
You’ll be notified by mail about the decision. If approved, coverage will typically start on your chosen effective date.
Important note: Do not cancel your current health insurance until you have been notified of your approval for this new plan.
We will apply the payment you’ve submitted to your first monthly payment. For credit cards, any additional payment that is required (based on the underwriting process) will be charged to the card. If you paid by check, any additional amount will be show up in your next payment.
*Investment services are independently offered by the HSA administrator.
**For covered expenses.
***Integrated Medical/Rx Deductible.