Pediatric dental benefits are required by the ACA. Although our medical plans don’t include pediatric dental benefits, you may choose an HMSA dental plan to get covered.
Earliest effective date for these plans is January 1, 2025.
| Plan | Deductible | Max out– of–pocket | Coinsurance | Doctor visit copayment | Specialist visit copayment | Premiums based on age: |
|---|---|---|---|---|---|---|
| Platinum PPO | $0 | $4,300 | 10% | $10 | $20 | $393.59 / month $428.58 / month $441.96 / month $455.33 / month $469.74 / month $484.14 / month $499.07 / month $514.50 / month $514.50 / month $514.50 / month $514.50 / month $516.56 / month $526.85 / month $539.20 / month $559.26 / month $575.73 / month $583.96 / month $596.31 / month $608.65 / month $616.37 / month $624.60 / month $628.72 / month $632.84 / month $636.95 / month $641.07 / month $649.30 / month $657.53 / month $669.88 / month $681.71 / month $698.18 / month $718.76 / month $742.94 / month $771.75 / month $804.16 / month $841.21 / month $877.74 / month $918.90 / month $959.54 / month $1004.30 / month $1049.58 / month $1098.46 / month $1147.34 / month $1200.33 / month $1253.84 / month $1310.95 / month $1339.24 / month $1396.35 / month $1445.75 / month $1478.16 / month $1518.80 / month $1543.5 / month |
| Gold PPO I | $500 | $7,800 | 20% 1 | $30 | $60 | $346.15 / month $376.92 / month $388.68 / month $400.44 / month $413.11 / month $425.78 / month $438.91 / month $452.48 / month $452.48 / month $452.48 / month $452.48 / month $454.29 / month $463.34 / month $474.20 / month $491.85 / month $506.33 / month $513.56 / month $524.42 / month $535.28 / month $542.07 / month $549.31 / month $552.93 / month $556.55 / month $560.17 / month $563.79 / month $571.03 / month $578.27 / month $589.13 / month $599.54 / month $614.02 / month $632.11 / month $653.38 / month $678.72 / month $707.23 / month $739.80 / month $771.93 / month $808.13 / month $843.88 / month $883.24 / month $923.06 / month $966.04 / month $1009.03 / month $1055.64 / month $1102.69 / month $1152.92 / month $1177.81 / month $1228.03 / month $1271.47 / month $1299.98 / month $1335.72 / month $1357.44 / month |
| Gold PPO II | $1,500 | $7,800 | 25% 1 | $30 | $60 | $325.01 / month $353.90 / month $364.95 / month $375.99 / month $387.89 / month $399.78 / month $412.10 / month $424.85 / month $424.85 / month $424.85 / month $424.85 / month $426.55 / month $435.05 / month $445.24 / month $461.81 / month $475.41 / month $482.20 / month $492.40 / month $502.60 / month $508.97 / month $515.77 / month $519.17 / month $522.57 / month $525.96 / month $529.36 / month $536.16 / month $542.96 / month $553.15 / month $562.93 / month $576.52 / month $593.52 / month $613.48 / month $637.28 / month $664.04 / month $694.63 / month $724.79 / month $758.78 / month $792.35 / month $829.31 / month $866.69 / month $907.05 / month $947.42 / month $991.18 / month $1035.36 / month $1082.52 / month $1105.88 / month $1153.04 / month $1193.83 / month $1220.59 / month $1254.16 / month $1274.55 / month |
| Silver PPO Direct | $5,000 | $8,000 | 40% 1 | $40 | $80 | $286.53 / month $312 / month $321.74 / month $331.48 / month $341.96 / month $352.45 / month $363.31 / month $374.55 / month $374.55 / month $374.55 / month $374.55 / month $376.05 / month $383.54 / month $392.53 / month $407.14 / month $419.12 / month $425.11 / month $434.10 / month $443.09 / month $448.71 / month $454.70 / month $457.70 / month $460.70 / month $463.69 / month $466.69 / month $472.68 / month $478.67 / month $487.66 / month $496.28 / month $508.26 / month $523.25 / month $540.85 / month $561.83 / month $585.42 / month $612.39 / month $638.98 / month $668.95 / month $698.54 / month $731.12 / month $764.08 / month $799.66 / month $835.25 / month $873.83 / month $912.78 / month $954.35 / month $974.95 / month $1016.53 / month $1052.49 / month $1076.08 / month $1105.67 / month $1123.65 / month |
| Silver PPO | $5,000 | $8,000 | 40% 1 | $40 | $80 | $364.72 / month $397.14 / month $409.54 / month $421.93 / month $435.28 / month $448.63 / month $462.46 / month $476.76 / month $476.76 / month $476.76 / month $476.76 / month $478.67 / month $488.20 / month $499.64 / month $518.24 / month $533.49 / month $541.12 / month $552.56 / month $564.01 / month $571.16 / month $578.79 / month $582.60 / month $586.41 / month $590.23 / month $594.04 / month $601.67 / month $609.30 / month $620.74 / month $631.71 / month $646.96 / month $666.03 / month $688.44 / month $715.14 / month $745.18 / month $779.50 / month $813.35 / month $851.49 / month $889.16 / month $930.64 / month $972.59 / month $1017.88 / month $1063.17 / month $1112.28 / month $1161.86 / month $1214.78 / month $1241.01 / month $1293.93 / month $1339.70 / month $1369.73 / month $1407.40 / month $1430.28 / month |
| Bronze PPO I | $7,500 | $9,200 | 50% 1 | $50 | $100 | $266.63 / month $290.33 / month $299.40 / month $308.46 / month $318.22 / month $327.98 / month $338.08 / month $348.54 / month $348.54 / month $348.54 / month $348.54 / month $349.93 / month $356.90 / month $365.27 / month $378.86 / month $390.02 / month $395.59 / month $403.96 / month $412.32 / month $417.55 / month $423.13 / month $425.92 / month $428.70 / month $431.49 / month $434.28 / month $439.86 / month $445.43 / month $453.80 / month $461.82 / month $472.97 / month $486.91 / month $503.29 / month $522.81 / month $544.77 / month $569.86 / month $594.61 / month $622.49 / month $650.03 / month $680.35 / month $711.02 / month $744.13 / month $777.24 / month $813.14 / month $849.39 / month $888.08 / month $907.25 / month $945.94 / month $979.40 / month $1001.36 / month $1028.89 / month $1045.62 / month |
| Bronze PPO II HSA | $7,100 | $7,100 | 0% 1 | $0 1 | $0 1 | $273.75 / month $298.08 / month $307.38 / month $316.69 / month $326.71 / month $336.73 / month $347.10 / month $357.84 / month $357.84 / month $357.84 / month $357.84 / month $359.27 / month $366.43 / month $375.02 / month $388.97 / month $400.42 / month $406.15 / month $414.74 / month $423.32 / month $428.69 / month $434.42 / month $437.28 / month $440.14 / month $443.01 / month $445.87 / month $451.59 / month $457.32 / month $465.91 / month $474.14 / month $485.59 / month $499.90 / month $516.72 / month $536.76 / month $559.30 / month $585.07 / month $610.48 / month $639.10 / month $667.37 / month $698.50 / month $729.99 / month $763.99 / month $797.98 / month $834.84 / month $872.06 / month $911.78 / month $931.46 / month $971.18 / month $1005.53 / month $1028.07 / month $1056.34 / month $1073.52 / month |
| Catastrophic Plan | $9,200 | $9,200 | 0% 1 | $35 2 | $0 1 | $153.38 / month $167.02 / month $172.23 / month $177.44 / month $183.06 / month $188.67 / month $194.49 / month $200.50 / month $200.50 / month $200.50 / month $200.50 / month $201.30 / month $205.31 / month $210.12 / month $217.94 / month $224.36 / month $227.57 / month $232.38 / month $237.19 / month $240.20 / month $243.41 / month $245.01 / month $246.62 / month $248.22 / month $249.82 / month $253.03 / month $256.24 / month $261.05 / month $265.66 / month $272.08 / month $280.10 / month $289.52 / month $300.75 / month $313.38 / month $327.82 / month $342.05 / month $358.09 / month $373.93 / month $391.38 / month $409.02 / month $428.07 / month $447.12 / month $467.77 / month $488.62 / month $510.87 / month $521.90 / month $544.16 / month $563.41 / month $576.04 / month $591.88 / month $601.50 / month |
Health benefits
These benefits are included in all HMSA individual plans and others are available when you enroll:
- HMSA’s Online Care.
- An annual preventive exam with no copayment.
- Generic drug coverage*.
- Adult vision coverage.
*All plans except the Bronze PPO II HSA plan and the Catastrophic plan cover generic drugs before you meet the deductible.
If you enroll or make changes to your health plan by Dec. 15, 2024, your plan will start Jan. 1, 2025. If you enroll or make changes to your health plan between Dec. 16, 2024, and Jan. 15, 2025, your plan will start Feb. 1, 2025.
Pediatric dental benefits are required by the ACA. Although our medical plans don’t include pediatric dental benefits, you may choose an HMSA dental plan to get covered.
Earliest effective date for these plans is January 1, 2024.
| Plan | Deductible | Max out– of–pocket | Coinsurance | Doctor visit copayment | Specialist visit copayment | Premiums based on age: |
|---|---|---|---|---|---|---|
| Platinum PPO | $0 | $3,200 | 10% | $10 | $20 | $374.22 / month $407.49 / month $420.21 / month $432.92 / month $446.62 / month $460.32 / month $474.50 / month $489.18 / month $489.18 / month $489.18 / month $489.18 / month $491.14 / month $500.92 / month $512.66 / month $531.74 / month $547.39 / month $555.22 / month $566.96 / month $578.70 / month $586.04 / month $593.86 / month $597.78 / month $601.69 / month $605.60 / month $609.52 / month $617.35 / month $625.17 / month $636.91 / month $648.16 / month 663.82 / month $683.38 / month $706.38 / month $733.77 / month $764.59 / month $799.81 / month $834.54 / month $873.68 / month $912.32 / month $954.88 / month $997.93 / month $1,044.40 / month $1,090.87 / month $1,141.26 / month $1,192.13 / month $1,246.43 / month $1,273.34 / month $1,327.63 / month $1,374.60 / month $1,405.41 / month $1,444.06 / month $1,467.54 / month |
| Gold PPO I | $500 | $8,700 | 20% 1 | $30 | $60 | $320.96 / month $349.49 / month $360.39 / month $371.30 / month $383.05 / month $394.80 / month $406.96 / month $419.55 / month $419.55 / month $419.55 / month $419.55 / month $421.23 / month $429.62 / month $439.69 / month $456.05 / month $469.48 / month $476.19 / month $486.26 / month $496.33 / month $502.62 / month $509.33 / month $512.69 / month $516.05 / month $519.40 / month $522.76 / month $529.47 / month $536.18 / month $546.25 / month $555.90 / month $569.33 / month $586.11 / month $605.83 / month $629.33 / month $655.76 / month $685.96 / month $715.75 / month $749.32 / month $782.46 / month $818.96 / month $855.88 / month $895.74 / month $935.60 / month $978.81 / month $1,022.44 / month $1,069.01 / month $1,092.09 / month $1,138.66 / month $1,178.94 / month $1,205.37 / month $1,238.51 / month $1,258.65 / month |
| Gold PPO II | $1,500 | $8,700 | 25% 1 | $30 | $60 | $292.15 / month $318.11 / month $328.04 / month $337.97 / month $348.67 / month $359.36 / month $370.43 / month $381.89 / month $381.89 / month $381.89 / month $381.89 / month $383.42 / month $391.06 / month $400.22 / month $415.11 / month $427.33 / month $433.45 / month $442.61 / month $451.78 / month $457.50 / month $463.61 / month $466.67 / month $469.72 / month $472.78 / month $475.83 / month $481.95 / month $488.06 / month $497.22 / month $506.00 / month $518.22 / month $533.50 / month $551.45 / month $572.84 / month $596.89 / month $624.39 / month $651.50 / month $682.06 / month $712.22 / month $745.45 / month $779.06 / month $815.34 / month $851.61 / month $890.95 / month $930.67 / month $973.06 / month $994.06 / month $1,036.45 / month $1,073.11 / month $1,097.17 / month $1,127.34 / month $1,145.67 / month |
| Silver PPO Direct | $5,900 | $9,100 | 40% 1 | $40 | $80 | $260.77 / month $283.95 / month $292.82 / month $301.68 / month $311.22 / month $320.77 / month $330.65 / month $340.88 / month $340.88 / month $340.88 / month $340.88 / month $342.24 / month $349.06 / month $357.24 / month $370.54 / month $381.44 / month $386.90 / month $395.08 / month $403.26 / month $408.37 / month $413.83 / month $416.56 / month $419.28 / month $422.01 / month $424.74 / month $430.19 / month $435.64 / month $443.83 / month $451.67 / month $462.57 / month $476.21 / month $492.23 / month $511.32 / month $532.80 / month $557.34 / month $581.54 / month $608.81 / month $635.74 / month $665.40 / month $695.40 / month $727.78 / month $760.16 / month $795.27 / month $830.72 / month $868.56 / month $887.31 / month $925.15 / month $957.87 / month $979.35 / month $1,006.28 / month $1,022.64 / month |
| Silver PPO | $5,900 | $9,100 | 40% 1 | $40 | $80 | $330.04 / month $359.38 / month $370.60 / month $381.82 / month $393.90 / month $405.98 / month $418.49 / month $431.43 / month $431.43 / month $431.43 / month $431.43 / month $433.16 / month $441.78 / month $452.14 / month $468.96 / month $482.77 / month $489.67 / month $500.03 / month $510.38 / month $516.85 / month $523.76 / month $527.21 / month $530.66 / month $534.11 / month $537.56 / month $544.46 / month $551.37 / month $561.72 / month $571.64 / month $585.45 / month $602.71 / month $622.98 / month $647.15 / month $674.33 / month $705.39 / month $736.02 / month $770.53 / month $804.62 / month $842.15 / month $880.12 / month $921.10 / month $962.09 / month $1,006.53 / month $1,051.39 / month $1,099.28 / month $1,123.01 / month $1,170.90 / month $1,212.32 / month $1,239.50 / month $1,273.58 / month $1,294.29 / month |
| Bronze PPO I | $7,500 | $9,400 | 50% 1 | $50 | $100 | $247.98 / month $270.03 / month $278.45 / month $286.88 / month $295.96 / month $305.03 / month $314.44 / month $324.16 / month $324.16 / month $324.16 / month $324.16 / month $325.46 / month $331.94 / month $339.72 / month $352.36 / month $362.74 / month $367.92 / month $375.70 / month $383.48 / month $388.34 / month $393.53 / month $396.12 / month $398.72 / month $401.31 / month $403.90 / month $409.09 / month $414.28 / month $422.06 / month $429.51 / month $439.89 / month $452.85 / month $468.09 / month $486.24 / month $506.66 / month $530.00 / month $553.02 / month $578.95 / month $604.56 / month $632.76 / month $661.29 / month $692.08 / month $722.88 / month $756.27 / month $789.98 / month $825.96 / month $843.79 / month $879.77 / month $910.89 / month $931.31 / month $956.92 / month $972.48 / month |
| Bronze PPO II HSA | $7,100 | $7,100 | 0% 1 | $0 1 | $0 1 | $256.46 / month $279.25 / month $287.97 / month $296.69 / month $306.07 / month $315.46 / month $325.18 / month $335.24 / month $335.24 / month $335.24 / month $335.24 / month $336.58 / month $343.29 / month $351.33 / month $364.41 / month $375.13 / month $380.50 / month $388.54 / month $396.59 / month $401.62 / month $406.98 / month $409.66 / month $412.35 / month $415.03 / month $417.71 / month $423.07 / month $428.44 / month $436.48 / month $444.19 / month $454.92 / month $468.33 / month $484.09 / month $502.86 / month $523.98 / month $548.12 / month $571.92 / month $598.74 / month $625.22 / month $654.39 / month $683.89 / month $715.74 / month $747.59 / month $782.11 / month $816.98 / month $854.19 / month $872.63 / month $909.84 / month $942.02 / month $963.14 / month $989.63 / month $1,005.72 / month |
| Catastrophic Plan | $9,450 | $9,450 | 0% 1 | $35 2 | $0 1 | $126.83 / month $138.10 / month $142.41 / month $146.72 / month $151.37 / month $156.01 / month $160.82 / month $165.79 / month $165.79 / month $165.79 / month $165.79 / month $166.45 / month $169.77 / month $173.75 / month $180.21 / month $185.52 / month $188.17 / month $192.15 / month $196.13 / month $198.62 / month $201.27 / month $202.60 / month $203.92 / month $205.25 / month $206.57 / month $209.23 / month $211.88 / month $215.86 / month $219.67 / month $224.98 / month $231.61 / month $239.40 / month $248.69 / month $259.13 / month $271.07 / month $282.84 / month $296.10 / month $309.20 / month $323.62 / month $338.21 / month $353.96 / month $369.71 / month $386.79 / month $404.03 / month $422.43 / month $431.55 / month $449.95 / month $465.87 / month $476.31 / month $489.41 / month $497.37 / month |
Health benefits
These benefits are included in all HMSA individual plans and others are available when you enroll:
- HMSA’s Online Care.
- An annual preventive exam with no copayment.
- Generic drug coverage*.
- Adult vision coverage.
*All plans except the Bronze PPO II HSA plan and the Catastrophic plan cover generic drugs before you meet the deductible.