Medical Benefits to Serve Your Needs

We work with CEBT to offer three medical insurance plan options for eligible employees. These plans are not bundled with dental or vision, and enrollment elections must be made separately. To estimate your benefit costs, use our Benefits Calculator.

PPO Select 4 (Base Plan)

Employee Cost

The monthly medical premiums listed below are based on full-time employment / 1.0 FTE. To estimate your benefit costs, use our Benefits Calculator.

Coverage:

  • Office Visit (Primary): Tier 1: $0 Copay | Tier 2: Ded + 50% to OOP Max
  • Office Visit (Specialty): Tier 1: $100 Copay | Tier 2: Ded + 50% to OOP Max
  • Deductible (Single): Tier 1: $4,000 | Tier 2: $6,000
  • Deductible (Family): Tier 1: $8,000 | Tier 2: $12,000
  • Coinsurance: Tier 1: 20% | Tier 2: 50%
  • Out-of-Pocket (OOP) Maximum (Single): Tier 1: $5,500 | Tier 2: $10,600
  • Out-of-Pocket (OOP) Maximum (Family): Tier 1: $11,000 | Tier 2: $21,200
  • Inpatient/Outpatient Hospital: Tier 1: Ded + 20% | Tier 2: Ded + 50%
  • Rx Retail: Generic $20 | Preferred $40 | Non-Preferred $60
  • Rx Mail Order: Two times Copay
  • Preventative Visit: Covered 100%
  • Mental Health: Covered 100% (Modern Health EAP + In-Network providers)
  • Urgent Care: Covered 100% (Tier 1 & 2)

PPO Select 3 (Buy-Up Option)

Coverage Highlights:

  • Office Visit (Primary): Tier 1: $0 Copay | Tier 2: Ded + 50% to OOP Max
  • Deductible (Single): Tier 1: $3,000 | Tier 2: $5,000
  • Deductible (Family): Tier 1: $6,000 | Tier 2: $10,000
  • Out-of-Pocket Max (Single): Tier 1: $5,000 | Tier 2: $10,000
  • Out-of-Pocket Max (Family): Tier 1: $10,000 | Tier 2: $20,000
  • Advanced Imaging: Tier 1: $500 Copay | Tier 2: Ded + 50%

PPO Select 6 (Buy-Up Option)

Coverage Highlights:

  • Office Visit Copay: $50
  • Deductible (Single/Family): $3,000 / $6,000
  • Out-of-Pocket Max (Single/Family): $5,000 / $10,000
  • Coinsurance: 20%
  • Urgent Care Copay: $75
  • Emergency Care: Deductible + 20%

Kaiser Permanente HMO 50 (Buy-Up Option)

Coverage Highlights:

  • Office Visit (Primary / Specialty): $50 Copay / $65 Copay
  • Deductible: N/A (Copay-based plan)
  • Out-of-Pocket (OOP) Maximum (Single/Family): $5,500 / $11,000
  • Inpatient Hospital: $2,000 Copay per admission
  • Outpatient Hospital: $1,000 Copay (Hospital) / $500 Copay (Surgery Center)
  • Rx Retail: Generic $20 | Preferred $40 | Non-Preferred $60 | Specialty 20% (up to $250)
  • Preventative Visit: Covered 100%
  • Lab/X-Ray: Lab: 100% Covered | X-Ray: $0 Diagnostic / $65 Therapeutic
  • Urgent Care / Emergency: $50 Copay / $250 Copay

Additional Member Resources

  • Modern Health: 1:1 mental health coaching and therapy sessions.
  • Lantern: $0 surgery and infusion therapy navigation for PPO/EPO members.
  • Marathon Health Centers: $0 primary care and coaching at CEBT Wellness Centers.

This comparison of coverage is intended only as a general description for the principle in-network features of the benefit plans. If there are questions about a particular benefit or the coverage tier, please refer to the full plan documents on the CEBT website.

*Charges are subject to Usual & Customary (U&C). These charges are considered in excess of the Reasonable Reimbursement, the Recognized Amount, the Usual and Customary charge, the Negotiated Rate, or the fee schedule. Exclusions under this category do not apply to payments that may be required under the No Surprises Act.

Preventative Services will be processed following the Federal Patient Protection and Affordable Care Act. For more information, visit the CEBT website.

PPO Note: Combination of PPO and Non PPO out of pocket limit will never exceed the Non PPO out of pocket limit.

PPO Plan deductibles fall under the definition of an Embedded deductible where any single member of a family doesn't have to meet the full family deductible for the after-deductible benefits to kick in. Once they meet the individual deductible, plan benefits will start to pay.

Kaiser Note: The member must use a contracted Kaiser Permanente provider for all care. Out-of-network providers are only covered if the charges are for emergency treatment. If this is not done, there is no guarantee that the charges will be covered. Kaiser Preventative Services will be processed following the Federal Patient Protection and Affordable Care Act. For a full list, visit the Kaiser Permanente website.