Medical Plans

The SmithRx plan offers a choice of four (4) medical plans designed to help you and your family maintain good health and financial well-being. Deciding which plan is best for you depends on your specific health care needs, preferences, budget, and lifestyle.

Three (3) medical plans are offered through Allied using the Aetna provider network. Kaiser Permanente is offered to California residents only.

Smith administers coverage using the Aetna Signature Administrators Network and Aetna Signature Administrators Extended Network (Utah Members).

To find a provider, utilize the ASA Network link below. If your provider is searching for your coverage, ensure the provider navigates the ASA/ASA Extended network.

If you need assistance finding a provider in the Intermountain Health network, please use this link and select either “Find a doctor” or “Find a location”

***Utah Members: Intermountain Health Care providers participate in the Aetna Signature Administrators Extended Network.

Find care and compare costs for providers and services in your network
View what’s covered under your plan and explore your unique benefit programs
See your claim details and view progress toward your deductible
View and share your health plan ID card with your doctor’s office

Plan Options

Allied/Aetna Bronze PPO Plan

$1,500/$4,500 In-Network Deductible (Individual/Family)
$7,900/$15,800 In-Network Out-Of-Pocket Maximum (Individual/Family)
Copays:

Telemedicine - $0
PCP - $25 copay per visit
Specialist - $60 copay per visit
Rx: $5/$50/$100/25%
Urgent Care - $30 copay per visit
ER: $250 per visit + 20% coinsurance

Diagnostic Labs: $15 copay
X-Rays and Complex Imaging: $350 copay
Inpatient surgery: 20% coinsurance after deductible

Allied/Aetna Silver PPO Plan

$500/$1,500 In-Network Deductible (Individual/Family)
$5,500/$11,000 In-Network Out-Of-Pocket Maximum (Individual/Family)
Copays:

Telemedicine - $0
PCP - $20 copay per visit
Specialist - $50 copay per visit
Rx: $5/$50/$100/25%
Urgent Care - $30 copay per visit
ER: $250 per visit + 20% coinsurance

Diagnostic Labs: $15 copay
X-Rays and Complex Imaging: $200 copay
Inpatient surgery: 20% coinsurance after deductible

Allied/Aetna Gold PPO Plan

$250/$750 In-Network Deductible (Individual/Family)
$3,800/$7,600 In-Network Out-Of-Pocket Maximum (Individual/Family)
Copays:

Telemedicine - $0
PCP - $15 copay per visit
Specialist - $30 copay per visit
Rx: $5/$50/$100/25%
Urgent Care - $15 copay per visit
ER: $225 per visit + 10% coinsurance

Diagnostic Labs: $10 copay
X-Rays and Complex Imaging: $100 copay
Inpatient surgery: 20% coinsurance after deductible

Kaiser Permanente Platinum 90 HMO 0/20 + Child Dental Plan

Now open to ALL California employees.
Employee premiums are age banded. Employee contribution is 10% of total premium. Cost is available in Workday.
$0/$0 In-Network Deductible (Individual/Family)
$4,500/$9,000 In-Network Out-Of-Pocket Maximum (Individual/Family)
Copays:

Telemedicine - $0
PCP - $20 copay per visit
Specialist - $30 copay per visit
Rx: $5/$20/$20/10%
Urgent Care - $20 copay per visit
ER - $150 copay per visit

Diagnostic Labs: $20 copay
X-Rays: $30 copay
Complex Imaging: $100 copay
Inpatient surgery: 20% coinsurance after deductible
Children's eye exam, glasses, and dental check-up - $0

ALLIED/KAISER PPO PLANS

	Bronze PPO Plan	Silver PPO Plan	Gold PPO Plan	Kaiser Platinum Plan
Network Name	Aetna (In-Network)	Aetna (In-Network)	Aetna (In-Network)	Kaiser Permanente (In-Network)
Calendar Year Deductible Individual Family	$1,500 $4,500	$500 $1,500	$250 $750	$0 $0
Out-of-Pocket Maximum Individual Family	$7,900 $15,800	$5,500 $11,000	$3,800 $7,600	$4,500 $9,000
Coinsurance	20%	20%	10%	10%
PCP Copay	$25 copay per visit	$20 copay per visit	$15 copay per visit	$20 per visit
Specialist Copay	$60 copay per visit	$50 copay per visit	$30 copay per visit	$30 per visit
Lab and X-ray *Dr Office & Lab Facilities	$15 copay per visit	$15 copay per visit	$10 copay per visit	$20 per test (Lab) $30 per order (X-ray)
Advanced Imaging	$350 copay; then 20% deductible does not apply	$200 copay; then 20% deductible does not apply	$100 copay; then 10% deductible does not apply	$100 per order
In Network Prescription Drug Card (preferred drugs)	$5 / $50 / $100	$5 / $50 / $100	$5 / $50 / $100	$5 / $20 / $20
Urgent Care Copay	$30 copay per visit	$30 copay per visit	$15 copay per visit	$20 per visit
Emergency Room Copay	$250 copay; then 20% deductible does not apply	$250 copay; then 20% deductible does not apply	$225 copay; then 10% deductible does not apply	$150 per visit
Inpatient Hospitalization	20% coinsurance after deductible	20% coinsurance after deductible	10% coinsurance after deductible	$250 per day
Outpatient Hospitalization	20% coinsurance after deductible	$200 copay; then 20% deductible does not apply	$200 copay; then 10% deductible does not apply	$125 per visit
Telehealth	$0	$0	$0	$0

EMPLOYEE COST PER MONTH (ALLIED MEMBERS)

EE ONLY	$82.86	$104.40	$118.48
EE + SPOUSE	$165.71	$208.80	$236.97
EE + CHILD(REN)	$145.00	$182.70	$207.35
FAMILY	$248.57	$313.19	$355.45

*Kaiser premiums are age-banded, to receive an estimated employee cost, please reach out to benefits@smithrx.com.

MedOne Rx

All members enrolled in an SmithRx Allied Medical Plan will automatically have prescription coverage through MedOne Rx.

How do I get my prescriptions at the pharmacy?

Provide your prescription beneﬁts card to your pharmacy and ask them to update your insurance proﬁle. The pharmacy will need the BIN, PCN, Member ID, and Rx Group number to process any covered prescription(s)

Which pharmacies can I go to? Is my local pharmacy in-network?

There are over 75,000 in-network retail pharmacies.

Who is my mail-order service provider?

MedOne Mail Order and Thrifty White Pharmacy provide mail order benefits.

Where do I get my specialty medications?

The RxAlly™ Specialty Advocacy Program is designed to help members secure access to specialty medications through Patient Assistance Programs. A specialty medication is a medication that treats complex medical conditions such as cancer, psoriatic arthritis, and multiple sclerosis, and often require specific handling and storage requirements. All specialty medications require a prior authorization once the member engages RxAlly.

While your patient assistance application is in process, you may be eligible to receive your medication through a bridge fill. A bridge fill is a fill of your specialty medication through your prescription drug coverage administered by MedOne. Prior to receiving your bridge fill, a medical necessity review may need to be completed.

What is a formulary and where can I find the drug formulary?

A formulary is a list of drugs that your doctor may prescribe for you that includes information related to coverage and cost of these drugs. This list may change over time. You can access your drug formulary by visiting the MedOne Member Portal. The portal shows what tier a medication is on and indicates if a medication requires a prior authorization or is subject to any other edits such as step therapy, etc.

MedOne can help lower your prescription drug costs:

MedOne works with preferred pharmacy partners to capture a variety of savings opportunities. RxAlly through MedOne can help you navigate alternative sources and support for Specialty Medications. This saves you money as many of these programs require little to no co-payment on medications
To help you reduce your out-of-pocket costs for prescription medications, our health plan now includes a great mail order program through a company called CanaRx. This benefit allows you to obtain certain brand-name medications at a ZERO COPAY.

Mark Cuban CostPlus Drug Program:

MCCPDC is in-network
The cost difference will vary on a medication-by-medication basis.
You should compare the costs using MCCPDC to determine the lowest cost pharmacy for your specific medication.

Recuro Health

Get care when you need it.

Imagine 360 has partnered with Recuro to provide members with telehealth access 24/7.

See board-certified providers for urgent care or primary care. You can also schedule consults with licensed counselors and psychiatrists. Prescriptions are sent to a pharmacy near you.

Teladoc Health

Teladoc Health's mission is to empower all people everywhere to live their healthiest lives. From Primary Care to Mental Health and Specialty Wellness and beyond, Teladoc Health puts your healthcare experience at your fingertips!

CancerCARE+

A cancer diagnosis can be scary and hard to navigate on your own. The CancerCARE Program is a free, fully integrated cancer solution included in YOUR Allied health plan that supports you from the first day of your diagnosis.

The compassionate medical team with the CancerCARE Program is there to support you and your family in the event of a cancer diagnosis, to advocate for your best interests, and to make sure that your needs are met during this challenging time. Your CancerCARE+ coordinator will:

Help to coordinate a second opinion with renowned national centers of excellence
Promote the utilization of clinical pathways prior to treatment planning
Ensure the most evidence-based and cost-effective treatment protocol is implemented quickly
Help the patient navigate all aspects of care
Connect the patient to the Cancer Centers of Excellence Network for complex treatment needs
Facilitate access to oncology experts who work to improve care and reduce costs

What Is An EOB?

EOB stands for Explanation of Benefits.

This is a document sent to you by your insurance administrator to let you know that a claim has been processed.

The most important thing to remember is that an EOB is NOT a bill, and you should not pay an in-network provider without receiving a matching EOB.

An EOB lets you know which healthcare provider has filed a claim on your behalf, what it was for, whether it was approved, and for how much.

You should always review your EOB to make sure it is correct.

SmartConnect For Medicare-Eligible

SmartConnect is an exclusive program created specifically for working or retiring adults (and family members) who are Medicare-eligible and may not have fully explored the benefits of Medicare coverage.

Staying on your employer’s coverage may be easy, but it’s not always the best option. In fact, Medicare plans could provide more coverage at a lower cost than your employer’s plan.

Continue to FSA