Yates LLC - 2024 Benefits Guide - Class 1

MEDICAL AND PHARMACY COVERAGE

Yates LLC offers the following plans through Meritain Health.

Insurance Carrier:

Meritain Health Medical Insurance

Basic Plan You pay:

Standard Plan You pay:

HSA Plan You pay:

In-Network:

Deductible (first dollar cost for covered in-network services) Individual / Family $1,000 / $3,000

$2,000 / $6,000

$5,000 / $10,000

Coinsurance (after you reach your deductible) Plan Pays 70%

80%

100%

Out-of-Pocket Maximum (includes deductibles, copays, prescription costs, and coinsurance) Individual / Family $5,500 / $12,700 $5,000 / $12,700

$5,000 / $10,000

Plan Features Preventive Care

100% deductible waived

100% deductible waived

100% deductible waived

Primary Care Visits

$25 Copay, then 100% deductible waived

$20 Copay, then 100% deductible waived

100% after deductible

Specialist Visits

$50 Copay, then 100% deductible waived

$40 Copay, then 100% deductible waived

100% after deductible

Urgent Care

$50 Copay, then 100% deductible waived

$50 Copay, then 100% deductible waived

100% after deductible

Emergency Room

$200 Copay, then 100% deductible waived

$200 Copay, then 100% deductible waived

100% after deductible

Diagnostic Testing & Blood Work

70% after deductible

80% after deductible

100% after deductible

Bloodwork - Quest Diagnostics

100% deductible waived

100% deductible waived

100% after deductible

Imaging

70% after deductible

80% after deductible

100% after deductible

Inpatient Hospital

70% after deductible

80% after deductible

100% after deductible

Outpatient Surgery

70% after deductible

80% after deductible

100% after deductible

Inpatient/Outpatient Physician Fees

70% after deductible

100% deductible waived

100% after deductible

Prescription Benefits 30-day supply Tier 1 - Generic

$7 Copay

$7 Copay

100% after deductible

Tier 2 - Formulary

$40 Copay

$40 Copay

100% after deductible

Tier 3 - Non-Formulary

$70 Copay

$70 Copay

100% after deductible

Tier 4 - Specialty

Contact ShaRx @ 314-451-3555, Option 1 or sharx@sharxplan.com

Mail Order 90-day supply

2x Copay

100% after deductible

Semi-Monthly Deduction (per paycheck cost for coverage) Employee Only $110.00

$123.75

$82.50

$275.00

$288.75

$206.25

Employee + Spouse

$220.00

$239.25

$151.25

Employee + Child(ren)

$363.00

$393.25

$275.00

Family

*HSA PLAN - YATES WILL MATCH $1,000 FOR INDIVIDUAL / $2,000 FOR FAMILY TO SAVINGS ACCOUNT*

6 | Yates LLC 2024 Benefits Guide

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