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Customer Service
Resources
Frequently Asked QuestionsMedical Benefits
Your employer offers medical insurance to protect the health of you and your family. It covers medical expenses such as visits to the doctor’s office, emergency care, and prescription drugs. It’s important to
have a medical plan that meets your needs and the needs of your family.
Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility. To find an in-network doctor, please visit https://members.healthgram.com.
Open Access Network |
In-Network |
In-Network |
|---|---|---|
Deductible |
$2,000 / $4,000 |
$3,300 / $6,600 |
Out-of-Pocket Max |
$4,000 / $8,000 |
$8,000 / $16,000 |
Coinsurance (plan/member) |
80% |
50% |
Physician Visits |
||
Primary Care Visit |
$25 Copay |
50% after Deductible |
Preventive Care |
No Charge |
50% after Deductible |
Specialist Visit |
$50 Copay |
50% after Deductible |
Telehealth |
$0 Copay |
50% after Deductible |
Hospital Services |
||
Physician Services |
20% after Deductible |
50% after Deductible |
Inpatient Hospitalization |
20% after Deductible |
50% after Deductible |
Outpatient Surgery |
20% after Deductible |
50% after Deductible |
Urgent Care |
$60 Copay |
50% after Deductible |
Emergency Room |
$150 Copay, then Deductible and Coinsurance |
$150 Copay, then Deductible and Coinsurance |
Prescription Drugs |
In-Network |
In-Network |
|---|---|---|
Rx Deductible (Employee/Family) |
$500 / $1,000 |
$500 / $1,000 |
Retail Prescriptions (34-day supply) |
||
Generic |
$12 |
50% after Copay |
Preferred Brand |
$35 |
50% after Copay |
Non-Preferred Brand |
$60 |
50% after Copay |
Specialty |
50% up to $250 Max |
50% after Copay |
Mail Order Prescriptions (102-day supply) |
||
Generic |
$36 |
50% after Copay |
Preferred Brand |
$105 |
50% after Copay |
Non-Preferred Brand |
$180 |
50% after Copay |
Specialty |
50% up to $250 Max |
50% after Copay |
Monthly Cost |
|
|---|---|
Employee Only |
$307.43 |
Employee + Spouse |
$1,107.19 |
Employee + Child(ren) |
$830.35 |
Employee + Family |
$1,623.96 |
Your employer offers medical insurance to protect the health of you and your family. It covers medical expenses such as visits to the doctor’s office, emergency care, and prescription drugs. It’s important to
have a medical plan that meets your needs and the needs of your family.
Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility. To find an in-network doctor, please visit https://members.healthgram.com.
Open Access Network |
In-Network |
Out-of-Network |
|---|---|---|
Deductible |
$2,500 / $5,000 |
$5,000 / $10,000 |
Out-of-Pocket Max |
$6,000 / $12,000 |
$12,000 / $24,000 |
Coinsurance (plan/member) |
70% / 30% |
50% / 50% |
Physician Visits |
||
Primary Care Visit |
$25 Copay |
50% after Deductible |
Preventive Care |
No Charge |
50% after Deductible |
Specialist Visit |
$50 Copay |
50% after Deductible |
Telehealth |
$0 Copay |
50% after Deductible |
Hospital Services |
||
Physician Services |
30% after Deductible |
50% after Deductible |
Inpatient Hospitalization |
30% after Deductible |
50% after Deductible |
Outpatient Surgery |
30% after Deductible |
50% after Deductible |
Urgent Care |
30% after Deductible |
50% after Deductible |
Emergency Room |
$150 Copay, then Deductible and Coinsurance |
$150 Copay, then Deductible and Coinsurance |
Prescription Drugs |
In-Network |
Out-of-Network |
|---|---|---|
Retail Prescriptions (34-day supply) |
||
Rx Deductible (Employee/Family) |
$500 / $1,000 |
$500 / $1,000 |
Generic |
$12 |
50% after Copay |
Preferred Brand |
$45 |
50% after Copay |
Non-Preferred Brand |
$70 |
50% after Copay |
Specialty |
50% up to $250 Max |
50% after Copay |
Mail Order Prescriptions (102-day supply) |
||
Generic |
$36 |
50% after Copay |
Preferred Brand |
$105 |
50% after Copay |
Non-Preferred Brand |
$180 |
50% after Copay |
Specialty |
50% up to $250 Max |
50% after Copay |
Monthly Cost |
|
|---|---|
Employee Only |
$66.09 |
Employee + Spouse |
$665.91 |
Employee + Child(ren) |
$455.71 |
Employee + Family |
$1,050.41 |
Your employer offers medical insurance to protect the health of you and your family. It covers medical expenses such as visits to the doctor’s office, emergency care, and prescription drugs. It’s important to
have a medical plan that meets your needs and the needs of your family.
Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility. To find an in-network doctor, please visit https://members.healthgram.com.
Open Access Network |
In-Network |
Out-of-Network |
|---|---|---|
Deductible |
$3,400 / $6,800 |
$3,400 / $6,800 |
Out-of-Pocket Max |
$5,500 / $11,000 |
$11,000 / $22,000 |
Coinsurance (plan/member) |
80% / 20% |
50% / 50% |
Physician Visits |
||
Primary Care Visit |
Deductible + 20% |
Deductible + 20% |
Preventive Care |
100% |
Deductible + 20% |
Specialist Visit |
Deductible + 20% |
Deductible + 20% |
Telehealth |
$0 Copay |
Deductible + 20% |
Hospital Services |
||
Physician Services |
Deductible + 20% |
Deductible + 20% |
Inpatient Hospitalization |
Deductible + 20% |
Deductible + 20% |
Outpatient Surgery |
Deductible + 20% |
Deductible + 20% |
Urgent Care |
Deductible + 20% |
Deductible + 20% |
Emergency Room |
Deductible + 20% |
Deductible + 20% |
Prescription Drug |
In-Network |
Out-of-Network |
|---|---|---|
Retail Prescriptions (34-day supply) |
||
Generic |
Deductible + 20% |
Deductible + 20% |
Preferred Brand |
Deductible + 20% |
Deductible + 20% |
Non-Preferred Brand |
Deductible + 20% |
Deductible + 20% |
Specialty |
Deductible + 20% |
Deductible + 20% |
Mail Order Prescriptions (102-day supply) |
||
Generic |
Deductible + 20% |
Deductible + 20% |
Preferred Brand |
Deductible + 20% |
Deductible + 20% |
Non-Preferred Brand |
Deductible + 20% |
Deductible + 20% |
Specialty |
Deductible + 20% |
Deductible + 20% |
Monthly Cost |
|
|---|---|
Employee Only |
$91.09 |
Employee + Spouse |
$690.91 |
Employee + Child(ren) |
$480.71 |
Employee + Family |
$1,075.41 |
Provided By
Healthgram
Provider Website
https://members.healthgram.com
Customer Service
Resources
Frequently Asked Questions