Dean Advantage plan options and details
Premier additional benefits
$50/quarter to spend on OTC items
$1500/year preventive and comprehensive dental
$0 premiums on eligible plans
2023 benefits overview
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
-
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
-
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
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
-
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
-
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:
Stage 2: initial coverage copay and coinsurance, you pay:
| | 1 month/30 day | 3 month/100 day |
| | Preferred retail and mail order | Standard retail | Mail order | Preferred retail | Standard 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.
