Medical and Pharmacy Coverage
Yates LLC offers the following plans through Meritain Health.
Insurance Carrier: Medical Plan Number:
Meritain Health Medical Insurance
Basic Plan
Standard Plan
In-Network: Office Visit Copay - Primary Care
$25 Copay, then 100% Deductible waived $20 Copay, then 100% Deductible waived Office Visit Copay - Specialist Care $50 Copay, then 100% Deductible waived $40 Copay, then 100% Deductible waived Urgent Care Copay $50 Copay, then 100% Deductible waived $50 Copay, then 100% Deductible waived Emergency Room Care $200 Copay, then 100% Deductible waived $200 Copay, then 100% Deductible waived Preventative Visit Copay 100% Deductible waived 100% Deductible waived Diagnostic Testing & Blood Work 70% after Deductible 80% after Deductible Bloodwork-Quest Diagnostics 100% 100% Imaging 70% after Deductible 80% after Deductible Imaging - US imaging $250 Copay, then Deductible waived $250 Copay, then Deductible waived Coinsurance 70% 80% Employee Deductible $1,000 $2,000 Family Deductible $3,000 $6,000 Employee Out-of-Pocket Max $5,500 $5,000 Family Out-of-Pocket Max $12,700 $12,700 Inpatient Hospital 70% after Deductible 80% after Deductible Outpatient Hospital or Facility 70% after Deductible 80% after Deductible Inpatient/Outpatient Physician Fees 70% after Deductible 100% Deductible waived Out-of-Network: Coinsurance 50% 60% Employee Deductible $4,000 $3,000 Family Deductible $12,000 $9,000 Employee Out-of-Pocket Max $11,500 $9,000 Family Out-of-Pocket Max $34,500 $27,000 Prescription Drugs: ( 30 Day Supply) Tier 1 - Generic $7 Copay $7 Copay Tier 2 - Formulary $40 Copay $40 Copay Tier 3 - Non-Formulary $70 Copay $70 Copay Tier 4 - Specialty Contact ShaRx @ 314-451-3555, Option 1 or sharx@sharxplan.com Mail Order (90 Day Supply) 2x Copay Semi-Monthly Deduction Employee Only $50.00 $90.00 Employee + Spouse $162.50 $187.50 Employee + Child(ren) $137.50 $162.50 Family $200.00 $230.00
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YATES LLC 2022 BENEFIT GUIDE
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