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.
If you’d like to download a PDF copy of your medical and prescription rates, click here.
Cost of Coverage
| Benefit | HRA Plan | POS Plan | HDHP Plan | ||||||
| Tulane Doctors | In-Network | Out-of-Network | Tulane Doctors | In-Network | Out-of-Network | Tulane Doctors | In-Network | Out-of-Network | |
| Annual/Calendar Year Deductible (Individual/Family) | $1,750/ $3,500 | $3,500/ $7,000 | $750/ $1,500 | $1,500/ $3,000 | $3,000/ $6,000 | $6,000/ $12,000 | |||
| Out-of-Pocket Maximum (Individual/Family) | $4,500/ $9,000 | $11,250/ $22,500 | $2,750/ $5,500 | $5,500/ $11,000 | $5,500/ $11,000 | $11,000/ $22,000 | |||
| Coinsurance | 20% | 40% | 20% | 40% | 20% | 40% | |||
| Physician | |||||||||
| Tulane Living Well Clinic | $0 Copay | $0 Copay | $0 after deductible | ||||||
| Tulane Telehealth | $0 Copay | $0 Copay | $0 after deductible | ||||||
| Doctor's 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* |
| Preventive Care | 100% | Not covered | 100% | Not covered | 100% | Not covered | |||
| Lab & X-Ray Services | 100% | 40% Coinsurance* | 100% | 40% Coinsurance* | 20% Coinsurance* | 40% Coinsurance* | |||
| Hospital Services | |||||||||
| Inpatient | 20% Coinsurance* | 40% Coinsurance* | 20% Coinsurance* | 40% Coinsurance* | 20% Coinsurance* | 40% Coinsurance* | |||
| Outpatient | 20% Coinsurance* | 40% Coinsurance* | 20% Coinsurance* | 40% Coinsurance* | 20% Coinsurance* | 40% Coinsurance* | |||
| Emergency Care | $150 Copay | $150 Copay | 20% Coinsurance* | ||||||
| Pregnancy & Maternity Care (Prenatal) | 20% Coinsurance* (no charge for office visit) | 40% Coinsurance* | 20% Coinsurance* (no charge for office visit) | 40% Coinsurance* | 20% Coinsurance* | 40% Coinsurance* | |||
Prescription Drugs
| Benefit | HRA Plan | POS Plan | HDHP Plan | ||||||
| Tulane Doctors | In-Network | Out-of-Network | Tulane Doctors | In-Network | Out-of-Network | Tulane Doctors | 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 | |||
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 | $71.22 | $114.42 | $206.40 | $279.96 | $153.67 | $195.94 | $288.06 | $360.05 | $66.44 | $106.32 | $186.05 | $252.50 |
| Employee + Spouse | $540.07 | $671.45 | $783.16 | $888.56 | $691.12 | $802.10 | $998.38 | $1,140.99 | $415.65 | $544.92 | $654.84 | $697.69 |
| Employee + Children | $413.88 | $582.04 | $762.97 | $856.61 | $535.58 | $707.54 | $978.80 | $1,118.63 | $307.33 | $430.24 | $491.71 | $553.17 |
| Employee + Family | $604.28 | $772.43 | $971.16 | $1,145.30 | $908.59 | $1,018.36 | $1,263.66 | $1,433.59 | $434.75 | $600.20 | $795.72 | $967.07 |
*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.
- 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.
If you’d like to download a PDF copy of your medical and prescription rates, click here.
