SDOC Enrollment Training Notes - Updated (2022 08 06)

Healthy Essentials

Healthy Advantage Plus

Medical

Tier 3 Tier 2

Tier 1

Tier 3

Tier 2

Tier 1

In-Network In-Network ***Follow MAP Recommendation and deductible will be waived for procedures***

Evolutions Network EMBS is the new TPA administering Claims https://mibenefits.ebms.com/auth/login • Same Plans & No Changes in deductible, co- insurance or OPM • Center for Employee Health • 407-483-5757 • SDOCEmployeeHealthCenter.net • Deductible is one bucket • Example: • Both plans offer the freedom to go to any provider but can save $$ via • Utilizing the SDOC Health Center • TeleMedicine • Green Imaging • MAP (procedures, 2 nd options, • Tier 1 providers • Elect Rx (if their Rx meets criteria) • For the premium difference between Healthy Essentials & Health Advantage Plus the employee is essentially purchasing. (depending on tier ) • A $300 / $600 lower deductible • 5% lower co-insurance • A lower OPM • Lower office visit co-pays • A copay for Urgent Care instead of deductible/co-insurance • 5% better co-insurance / $5 lower copay on lab work.

Deductible (Ind./ Family) PlanYear

$1,250 / $2,500

$900 / $1,800

$950 / $1,900

$600 / $1,200

Co-Insurance

30%

25%

$4,000 / $8,000

$3,000 / $6,000

OPM . (includes deductible, coinsurance & copays????) SDOC Center for Employee Health Co-pay TeleMedicine Preventative Care PCP Office Visit (non- SDOC Health Center)

$6,300 /$12,000

$5,700 / $11,400

$40

$20

$30

$25

$15

Deductible / Co-insurance

Specialist Office Visit Emergency Room

$80

$40

$60

$50

$40

Deductible / Co-insurance

Urgent Care

$100

Labwork –Done at Independent Lab

30% No Deductible

30% No Deductible (Ex: Labcorp

$10 (Ex: Quest Diagnostics

25% No Deductible

25% No Deductible (Ex: Labcorp

$5 (Ex: Quest Diagnostics

Labwork – Done elsewhere

Deductible / Co-insurance Deductible / Co-insurance

Advanced Imaging

Advanced Imaging thru Green Imaging