Medical Plan
Your medical plan pays benefits for both in-network and out-of-network care and includes a Health Reimbursement Account — or HRA — funded by Tidelands Health. It also includes coverage for prescription drugs.
About the Plan
- You will save the most money when you choose in‐network doctors and facilities through Tidelands Health.
- Benefits will also be paid for in-network providers that you access through Blue Preferred PPO, but you will pay more out of your pocket.
- Out-of-network benefits are paid for doctors, facilities and pharmacies that are not part of either the Tidelands Health or Blue Preferred PPO networks. However, you will pay the most out of your pocket when you go out-of-network.
About the Health Reimbursement Account
The medical plan includes an HRA funded by Tidelands Health. Each year, you have the opportunity to earn an HRA contribution when you complete your online lifestyle questionnaire by July 31 and earn points within the YouCare program. The amount of your HRA contribution depends upon completing required activities and the Coverage Tier you select each year during Open Enrollment. You can use your HRA contribution dollars to help pay for qualified medical, dental, and vision out-of-pocket expenses. Learn more about the HRA and how much Tidelands Health contributes.
Quick Cost Comparison
Below is a quick summary of your out-of-pocket costs when you use in-network and out-of-network providers. For more information, view a detailed comparison.
| In-Network | Out-of-Network | ||
|---|---|---|---|
| Tidelands Health | Blue Preferred PPO | ||
| Office Visits Primary Care, including Telehealth Specialist, including Telehealth |
$25 copay* $50 copay* |
$50 copay* $100 copay* |
50% after deductible (no Telehealth) |
| Deductible | |||
| Individual | $1,500 | $3,000 | $4,500 |
| Family | $3,000 | $6,000 | $9,000 |
| Out-of-Pocket Maximum | |||
| Individual | $4,000 | $8,000 | $9,000 |
| Family | $8,000 | $16,000 | $18,000 |
| Coinsurance | 15% | 25% | 50% |
| Emergency Room | 15% after deductible | 15% after deductible | 15% after deductible |
* Deductible waived
Make the Most of Your Benefits
Where you go for care matters, both to your health and how much you’ll pay. It’s smart to be aware of factors that impact your costs:
Save When You Stay In-Network
You save the most when you choose in-network doctors, providers, pharmacies and facilities. To find a provider, Log on to tidelandshealthplan.com or call 877-498-6693. For Tidelands Health providers visit tidelandshealth.org.
Need lab work? You pay a $50 copay for labs performed at Tidelands Health unless labs are performed as part of your provider office visit or as preventive labs. Non-preventive labs and tests processed through LabCorp or other outside labs are subject to the plan deductible.
Use Quantum Health Care Coordinators
Care Coordinators are your personal healthcare advocates with a team of dedicated nurses, health benefit experts and claims specialists. Contact them for guidance to help ensure you have the best health experience at an affordable cost. They can:
- Issue/replace ID cards
- Answer claims, billing and benefits questions
- Help manage chronic conditions
- Find in-network providers
- Help reduce unnecessary out-of-pocket costs
Log on to tidelandshealthplan.com or call 877-498-6693.
Be Knowledgeable about Balance Billing
The amount the plan pays for covered services provided by non‐network providers is based on a maximum allowable amount for the specific service rendered. Although the plan features an out‐of‐pocket maximum for out‐of‐network services, please note the maximum allowed amount for an eligible procedure may not be equal to the amount charged by your out‐of‐network provider. They may bill you for the difference between the amount charged and the maximum allowed amount. This is called balance billing, and the amount billed to you can be substantial.
The plan’s out‐of‐pocket maximum will not include amounts more than the allowable charge and other non‐covered expenses as defined by your plan. The maximum reimbursable amount for non‐network providers can be based on a number of schedules, such as a percentage of reasonable and customary or a percentage of Medicare.
The plan document or carrier’s master policy is the controlling document, and this summary does not include all of the terms, coverage, exclusions, limitations, and conditions of the actual plan language. Call your Quantum Health Care Coordinator at 877-498-6693 if you have questions about the amount being billed by your provider.
Review Your Medical Plan Explanation of Benefits (EOB)
Your claims are administered by Planned Administrators, Inc.— PAI. Visit them at paisc.com for more information or to find your claim’s Explanation of Benefits (EOBs). If you’re newly enrolled, select “Member Portal” and create your profile using the name shown on your ID Card.
Sign Up for MASA Medical Transportation Services
MASA is the simple solution to a complex problem for millions of Americans. As the leading provider of emergency and medical transport benefits, MASA supports members by protecting them from out-of-pocket costs for medical transport while also offering services for use during recovery and beyond.
All full-time and part-time employees are eligible to sign up for a membership with MASA Medical Transportation Services. Qualifications for MASA protection include:
- You must hold active, primary health insurance at the time of serious emergency/incident occurring:
- MASA applies after your primary insurance makes a decision on the claim and makes any payment
- If you do not have active, primary health insurance at the time of your claim, MASA will pay 20% of the total bill
- You must be above 18 years of age to purchase MASA
- You must live primarily in a US 50-states residence
Note: If you have a pre-existing condition, all non-emergency benefits will not apply during the first 90 days of your enrollment.
Choose from two MASA Access plans:
- Emergent Plus provides emergency air and ground transportation services, non-emergent hospital to hospital, and repatriation anywhere in the United States and Canada, regardless of whether the provider is in or out of a medical plan’s provider network.
- Platinum provides all of the above, plus emergency transportation services worldwide.
Enroll at any time through Workday. Learn more about the Emergent Plus and Platinum memberships.
| MASA MTS Monthly Premiums | |
|---|---|
| Emergent Plus Membership | $14.00 |
| Platinum Membership | $39.00 |