Major Plans - Metal Plans

Major Plans - Metal Plans

Our major medical PPO plans offer individuals and groups access to flexible and affordable healthcare. The plans offer you access to telemedicine and  visits with Board Certified physicians/specialist, hospitals, pharmacy discounts, and more. They are for US Residents only.

  • Low Co-Pay and Affordable Deductibles
  • Office and Specialist Visits
  • Hospital, Critical Care, ER, Imaging, X-ray, Urgent Care, Laboratory
  • Telemedicine is accessible 24/7, 365 days
  • Preventive and Wellness Benefits
  • Specialty and Preferred Drugs Tier
  • Reliashield Essential Individual Plan Included
Plan Comparison

Here is a high level view comparing these plans side by side. For more details click on the plans above.

Bronze Silver
Network Non-Network Network Non-Network
ACA Preventative Benefits (63 Items) 100% 100% 100% 100%
Telemedicine by Remedy.Me 100% 100% 100% 100%
ReliaShield Essential Individual Plan 100% 100% 100% 100%
ACA Mandated Generic Tier 1 - $10 Co-Pay Applies to All Plans 100% Not Available 100% Not Available
ACA Optional Generic Tier 2 - $35 Co-Pay Applies to All Plans 100% Not Available 100% Not Available
ACA Optional Generic Tier 3 - $60 Co-Pay Applies to All Plans 100% Not Available 100% Not Available
ACA - Formulary Drug Tier 4 Not Covered Not Covered 25% after deductible up to $250 / prescription Not Covered
ACA - Formulary Drug Tier 5 Not Covered Not Covered Not Covered Not Covered
Deductible – Individual/Family $6,350 / $12,700 $12,700 / $25,400 $3,500 / $12,000 $7,000 / $24,000
Out-of-Pocket Maximum – Individual/Family $6,350 / $15,700 $12,700 / $31,400 $6,350 / $15,700 $12,700 / $25,400
Responsibility Share 30% after deductible 50% after deductible 30% after deductible 40% after deductible
Hospitalization In-Patient 30% after deductible 50% after deductible 30% after deductible 40% after deductible
Hospitalization Out-Patient 30% after deductible 50% after deductible 30% after deductible 40% after deductible
Emergency Room Services 30% after deductible 30% after deductible 30% after deductible 40% after deductible
Urgent Care 30% after deductible 50% after deductible 30% after deductible 40% after deductible
Primary Care/Office Visits Co-Pay $40 50% after deductible $30 40% after deductible
Specialist Visits Co-Pay $80 50% after deductible $45 40% after deductible
Imaging 30% after deductible 50% after deductible 30% after deductible 40% after deductible
Laboratory Outpatient and Professional Services 30% after deductible 50% after deductible 30% after deductible 40% after deductible
X-rays and Diagnostic Imaging 30% after deductible 50% after deductible 30% after deductible 40% after deductible
Ambulance 30% after deductible 50% after deductible 30% after deductible 40% after deductible
Hospice Care 30% after deductible 50% after deductible 30% after deductible 40% after deductible
Durable Medical Equipment Not Covered Not Covered Not Covered Not Covered
Gold Platinum
Network Non-Network Network Non-Network
ACA Preventative Benefits (63 Items) 100% 100% 100% 100%
Telemedicine by Remedy.Me 100% 100% 100% 100%
ReliaShield Essential Individual Plan 100% 100% 100% 100%
ACA Mandated Generic Tier 1 - $10 Co-Pay Applies to All Plans 100% Not Available 100% Not Available
ACA Optional Generic Tier 2 - $35 Co-Pay Applies to All Plans 100% Not Available 100% Not Available
ACA Optional Generic Tier 3 - $60 Co-Pay Applies to All Plans 100% Not Available 100% Not Available
ACA - Formulary Drug Tier 4 25% after deductible up to $250 / prescription Not Covered 25% after deductible up to $250 / prescription Not Covered
ACA - Formulary Drug Tier 5 Not Covered Not Covered Not Covered Not Covered
Deductible – Individual/Family $2,500 / $5,000 $5,000 / $10,000 $1,500 / $3,500 $3,000 / $7,000
Out-of-Pocket Maximum – Individual/Family $4,000 / $12,700 $8,000 / $25,400 $4,000 / $12,700 $8,000 / $15,400
Responsibility Share 20% after deductible 30% after deductible 10% after deductible 30% after deductible
Hospitalization In-Patient 20% after deductible 30% after deductible 10% after deductible 30% after deductible
Hospitalization Out-Patient 20% after deductible 30% after deductible 10% after deductible 30% after deductible
Emergency Room Services 20% after deductible 30% after deductible 10% after deductible 30% after deductible
Urgent Care 20% after deductible 30% after deductible 10% after deductible 30% after deductible
Primary Care/Office Visits Co-Pay $25 30% after deductible $20 30% after deductible
Specialist Visits Co-Pay $40 30% after deductible $35 30% after deductible
Imaging 20% after deductible 30% after deductible 10% after deductible 30% after deductible
Laboratory Outpatient and Professional Services 20% after deductible 30% after deductible 10% after deductible 30% after deductible
X-rays and Diagnostic Imaging 20% after deductible 30% after deductible 10% after deductible 30% after deductible
Ambulance 20% after deductible 30% after deductible 10% after deductible 30% after deductible
Hospice Care 20% after deductible 30% after deductible 10% after deductible 30% after deductible
Durable Medical Equipment Not Covered Not Covered Not Covered Not Covered