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Benefits Coverage
Just like most traditional employer-sponsored health plans, Inclusive Health - Federal Option 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 - Federal Option 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 Option and the Federal Option
Copay Information for Prescription Drugs under the PPO 1000, PPO 2500 and PPO 3500 plans:
$10 for Generic Drugs
$40 for Brand Drugs
NEW! 20% or $250 copay for Specialty Drugs with an annual maximum of $100,000 per calendar year.
NEW! Amendment to IH Policy dated 2.01.2025
| Coverage 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%.
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.
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