Page 7 - 2020 Stein Mart Benefits
P. 7
MEDICAL INSURANCE
Traditional Plan Health Savings Plan
In-Network Out-of-Network* In-Network Out-of-Network*
Calendar Year Deductible
Associate $1,000** $2,000 $3,000 $6,000
Associate + Dependents $2,000** $4,000 $6,000 $12,000
Coinsurance (what you pay) 20% 40% 20% 40%
Out-of-Pocket Max***
Associate $4,500 no limit to what $6,000 no limit to what
Associate + Dependents $9,000 you pay $12,000 you pay
Services
Preventive Care Covered at 100% Covered at 100%
Primary Care Visit $30 copay
Specialty Visit $60 copay
Urgent Care $40 copay
Diagnostic Imaging - 40% after 20% after 40% after
Outpatient 20% after deductible deductible deductible deductible
(CT Scans, PET Scans, MRI)
Mental Health - Outpatient $30 copay
Rehabilitation Services - $60 copay
Outpatient (Physical Therapy)
Hospital Services
Inpatient or Outpatient 20% after deductible 40% after deductible 20% after deductible 40% after deductible
Emergency Room
(deductible waived if admitted $350 copay $350 copay 20% after deductible 20% after deductible
within 24 hours)
* Out-of-network is subject to balance billing.
** On the Traditional plan, copayments and prescription copayments do not apply towards the deductible.
*** Out-of-pocket max is the most you have to pay for covered services in a plan year. After you spend this amount on deductibles,
copayments, and coinsurance, the plan pays 100% of the cost for covered benefits. With Associate + Dependents coverage, the
individual deductible and out-of-pocket maximum applies to each individual covered. Once any member satisfies an individual limit,
the plan begins covering that member's eligible expenses. Once a combination of family members satisfy the family deductible and
out-of-pocket maximum, the plan begins covering all family members’ eligible expenses.
Associate Rates
Traditional Plan Health Savings Plan
Weekly Semi Monthly Weekly Semi Monthly
Associate Only $63.71 $138.04 $23.68 $51.31
Associate and Spouse $150.52 $326.13 $115.57 $250.40
Associate and Children $125.11 $271.07 $90.50 $196.08
Family $201.56 $436.72 $150.68 $326.48
H E A L T H T I P - g e t r e g u l a r c h e c k u p s
Prevention and early detection of diseases is the
best way to achieve optimal health. Both health
plans cover in-network preventive care at 100%.
Assistant Store Managers, Asset Protection and Loss 5
Prevention and Semi-Monthly Associates For 2020 Benefits
Traditional Plan Health Savings Plan
In-Network Out-of-Network* In-Network Out-of-Network*
Calendar Year Deductible
Associate $1,000** $2,000 $3,000 $6,000
Associate + Dependents $2,000** $4,000 $6,000 $12,000
Coinsurance (what you pay) 20% 40% 20% 40%
Out-of-Pocket Max***
Associate $4,500 no limit to what $6,000 no limit to what
Associate + Dependents $9,000 you pay $12,000 you pay
Services
Preventive Care Covered at 100% Covered at 100%
Primary Care Visit $30 copay
Specialty Visit $60 copay
Urgent Care $40 copay
Diagnostic Imaging - 40% after 20% after 40% after
Outpatient 20% after deductible deductible deductible deductible
(CT Scans, PET Scans, MRI)
Mental Health - Outpatient $30 copay
Rehabilitation Services - $60 copay
Outpatient (Physical Therapy)
Hospital Services
Inpatient or Outpatient 20% after deductible 40% after deductible 20% after deductible 40% after deductible
Emergency Room
(deductible waived if admitted $350 copay $350 copay 20% after deductible 20% after deductible
within 24 hours)
* Out-of-network is subject to balance billing.
** On the Traditional plan, copayments and prescription copayments do not apply towards the deductible.
*** Out-of-pocket max is the most you have to pay for covered services in a plan year. After you spend this amount on deductibles,
copayments, and coinsurance, the plan pays 100% of the cost for covered benefits. With Associate + Dependents coverage, the
individual deductible and out-of-pocket maximum applies to each individual covered. Once any member satisfies an individual limit,
the plan begins covering that member's eligible expenses. Once a combination of family members satisfy the family deductible and
out-of-pocket maximum, the plan begins covering all family members’ eligible expenses.
Associate Rates
Traditional Plan Health Savings Plan
Weekly Semi Monthly Weekly Semi Monthly
Associate Only $63.71 $138.04 $23.68 $51.31
Associate and Spouse $150.52 $326.13 $115.57 $250.40
Associate and Children $125.11 $271.07 $90.50 $196.08
Family $201.56 $436.72 $150.68 $326.48
H E A L T H T I P - g e t r e g u l a r c h e c k u p s
Prevention and early detection of diseases is the
best way to achieve optimal health. Both health
plans cover in-network preventive care at 100%.
Assistant Store Managers, Asset Protection and Loss 5
Prevention and Semi-Monthly Associates For 2020 Benefits
