Dean Advantage plan options and details

Premier additional benefits

2023 plans

Our 2023 plans include these extra benefits and more.

2023 benefits overview

Essential (HMO)

$
0
per month, in-network only
  • Additional savings
    N/A
  • Hospital copay
    $350/day for days 1-5
     
  • Primary care copay
    $0
  • Specialist copay
    $50
  • Emergency room copay
    $110
  • Urgent care copay
    $50
  • Ground ambulance
    $275
  • Therapy: physical, occupational, speech
    $40
  • Outpatient surgery
    $350
     
  • Maximum out-of-pocket (per year)
    $5,500

Assurance (HMO-POS)

$
50
per month
  • Additional savings
    N/A
  • Hospital copay
    In-network: $350/day for days 1-5
    Out-of-network: $600/day for days 1-7
  • Primary care copay
    In-network: $0, Out-of-network: $60
  • Specialist copay
    In-network: $40, Out-of-network: $60
  • Emergency room copay
    $110
  • Urgent care copay
    $40
  • Ground ambulance
    $275
  • Therapy: physical, occupational, speech
    In-network: $40, Out-of-network: $60
  • Outpatient surgery
    In-network: $350
    Out-of-network: 40% coinsurance
  • Maximum out-of-pocket (per year)
    $4,500

Balance (HMO-POS)

$
97
per month
  • Additional savings
    N/A
  • Hospital copay
    In-Network: $350/day for days 1-5
    Out-of-network: $600/day for days 1-7
  • Primary care copay
    In-network: $0, Out-of-network: $60
  • Specialist copay
    In-network: $30, Out-of-network: $60
  • Emergency room copay
    $125
  • Urgent care copay
    $30
  • Ground ambulance
    $275
  • Therapy: physical, occupational, speech
    In-network: $40, Out-of-network: $60
  • Outpatient surgery
    In-network: $350
    Out-of-network: 40% coinsurance
  • Maximum out-of-pocket (per year)
    $3,650

Complete (HMO)

$
251
per month, in-network only
  • Additional savings
    N/A
     
  • Hospital copay
    $350/day for days 1-5
     
  • Primary care copay
    $0
  • Specialist copay
    $10
  • Emergency room copay
    $125
  • Urgent care copay
    $10
  • Ground ambulance
    $275
  • Therapy: physical, occupational, speech
    $40
  • Outpatient surgery
    $350
     
  • Maximum out-of-pocket (per year)
    $2,000

Harmony (HMO-POS) MA-only

$
0
per month
  • Additional savings
    $20 monthly Part B premium reduction
     
  • Hospital copay
    In-network: $350/day for days 1-5
    Out-of-network: $600/day for days 1-7
  • Primary care copay
    In-network: $0, Out-of-network: $75
  • Specialist copay
    In-network: $35, Out-of-network: $75
  • Emergency room copay
    $110
  • Urgent care copay
    $35
  • Ground ambulance
    $275
  • Therapy: physical, occupational, speech
    In-network: $40, Out-of-network: $75
  • Outpatient surgery
    In-network: $350
    Out-of-network: 40% coinsurance
  • Maximum out-of-pocket (per year)
    $4,500

SSM Presence (HMO-POS)*

$
0
per month
  • Additional savings
    FlexSpend: $650 yearly for dental/vision/hearing
  • Hospital copay
    In-Network: $350/day for days 1-5
    Out-of-network: $600/day for days 1-7
  • Primary care copay
    In-network: $0, Out-of-network: $60
  • Specialist copay
    In-network: $40, Out-of-network: $60
  • Emergency room copay
    $90
  • Urgent care copay
    $40
  • Ground ambulance
    $275
  • Therapy: physical, occupational, speech
    In-network: $40, Out-of-network: $60
  • Outpatient surgery
    In-network: $350
    Out-of-network: 40% coinsurance
  • Maximum out-of-pocket (per year)
    $4,900

2023 part D drug overview

Stage 1: initial coverage deductible (applies to Tiers 3-5), you pay:

Essential (HMO)

$
250
-

Assurance (HMO-POS)

$
150
-

Balance (HMO POS)

$
100
-

Complete (HMO)

$
0
-

SSM Presence* (HMO POS)

$
250
-

Stage 2: initial coverage copay and coinsurance, you pay:

 1 month/30 day3 month/100 day
 Preferred retail and mail orderStandard retailMail orderPreferred retailStandard retail
Tier 1$2$7$0$2$7
Tier 2$10$15$0$20$30
Tier 3$42$47$117.50$117.50$130
Tier 4$95$100$285$285$300
Tier 5
Cost Sharing Varies by Plan

Essential: 29%
Assurance: 30%
Balance: 31%
Complete: 33%
SSM Presence: 29%

Not applicable


Stage 3: coverage gap (donut hole), you pay:

25% coinsurance

Stage 4: catastrophic coverage, you pay:

Generic: 5% or $4.15
Brand: 5% or $10.35


Drug dispensing fees may apply. Benefits vary by plan. Please see the summary of benefits (PDF updated 10/1/2022) for full plan details.