Benefit Information - FEDERAL OPTION

Just like most traditional employer-sponsored health plans, Inclusive Health covers a broad range of services, including preventive care, urgent care, outpatient services, a prescription drug benefit and other common health care services. Inclusive Health offers several plan options, so you can choose the plan that best meets your individual medical and financial needs.

Benefits Policies, Summaries and Schedules

• PPO 1000: Policy and Benefits Summary | Benefit Schedule
  
  
• PPO 2500: Policy and Benefits Summary | Benefit Schedule
  
  
• PPO 3500: Policy and Benefits Summary | Benefit Schedule
  
  
• High Deductible Health Plan 4500 (HDHP):
           Policy and Benefits Summary | Benefit Schedule
  

Click here to download a comparison of Benefits between the State and Federal Options.

Copay Information for Prescription Drugs under the PPO 1000, PPO 2500 and PPO 3500 plans:

$10 for Generic Drugs
$40 for Brand Drugs
20% or $250 copay for Specialty Drugs.

Options and Details	PPO 1000	PPO 2500	PPO 3500	HDHP 4500
Annual Deductible	$1000 Applies to medical	$2500 Applies to medical	$3500 Applies to medical	$4500 Applies to medical and drug
Coinsurance	80% in network 50% out of network	80% in network 50% out of network	80% in network 50% out of network	100% in network 100% out of network
Annual Out of Pocket Maximum	$5950 in network $7000 out of network	$5950 in network $7000 out of network	$5950 in network $7000 out of network	$4500 in network $4500 out of network
Lifetime Benefits Maximum	$1 million	$1 million	$1 million	$1 million

Please note: The copays only apply to the PPO1000, PPO2500 and the PPO3500 plans. If you selected the HDHP 4500 High deductible plan, prescriptions will not be reimbursed until you have satisfied your entire $4500 deductible. You will pay the Inclusive Health - Federal Option negotiated price for a prescription until you have reached the $4500 deductible, then all services are covered at 100%.

All deductibles are calculated on a calendar year basis. A new deductible will begin each January.

Provider Network

The PPO plans (PPO 1000, PPO 2500 and PPO 3500) and the use of a network provider feature lower out of pocket expenses when using a network provider. You may use a provider that is not in the Inclusive Health network, but you will have a higher out of pocket expense. Please see your policy for the specific benefits.

Please note: North Carolina providers are forbidden under state law from balance billing you for any amounts above the Inclusive Health allowed/negotiated rate. For services received from providers outside of North Carolina, however, you may be subject to being balance billed for charges in excess of the Inclusive Health allowed/negotiated rate.