HMA Group Plan Solution

The HMA Group plan solution has all the benefits of our MEC offerings. The solution offers Small Co-pays, No Deductibles, Prescription Lab Services, Drug Coverage, and even a Hospital Component for Inpatient, Outpatient, Emergency Room, and Ambulance Services. Plus the plans have the added benefit of advanced information solutions that provide participants:

  • Instant access to expert medical advice and opinion via text message
  • The ability to search locally for the best price on prescriptions
  • Search for medical procedures and prices in your local area
  • Reminders about plan updates and changes, and tips for accessing cost effective health care

All these services are available at a cost effective price, and a four (4) year “rate lock”.

The HMA Group Plan Solution requires a minimum group size of four (4) employees.

Basic
Plus
Advantage
Premier
PPO Network Services: PHCS
Preventive Benefits – Covers all mandated Preventive benefits required by PPACA
Note: This list will be updated from time to time and a current list of covered preventive services is available at healthcare.gov
Medical Benefits - Must utilize PHCS participating provider or facility.
All 21 Preventive Services for Adults
Basic100% Coverage for Mandated Preventive Care Services
Plus100% Coverage for Mandated Preventive Care Services
Advantage100% Coverage for Mandated Preventive Care Services
Premier100% Coverage for Mandated Preventive Care Services
All 28 Preventive Services for Women
Basic100% Coverage for Mandated Preventive Care Services
Plus100% Coverage for Mandated Preventive Care Services
Advantage100% Coverage for Mandated Preventive Care Services
Premier100% Coverage for Mandated Preventive Care Services
All 31 Preventive Services for Children
Basic100% Coverage for Mandated Preventive Care Services
Plus100% Coverage for Mandated Preventive Care Services
Advantage 100% Coverage for Mandated Preventive Care Services
Premier100% Coverage for Mandated Preventive Care Services
Telemedicine – Health Wallet
Basic$0 Copay, unlimited use for all family members
Plus$0 Copay, unlimited use for all family members
Advantage$0 Copay, unlimited use for all family members
Premier$0 Copay, unlimited use for all family members
Primary Care Office Visit
Basic$0 Copay, Max 1 visit
Plus$0 Copay, Max 1 visit
Advantage$20 Copay (Max 3 visits per calendar year)
Premier$20 Copay (Max 3 visits per calendar year)
Specialists Office Visit
BasicNot Covered
PlusNot Covered
Advantage$50 Copay (Max 3 visits per calendar year)
Premier$50 Copay (Max 3 visits per calendar year)
Urgent Care
BasicNot Covered
PlusNot Covered
Advantage$50 Copay (Max 3 visits per calendar year)
Premier$50 Copay (Max 3 visits per calendar year)
Diagnostic X-Ray, Lab
BasicNot Covered
PlusNot Covered
Advantage$50 Copay (Max 5 visits per calendar year)
Premier$50 Copay (Max 5 visits per calendar year)
CT Scan or MRI
BasicNot Covered
PlusNot Covered
Advantage$200 Copay (Max 1 CT Scan or MRI per Calendar Year)
Premier$200 Copay (Max 1 CT Scan or MRI per Calendar Year)
*Hospital, Surgical, Ambulance, Emergency Room
BasicNot Covered
PlusNot Covered
AdvantageNot Covered
Premier***$0 Deductible 50% Coinsurance to $5,000, Maximum benefit $2,500.
Prescription Drug Benefits -WellDyneRx®
Tier I – Low Cost Generics
WelldyneRx discount prescription drug plan*
WelldyneRx discount prescription drug plan*
$1 Copay
$1 Copay
Tier 2 - Generics
WelldyneRx discount prescription drug plan*
WelldyneRx discount prescription drug plan*
10% Coinsurance
10% Coinsurance
Tier 3- Preferred Brand
WelldyneRx discount prescription drug plan*
WelldyneRx discount prescription drug plan*
20% Coinsurance
20% Coinsurance
Tier 4 – Non-Preferred Brand
WelldyneRx discount prescription drug plan*
WelldyneRx discount prescription drug plan*
40% Coinsurance
40% Coinsurance
Tier 5 – Generic & Preferred Specialty
WelldyneRx discount prescription drug plan*
WelldyneRx discount prescription drug plan*
10% Coinsurance (Plan pays 90% up to a maximum of $150 per Rx)
10% Coinsurance (Plan pays 90% up to a maximum of $150 per Rx)
Tier 6 – Non-Preferred Specialty
WelldyneRx discount prescription drug plan*
WelldyneRx discount prescription drug plan*
20% Coinsurance (Plan pays 80% up to a maximum of $250 per Rx)
20% Coinsurance (Plan pays 80% up to a maximum of $250 per Rx)
*WelldyneRx provides a discount prescription drug plan for the Basic Plan. Discount varies based on Pharmacy and Region from 40 to 70% off retail level on all FDA Approved Medications.
Contribution Schedule (Rates)
Four Year Rate Lock: Increase in years 2 through 4 cannot exceed 3% on an accumulative basis
EE Only
$70.00
$82.85
$133.75
$218.00
EE Plus Child(ren)
$90.00
$123.17
$202.24
$364.00
EE Plus Spouse
$90.00
$132.59
$218.24
$364.00
EE Plus Family
$90.00
$176.83
$293.30
$430.00
Disclaimer: Apex Management Group Suite of Healthcare Solutions are not insurance products, but self-funded plans.
Please see Plan Document and SPD for full details.