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Point-of-Service (POS) Federally-Qualified Plans (F-Plans)

The plans listed below are federally-qualified mandated plans for use with:

  • Groups with ten (10) or more employees, unless the group is grandfathered under the standard POS Plan Benefits
  • Groups with ten (10) or more employees after the group's plan renewal on or after 12/1/2010; until that renewal occurs, group participants should refer to the standard POS Plan Benefits information

Please contact us for more information.


Plan Name Deductible Coinsurance Out of Pocket Office Visit Prescription Benefit Plan Options
In Network Out of Network In Network Out of Network In Network
Single Family Single Family In Network Out of Network Single Family Single Family PCP Specialist
F-POS1 $250 $500 $250 $500 N/A 20% $250 $500 $2500 $5000 $15 $30

50009 - Standard 5 Tier $10/25/50/50/80


50071 - Standard 5 Tier $20/40/60/60/100


52019 - $150 Deductible then $10/25/50/50/80


52029 - $250 Deductible then $10/25/50/50/80


52059 - $500 Deductible then $10/25/50/50/80


70001 - 50% Co-insurance

             
F-POS2 $250 $500 $500 $1000 20% 30% $1500 $3000 $3000 $6000 $20 $40
F-POS3 $500 $1000 $1000 $2000 20% 30% $2500 $5000 $5000 $1000 $25 $50
F-POS4 $750 $2250 $1750 $5250 20% 30% $3000 $6000 $6000 $12000 $25 $50
F-POS5 $1000 $3000 $2000 $6000 20% 30% $4000 $8000 $8000 $16000 $25 $50
F-POS6 $1500 $4500 $3500 $10500 20% 30% $5000 $10000 $10000 $20000 $25 $50
F-CDPOS1 $1500 $3000 $3000 $6000 0% 30% $1500 $3000 $4500 $9000 D/C D/C
F-CDPOS2 $2500 $5000 $5000 $10000 0% 30% $2500 $5000 $6500 $13000 D/C D/C
F-CDPOS3 $3500 $7000 $7000 $14000 0% 30% $3500 $7000 $8500 $17000 D/C D/C
F-P250 Co-choice $250 $500 $500 $1000 20% 40% $2250 $4500 $4500 $9000 $30 $60
F-P500 Co-choice $500 $1000 $1000 $2000 20% 40% $2500 $5000 $5000 $10000 $30 $60
F-P750 Co-choice $750 $1500 $1500 $3000 20% 40% $2750 $5500 $5500 $11000 $30 $60
F-P1000 Co-choice $1000 $2000 $2000 $4000 20% 40% $3000 $6000 $6000 $12000 $30 $60
F-P1500 Co-choice $1500 $3000 $3000 $6000 20% 40% $3500 $7000 $7000 $14000 $30 $60
F-P2000 Co-choice $2000 $4000 $4000 $8000 20% 40% $4000 $8000 $8000 $16000 $30 $60
F-P2500 Co-choice $2500 $5000 $5000 $10000 20% 40% $4500 $9000 $9000 $18000 $30 $60
F-P3000 Co-choice $3000 $6000 $6000 $12000 20% 40% $5000 $10000 $10000 $20000 $30 $60
F-P3500 Co-choice $3500 $7000 $7000 $14000 20% 40% $5500 $11000 $11000 $22000 $30 $60
F-P4000 Co-choice $4000 $8000 $8000 $16000 20% 40% $6000 $12000 $12000 $24000 $30 $60
F-P4500 Co-choice $4500 $9000 $9000 $18000 20% 40% $6500 $13000 $13000 $26000 $30 $60
F-P5000 Co-choice $5000 $10000 $10000 $20000 20% 40% $7000 $14000 $14000 $28000 $30 $60
F-HSAP1500 - 0% $1500 $3000 $2500 $5000 0% 20% $1500 $3000 $4500 $9000 D D
F-HSAP2000 - 0% $2000 $4000 $3000 $6000 0% 20% $2000 $4000 $5000 $10000 D D 100% HSA POS  
F-HSAP2500 - 0% $2500 $5000 $3500 $7000 0% 20% $2500 $5000 $5500 $11000 D D
F-HSAP3000 - 0% $3000 $6000 $4000 $8000 0% 20% $3000 $6000 $6000 $12000 D D
F-HSAP3500 - 0% $3500 $7000 $4500 $9000 0% 20% $3500 $7000 $6500 $13000 D D
F-HSAP4000 - 0% $4000 $8000 $5000 $10000 0% 20% $4000 $8000 $7000 $14000 D D
F-HSAP4500 - 0% $4500 $9000 $5500 $11000 0% 20% $500 $9000 $7500 $15000 D D
F-HSAP5000 - 0% $5000 $10000 $6000 $12000 0% 20% $5000 $10000 $8000 $16000 D D
F-HSAP1500 - 10% $1500 $3000 $2500 $5000 10% 30% $2000 $4000 $5500 $11000 D/C D/C 50015 - 5 Tier $10/25/50/50/80
50201 - 5 Tier $20/40/60/60/100
50501 - Deductible then 50% Co-insurance
F-HSAP2000 - 10% $2000 $4000 $3000 $6000 10% 30% $2500 $5000 $6000 $12000 D/C D/C 50013 - 5 Tier $10/25/50/50/80
50203 - 5 Tier $20/40/60/60/100
50503 - Deductible then 50% Co-insurance
F-HSAP2500 - 10% $2500 $5000 $3500 $7000 10% 30% $3000 $6000 $6500 $13000 D/C D/C 50017 - 5 Tier $10/25/50/50/80
50205 - 5 Tier $20/40/60/60/100
50505 - Deductible then 50% Co-insurance
F-HSAP3000 - 10% $3000 $6000 $4000 $8000 10% 30% $3500 $7000 $7000 $14000 D/C D/C 50011 - 5 Tier $10/25/50/50/80
50207 - 5 Tier $20/40/60/60/100
50507 - Deductible then 50% Co-insurance
F-HSAP1500 - 20% $1500 $3000 $2500 $5000 20% 40% $2500 $5000 $6500 $13000 D/C D/C 50019 - 5 Tier $10/25/50/50/80
50217 - 5 Tier $20/40/60/60/100
50509 - Deductible then 50% Co-insurance
F-SAP2000 - 20% $2000 $4000

$3000

 $6000 20% 40% $3000 $6000 $7000 $14000 D/C D/C 50021 - 5 Tier $10/25/50/50/80
50219 - 5 Tier $20/40/60/60/100
50511 - Deductible then 50% Co-insurance
F-HSAP2500 - 20% $2500 $5000 $3500 $7000 20% 40% $3500 $7000 $7500 $15000 D/C D/C 50023 - 5 Tier $10/25/50/50/80
50221 - 5 Tier $20/40/60/60/100
50513 - Deductible then 50% Co-insurance
F-HSAP3000 - 20% $3000 $6000 $4000 $8000 20% 40% $4000 $8000 $8000 $16000 D/C D/C 50025 - 5 Tier $10/25/50/50/80
50223 - 5 Tier $20/40/60/60/100
50515 - Deductible then 50% Co-insurance
F-HSAP3500 - 20% $3500 $7000 $4500 $9000 20% 40% $4000 $8000 $9000 $18000 D/C D/C 50045 - 5 Tier $10/25/50/50/80
50225 - 5 Tier $20/40/60/60/100
50525 - Deductible then 50% Co-insurance
F-HSAP4000 - 20% $4000 $8000 $5000 $10000 20% 40% $5000 $10000 $10000 $20000 D/C D/C 50047 - 5 Tier $10/25/50/50/80
50227 - 5 Tier $20/40/60/60/100
50527 - Deductible then 50% Co-insurance
F-HSAP4500 - 20% $4500 $9000 $5500 $11000 20% 40% $5500 $11000 $11000 $22000 D/C D/C 50049 - 5 Tier $10/25/50/50/80
50229 - 5 Tier $20/40/60/60/100
50529 - Deductible then 50% Co-insurance
F-HSAP5000 - 20% $5000 $10000 $5600 $11200 20% 40% $5600 $11200 $11200 $22400 D/C D/C 50051 - 5 Tier $10/25/50/50/80
50231 - 5 Tier $20/40/60/60/100
50531 - Deductible then 50% Co-insurance