Each person’s health care needs are different. That’s why our medical plan offers multiple options so that you can choose the coverage level best-suited to your personal situation. For more details and resources, check Medical Coverage Resources.
If you’d like to download a PDF copy of your 2025 medical and prescription rates, click here.
If you’d like to download a PDF copy of your 2026 medical and prescription rates, click here.
Cost of Coverage
| Medical Benefit | HRA Plan | POS Plan | HDHP Plan | ||||||
| LCMC Facilities | In-Network | Out-of-Network | LCMC Facilities | In-Network | Out-of-Network | LCMC Facilities | In-Network | Out-of-Network | |
| Annual Deductible (Individual/Family) | $875/ | $1,750/ | $3,500/ | $325/ | $750/ | $1,500/ | $1,700/ | $3,000/ | $6,000/ |
| Out-of-Pocket Max (Individual/Family) | $2,250/ | $4,500/ | $11,250/ | $1,375/ | $2,750/ | $5,500/ | $2,750/ | $5,500/ | $11,000/ |
| Coinsurance | 20% | 40% | 20% | 40% | 20% After Deductible | 40% After Deductible | |||
| Physician Services | |||||||||
| Living Well Clinic | $0 Copay | $0 Copay | $0 Copay | ||||||
| Tulane Telehealth | General Medical - $0 Copay / Specialist - $25 Copay | General Medical - $0 Copay / Specialist - $25 Copay | 100% Covered After Deductible | ||||||
| Preventative Care | 100% Covered | Not Covered | 100% Covered | Not Covered | 100% (Deductible Waived) | No Coverage | |||
| PCP Office Visit | $5 Copay | $25 Copay | 40% Coinsurance | $5 Copay | $25 Copay | 40% Coinsurance | 10% Coinsurance* | 20% Coinsurance* | 40% Coinsurance* |
| Specialist Office Visit | $30 Copay | $50 Copay | 40% Coinsurance | $20 Copay | $40 Copay | 40% Coinsurance | 10% Coinsurance* | 20% Coinsurance* | 40% Coinsurance* |
| Lab & X-Ray Services | 100% | 40% Coinsurance | 100% | 40% Coinsurance | 20% Coinsurance* | 40% Coinsurance* | |||
| Hospital Services | |||||||||
| Hospital Inpatient | 20% Coinsurance* | 40% Coinsurance* | 20% Coinsurance* | 40% Coinsurance* | 20% Coinsurance* | 40% Coinsurance* | |||
| Hospital Outpatient | 20% Coinsurance* | 40% Coinsurance* | 20% Coinsurance* | 40% Coinsurance* | 20% Coinsurance* | 40% Coinsurance* | |||
| Pregnancy & Maternity Care | 20% Coinsurance (no charge for office visit) | 40% Coinsurance* | 20% Coinsurance (no charge for office visit) | 40% Coinsurance* | 20% Coinsurance (no charge for office visit) | 40% Coinsurance* | |||
| Emergency Room | $150 Copay | $150 Copay | 20% Coinsurance* | ||||||
Prescription Drugs
| Benefit | HRA Plan | POS Plan | HDHP Plan | |||
| In-Network | Out-of-Network | In-Network | Out-of-Network | In-Network | Out-of-Network | |
| Retail (30-day Supply) | ||||||
| Generic | $10 Copay | $10 Copay | $10 Copay | $10 Copay | 20% Coinsurance* | 20% Coinsurance* |
| Preferred Brand | $30 Copay | $30 Copay | $30 Copay | $30 Copay | 20% Coinsurance* | 20% Coinsurance* |
| Non-preferred Brand | $50 Copay | $50 Copay | $50 Copay | $50 Copay | 20% Coinsurance* | 20% Coinsurance* |
| Mail Order (90-day Supply) | ||||||
| Generic | $25 Copay | N/A | $25 Copay | N/A | 20% Coinsurance* | N/A |
| Preferred Brand | $75 Copay | N/A | $75 Copay | N/A | 20% Coinsurance* | N/A |
| Non-preferred Brand | $125 Copay | N/A | $125 Copay | N/A | 20% Coinsurance* | N/A |
*Coinsurance applied after deductible is met. NOTE: Deductibles, copays, and coinsurance accumulate toward the out-of-pocket maximums. Usual, Customary, and Reasonable charges apply for all out-of-network benefits.
** There is a $150 copay for GLP-1s prescribed for weight loss.
NOTE: Your medical plan options must offer certain preventive care benefits to you in-network without cost sharing and these preventive care benefits generally are updated annually. Under the Affordable Care Act, the medical plans generally may use reasonable medical management techniques to determine frequency, method, treatment or setting for a recommended preventive care service.
Monthly Paycheck Deductions
| Monthly Paycheck Deductions | HRA Plan | POS Plan | HDHP Plan | |||||||||
<$52,500 | $52,500 - $84,699 | $84,700 - $109,999 | $110,000 & Above | <$52,500 | $52,500 - $84,699 | $84,700 - $109,999 | $110,000 & Above | <$52,500 | $52,500 - $84,699 | $84,700 - $109,999 | $110,000 & Above | |
| Employee Only | $74.07 | $119.00 | $214.66 | $291.16 | $159.82 | $203.78 | $299.58 | $374.45 | $69.10 | $110.57 | $193.49 | $262.60 |
| Employee + Spouse | $561.67 | $698.31 | $814.49 | $924.10 | $718.76 | $834.18 | $1,038.32 | $1,186.63 | $432.28 | $566.72 | $681.03 | $725.60 |
| Employee + Children | $430.44 | $605.32 | $793.49 | $890.87 | $557.00 | $735.84 | $1,017.95 | $1,163.38 | $319.62 | $447.45 | $511.38 | $575.30 |
| Employee + Family | $628.45 | $803.33 | $1,010.01 | $1,191.11 | $944.93 | $1,059.09 | $1,314.21 | $1,490.93 | $452.14 | $624.21 | $827.55 | $1,005.75 |
- The HDHP plan has an aggregate deductible while the HRA and POS plans have an embedded deductible. All plans have an embedded out-of-pocket maximum.
- Aggregate Deductible (HDHP): For Employee +1 or more coverage, the entire family deductible must be met before the plan covers any costs. Once the family deductible is met, the plan covers eligible expenses for all family members.
- Embedded Deductible (HRA/POS): No family member will have to pay more than the individual deductible before their benefits are covered. Once the family deductible is met, all family members’ medical expenses are covered, even if they haven’t met their individual deductibles.
- Embedded OOP Max: Each family member has their own individual out-of-pocket maximum (OOP Max). Once a member meets their OOP Max, the plan pays 100% of that member’s covered expenses. The family OOP Max can be met by one or more members of the family.
