Page 5 - Ampact 2022 Benefit Guide

Your Health Care

Coverage

Your health care coverage includes medical, dental
and vision plans. Detailed information about each
plan is in this section.

Your Medical
You have three medical plan options:

• $500-$25 PPO
• $1,500-100% Non-Embedded HSA
• $2,800-100% Embedded HSA

In/Out-of-Network Coverage

Each medical plan features in- and out-of-network WHAT’S THE DIFFERENCE?
coverage; individual and family deductibles;
copays; coinsurance; and out-of-pocket maximums. PLAN FOR ME TOOL
Some offer a lower monthly cost, a higher Consider your personal situation and the differences
deductible, and lower coinsurance amounts, while between the options when making your decision.
others cost more each month but offer a lower When you are choosing a plan, it is helpful to know
deductible and higher levels of coinsurance. If you what plan best fits your needs. HealthPartners Plan for
don’t understand some of these terms, please refer Me makes it easy to compare plan options so you
to the Glossary on page 21. can choose the right plan for you.

You may use in- or out-of-network providers. You will You can compare your health plan options, see how
always pay less if you see a doctor or receive your prescriptions are covered, check if your doctor is
services within the provider network because the in the network, and experience sample plan
plan pays more for “in-network services.” scenarios.

Deductible Get started by visiting:
You must meet an annual deductible before the
medical plan begins to cover a portion of your http://www.healthpartners.com/planforme
costs. Once the deductible is met, the medical plan Group Number: 25124
begins to pay for a percentage of covered Site Number: ALL
expenses (this is called coinsurance). Effective Date: 08/01/2022

Out-of-Pocket Maximums
Out-of-pocket maximums apply to all the plans. This For In-Network Providers choose:
is the maximum amount you will pay for health care
costs during the plan year. Once you have reached HealthPartners Open Access Network
the out-of-pocket maximum, the plan will fully cover
eligible medical expenses for the rest of the benefits To locate providers who participate with your
plan year. If you see an out-of-network provider, you HealthPartners network call 952-883-5000 or 800-
may be responsible for out-of-pocket costs that are
considered above the “reasonable and customary” 883-2177 or go to www.healthpartners.com
fees.

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Effective August 1, 2022-July 31, 2023