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, and enrollment is open year round.

Apex products are not available in MA, ND.

Contact Apex Management Group to Learn More

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 2 visits
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 -Citizens Rx
Tier I – Low Cost Generics
Citizens Rx discount prescription drug plan*
Citizens Rx discount prescription drug plan*
$1 Copay
$1 Copay
Tier 2 - Generics
Citizens Rx discount prescription drug plan*
Citizens Rx discount prescription drug plan*
10% Coinsurance
10% Coinsurance
Tier 3- Preferred Brand
Citizens Rx discount prescription drug plan*
Citizens Rx discount prescription drug plan*
20% Coinsurance
20% Coinsurance
Tier 4 – Non-Preferred Brand
Citizens Rx discount prescription drug plan*
Citizens Rx discount prescription drug plan*
40% Coinsurance
40% Coinsurance
Tier 5 – Generic & Preferred Specialty
Citizens Rx discount prescription drug plan*
Citizens Rx 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
Citizens Rx discount prescription drug plan*
Citizens Rx 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)
*Citizens Rx 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 Health Care Solutions are not insurance products, but self-funded plans.
Please see Plan Document and SPD for full details.

 

 

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