Employer Group Benefit Plan Information

Large Employer Group Benefit Plans

For our Large Employer Groups, Capital Health Plan has developed rich benefit plan options that focus on the delivery of evidence-based medical care under the direction of primary care physicians in an effective, timely, and cost-effective manner. To review these plans, download our side-by-side comparison of the 2018 Large Employer Group plans.

Benefit Description Capital Selection
15/30/50 | 15/50/100
Principal Choice
15/50/100
Quality Choice
15/50/100
Single Deductible N/A N/A N/A
Family Deductible N/A N/A N/A
MOOP
Single/Family
Medical & Rx Separate
$2,000/$4,500 Medical
$4,600/$8,700 Rx
$2,000/$4,500 Medical
$4,850/$9,200 Rx
$2,000/$4,500 Medical
$4,850/$9,200 Rx
Primary Care Visit $15 $15 $15
Specialist Visit
(all specialists including Chiropractors & OBs)
$40 $50 $75
Mental/Behavioral Health & Substance Abuse Disorder Visits $40 $50 $75
Imaging (CT/PET Scans/MRIs) $100 $150 $250
Tier 1 Drugs $15 | $15 $15 $15
Tier 2 Drugs $30 | $50 $50 $50
Tier 3 Drugs $50 | $100 $100 $100
Tier 4 Drugs (specialty) $50 | $100 $100 $100
ASC $100 $200 $250
Outpatient Hospital $250 $350 $500
ER (waived if admitted) $250 $350 $500
Ambulance $100 $200 $250
Urgent Care $25 $50 $50
Inpatient Hospital (includes Medical and MH/SH) $250 $350 $500
Rehabilitative Therapies (PT/OT/ST) $40 $50 $75
Routine Eye Exam (CHP Eye Care centers) $15 $15 $15
Telehealth $15 $15 $15

Please contact the Capital Health Plan Sales Team to discuss the benefit plan options that are available to your clients.

Request a proposal

Small Employer Group Benefit Plans

For our Small Employer Groups, Capital Health Plan offers three Affordable Care Act (ACA)-compliant benefit plans. To review these plans, download our side-by-side comparison of the 2018 Small Employer Group plans.

Benefit Description 3101 - Platinum 3102 - Platinum 3104 - Gold
Single Deductible N/A N/A N/A
Family Deductible N/A N/A N/A
MOOP
Single/Family
Medical & Rx Separate
$3,500/$7,000 Medical
$3,500/$7,000 Rx
$3,500/$7,000 Medical
$3,500/$7,000 Rx
$3,500/$7,000 Medical
$3,500/$7,000 Rx
Primary Care Visit $15 $15 (CHP Offices)
$25 (Affiliate Offices)
$50
Specialist Visit
(all specialists including Chiropractors & OBs)
$40 $50 $100
Mental/Behavioral Health & Substance Abuse Disorder Visits $40 $50 $100
Imaging (CT/PET Scans/MRIs) $100 $100 $100
Tier 1 Drugs $15 $15 $15
Tier 2 Drugs $30 $30 $50
Tier 3 Drugs $50 $50 $100
Tier 4 Drugs (specialty) $50 $50 $100
ASC $200 $200 $250
Outpatient Hospital $200 $200 $500
ER (waived if admitted) $250 $350 $750
Ambulance $0 $100 $100
Urgent Care $25 $25 $75
Inpatient Hospital (includes Medical and MH/SH) $250 $350 $750/day for first 5 days
Rehabilitative Therapies (PT/OT/ST) $40 $50 $100
Routine Eye Exam (CHP Eye Care centers) $15 $15 $35
Telehealth $15 $15 $15

Please contact the Capital Health Plan Sales Team to discuss the benefit plan options that are available to your clients.

Request a proposal