Loop Recruitting - 2023 Benefits Guide

Medical and Pharmacy Coverage

Loop Recruiting offers the following plans through AllState Benefits and offers “in and out-of-network” benefits.

Insurance Carrier:

AllState Benefits Medical Insurance Cigna OAP Open Access Plan Network

Medical Plan:

In-Network: Office Visit Copay - Primary Care

$40 Copay

Office Visit Copay - Specialist Care

$60 Copay

Urgent Care Copay

$75 Copay

Emergency Room Care

20% Coinsurance; after deductible

Preventative Visit Copay

$0

Diagnostic Testing & Blood Work

20% Coinsurance; after deductible

Imaging

20% Coinsurance; after deductible

Coinsurance

20%

Employee Deductible

$3,000

Family Deductible

$6,000

Employee Out-of-Pocket Max

$7,900

Family Out-of-Pocket Max

$15,800

Inpatient Hospital

20% Coinsurance; after deductible

Outpatient Hospital or Facility

20% Coinsurance; after deductible

Out-of-Network: Coinsurance

50%

Employee Deductible

$6,000

Family Deductible

$12,000

Employee Out-of-Pocket Max

$23,700

Family Out-of-Pocket Max

$47,400

Prescription Drugs: ( 30 Day Supply) Tier 1 - Generic

$20 Copay

Tier 2 - Preferred

$50 Copay

Tier 3 - Non-Preferred

$75 Copay

Tier 4 - Specialty

20% Coinsurance

Bi-Weekly Payroll Deduction Employee Only

$71.84

$294.54 $208.34 $402.33

Employee + Spouse Employee + Child(ren)

Family

4

LOOP RECRUITING 2023 BENEFITS GUIDE

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