Lifestyle Health Plans Affinity Plans – Full Sail Insurance Services

HMA Group Plan Solution

The HMA Group plan solution has all the benefits of our MEC offerings. The solution offers Small Co-pays, No Deductibles, Prescription Lab Services, Drug Coverage, and even a Hospital Component for Inpatient, Outpatient, Emergency Room, and Ambulance Services. Plus the plans have the added benefit of advanced information solutions that provide participants:

Instant access to expert medical advice and opinion via text message
The ability to search locally for the best price on prescriptions
Search for medical procedures and prices in your local area
Reminders about plan updates and changes, and tips for accessing cost effective health care

All these services are available at a cost effective price, and a four (4) year “rate lock”.
The HMA Group Plan Solution requires a minimum group size of four (4) employees, and enrollment is open year round.
Apex products are not available in MA, ND.

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SERVICES		BASIC
PPO Network Services: PHCS
Preventive Benefits – Covers all mandated Preventive benefits required by PPACA Note: This list will be updated from time to time and a current list of covered preventive services is available at healthcare.gov Medical Benefits – Must utilize a PHCS Network provider or facility. PHCS is part of MultiPlan, Inc. Call to confirm.
All 21 Preventive Services for Adults		100% Coverage for Mandated Preventive Care Services
All 28 Preventive Services for Women		100% Coverage for Mandated Preventive Care Services
All 31 Preventive Services for Children		100% Coverage for Mandated Preventive Care Services
Telemedicine – Health Wallet		$0 Copay, unlimited use for all family members
Primary Care Office Visit		$0 Copay, Max 1 visit
Specialists Office Visit		Not Covered
Urgent Care		Not Covered
Diagnostic X-Ray, Lab		Not Covered
CT Scan or MRI		Not Covered
*Hospital, Surgical, Ambulance, Emergency Room		Not Covered
Prescription Drug Benefits -Citizens Rx
Tier I – Low Cost Generics		Citizens Rx discount prescription drug plan*
Tier 2 – Generics		Citizens Rx discount prescription drug plan*
Tier 3- Preferred Brand		Citizens Rx discount prescription drug plan*
Tier 4 – Non-Preferred Brand		Citizens Rx discount prescription drug plan*
Tier 5 – Generic & Preferred Specialty		Citizens Rx discount prescription drug plan*
Tier 6 – Non-Preferred Specialty		Citizens Rx discount prescription drug plan*
*Citizens Rx provides a discount prescription drug plan for the Basic Plan. Discount varies based on Pharmacy and Region from 40 to 70% off retail level on all FDA Approved Medications
Contribution Schedule (Monthly Rates) Four Year Rate Lock: Increase in years 2 through 4 cannot exceed 3% on an accumulative basis
EE Only		$74.90
EE Plus Child(ren)		$96.30
EE Plus Spouse		$96.30
EE Plus Family		$96.30
Disclaimer: Apex Management Group Suite of Health Care Solutions are not insurance products, but self-funded plans. Please see Plan Document and SPD for full details.

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SERVICES		PLUS
PPO Network Services: PHCS
Preventive Benefits – Covers all mandated Preventive benefits required by PPACA Note: This list will be updated from time to time and a current list of covered preventive services is available at healthcare.gov Medical Benefits – Must utilize a PHCS Network provider or facility. PHCS is part of MultiPlan, Inc. Call to confirm.
All 21 Preventive Services for Adults		100% Coverage for Mandated Preventive Care Services
All 28 Preventive Services for Women		100% Coverage for Mandated Preventive Care Services
All 31 Preventive Services for Children		100% Coverage for Mandated Preventive Care Services
Telemedicine – Health Wallet		$0 Copay, unlimited use for all family members
Primary Care Office Visit		$0 Copay, Max 2 visits
Specialists Office Visit		Not Covered
Urgent Care		Not Covered
Diagnostic X-Ray, Lab		Not Covered
CT Scan or MRI		Not Covered
*Hospital, Surgical, Ambulance, Emergency Room		Not Covered
Prescription Drug Benefits -Citizens Rx
Tier I – Low Cost Generics		Citizens Rx discount prescription drug plan*
Tier 2 – Generics		Citizens Rx discount prescription drug plan*
Tier 3- Preferred Brand		Citizens Rx discount prescription drug plan*
Tier 4 – Non-Preferred Brand		Citizens Rx discount prescription drug plan*
Tier 5 – Generic & Preferred Specialty		Citizens Rx discount prescription drug plan*
Tier 6 – Non-Preferred Specialty		Citizens Rx discount prescription drug plan*
*Citizens Rx provides a discount prescription drug plan for the Basic Plan. Discount varies based on Pharmacy and Region from 40 to 70% off retail level on all FDA Approved Medications
Contribution Schedule (Monthly Rates) Four Year Rate Lock: Increase in years 2 through 4 cannot exceed 3% on an accumulative basis
EE Only		$88.75
EE Plus Child(ren)		$130.50
EE Plus Spouse		$142.00
EE Plus Family		$189.25
Disclaimer: Apex Management Group Suite of Health Care Solutions are not insurance products, but self-funded plans. Please see Plan Document and SPD for full details.

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SERVICES		ADVANTAGE
PPO Network Services: PHCS
Preventive Benefits – Covers all mandated Preventive benefits required by PPACA Note: This list will be updated from time to time and a current list of covered preventive services is available at healthcare.gov Medical Benefits – Must utilize a PHCS Network provider or facility. PHCS is part of MultiPlan, Inc. Call to confirm.
All 21 Preventive Services for Adults		100% Coverage for Mandated Preventive Care Services
All 28 Preventive Services for Women		100% Coverage for Mandated Preventive Care Services
All 31 Preventive Services for Children		100% Coverage for Mandated Preventive Care Services
Telemedicine – Health Wallet		$0 Copay, unlimited use for all family members
Primary Care Office Visit		$20 Copay (Max 3 visits per calendar year)
Specialists Office Visit		$50 Copay (Max 3 visits per calendar year)
Urgent Care		$50 Copay (Max 3 visits per calendar year)
Diagnostic X-Ray, Lab		$50 Copay (Max 5 visits per calendar year)
CT Scan or MRI		$200 Copay (Max 1 CT Scan or MRI per Calendar Year)
*Hospital, Surgical, Ambulance, Emergency Room		Not Covered
Prescription Drug Benefits -Citizens Rx
Tier I – Low Cost Generics		$1 Copay
Tier 2 – Generics		10% Coinsurance
Tier 3- Preferred Brand		20% Coinsurance
Tier 4 – Non-Preferred Brand		40% Coinsurance
Tier 5 – Generic & Preferred Specialty		10% Coinsurance (Plan pays 90% up to a maximum of $150 per Rx)
Tier 6 – Non-Preferred Specialty		20% Coinsurance (Plan pays 80% up to a maximum of $250 per Rx)
*Citizens Rx provides a discount prescription drug plan for the Basic Plan. Discount varies based on Pharmacy and Region from 40 to 70% off retail level on all FDA Approved Medications
Contribution Schedule (Monthly Rates) Four Year Rate Lock: Increase in years 2 through 4 cannot exceed 3% on an accumulative basis
EE Only		$143.11
EE Plus Child(ren)		$216.40
EE Plus Spouse		$233.50
EE Plus Family		$313.75
Disclaimer: Apex Management Group Suite of Health Care Solutions are not insurance products, but self-funded plans. Please see Plan Document and SPD for full details.

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SERVICES		PREMIER
PPO Network Services: PHCS
Preventive Benefits – Covers all mandated Preventive benefits required by PPACA Note: This list will be updated from time to time and a current list of covered preventive services is available at healthcare.gov Medical Benefits – Must utilize a PHCS Network provider or facility. PHCS is part of MultiPlan, Inc. Call to confirm.
All 21 Preventive Services for Adults		100% Coverage for Mandated Preventive Care Services
All 28 Preventive Services for Women		100% Coverage for Mandated Preventive Care Services
All 31 Preventive Services for Children		100% Coverage for Mandated Preventive Care Services
Telemedicine – Health Wallet		$0 Copay, unlimited use for all family members
Primary Care Office Visit		$20 Copay (Max 3 visits per calendar year)
Specialists Office Visit		$50 Copay (Max 3 visits per calendar year)
Urgent Care		$50 Copay (Max 3 visits per calendar year)
Diagnostic X-Ray, Lab		$50 Copay (Max 5 visits per calendar year)
CT Scan or MRI		$200 Copay (Max 1 CT Scan or MRI per Calendar Year)
*Hospital, Surgical, Ambulance, Emergency Room		***$0 Deductible 50% Coinsurance to $5,000, Maximum benefit $2,500
Prescription Drug Benefits -Citizens Rx
Tier I – Low Cost Generics		$1 Copay
Tier 2 – Generics		10% Coinsurance
Tier 3- Preferred Brand		20% Coinsurance
Tier 4 – Non-Preferred Brand		40% Coinsurance
Tier 5 – Generic & Preferred Specialty		10% Coinsurance (Plan pays 90% up to a maximum of $150 per Rx)
Tier 6 – Non-Preferred Specialty		20% Coinsurance (Plan pays 80% up to a maximum of $250 per Rx)
*Citizens Rx provides a discount prescription drug plan for the Basic Plan. Discount varies based on Pharmacy and Region from 40 to 70% off retail level on all FDA Approved Medications
Contribution Schedule (Monthly Rates) Four Year Rate Lock: Increase in years 2 through 4 cannot exceed 3% on an accumulative basis
EE Only		$244.50
EE Plus Child(ren)		$374.90
EE Plus Spouse		$374.90
EE Plus Family		$443.00
Disclaimer: Apex Management Group Suite of Health Care Solutions are not insurance products, but self-funded plans. Please see Plan Document and SPD for full details.

CHANGING THE WAY HEALTHCARE IS DELIVERED

Need medical atention?

Forget about having to rely on medical information that is not accurate to your needs. Why not consolidate everything you need to stay healthy inside one single place?
We built tools that make our clients life more easy. Find out how you can benefit from the tools we have built in to this application to make your healthcare needs easier to take care of.

My Plan Info

A centralized location with current medical insurance plan design information, real-time deductible-utilization and the capacity to hold up to 15 electonic ID cards

RX Market

USearch for any prescription to see what the pharmacies around you are charging for the drug, The Rx Market has an embedded manufacturers discount code for even better pricing, as well as useful information such as pictures, warnings, dosages and storage recommendations

TeleHealth

Unlimited access to a national network of licensed doctors via telephone or video chat, who can help to diagnose and even prescribe in real-time directly from your mobile device

User Engagement

Receive important reminders about plan updates, benefit changes, feature updates and tips on how to access cost-effective and convenient healthcare whenever you need it most.

Medical Market

Medical Market Now you can search for anything from an allergy shot to a cardiovascular bypass using the current location of your mobile device, and see what different facilities are charging for different medical procedures. The results are pretty astounding

Healthcare Concierge

Instant access to a dedicated healthcare concierge that can help you better understand and more effectively utilize your benefits

Go to the Apple App Store or Google Play Stor
Type in "The Health Wallet"
Download "The Health Wallet" App
Open "The Health Wallet” App
To login, enter your SSN or Member ID, along with your birthday
Once you are logged in, you will have immediate access a suite of digital health benefits
Click on "My Plan Info" to access your medical, dental, vision ID cards and other lines of coverage information

HMA Group Plan Solution

HMA Group Plan Solution

CHANGING THE WAY HEALTHCARE IS DELIVERED

Need medical atention?

My Plan Info

RX Market

TeleHealth

User Engagement

Medical Market

Healthcare Concierge

How To Use Health Wallet

Your medical card data, beautifully organized from now on

Company

Support

Headquarters

How Self-Funded Health Insurance Plans Work

Group Self-Funded Health Coverage