For 2025, the Centivo PCP Partnership Plan will be available in Southern California, Dallas, TX, Denver, CO, Kansas City (KS and MO), and Seattle and Spokane, Washington.
- This plan offers affordable healthcare with a low deductible, FREE primary care visits and set copays for most other care.
- The core of the PCP Partnership Plan is a relationship between you and your designated primary care doctor within the Centivo network who can help keep you healthier, improve your healthcare experience and keep your costs low.
- Your doctor, who leads your Primary Care Team, will refer you to high-quality, in-network specialists, ensuring that you’ll get the right care for your needs at the best price.
- When you see your primary care doctor first (remember, these visits are FREE), get referrals for specialty care and see in-network specialists, you’ll get predictable copays, so you’ll know what you owe before going to the doctor.
| 2025 CENTIVO PCP PARTNERSHIP PLAN | |
|---|---|
| Provider network | Southern CA: Providers who are affiliated with MemorialCare, UCLA Health and Scripps Health
Denver, CO: Providers who are affiliated with Advent Health and CommonSpirit (formerly known as Centura) Dallas, TX: Providers who are affiliated with Baylor Scott & White Quality Alliance, an accountable care organization (ACO) affiliated with Baylor Scott & White Health Kansas City, KS and MO: Providers who are affiliated with Centrus Health Seattle, WA: Providers who are affiliated with Embright Health System and University of Washington, Harborview Medical Center Spokane, WA: Providers who are affiliated with CHAS Heath and Multicare Health System |
| Primary Care Physician (PCP) to manage care | Required |
| Referrals needed to see a specialist | Required |
| Calendar Year Deductible | $1,000 per individual/$2,000 per family |
| Health Savings Account (HSA) | N/A |
| Coinsurance (You Pay) After Meeting Deductible | N/A |
| Calendar Year Out-of-Pocket Maximum | $4,000 per individual/$8,000 per family |
| Preventive Care | In-network only: Covered in full (calendar year deductible waived) |
| Office Visit (You Pay) | PCP: FREE, Specialist: $50 copay |
| Hospitalization | $900 copay after deductible (per hospitalization) |
| Pharmacy Retail (30-day supply)4 |
Network pharmacy: specified preventive drugs – 100% covered2/$5 copay5; generic – $10 copay1; brand formulary – $25 copay1; brand non-formulary – $40 copay1 |
| Pharmacy Mail Services (up to 90-day supply) |
Network pharmacy: specified preventive drugs – 100% covered2/$10 copay5; generic – $20 copay1; brand formulary – $50 copay1; brand non-formulary – $80 copay1 |
- After calendar year deductible.
- Calendar year deductible waived.
- May be available at Cerpass retail pharmacy or Pharmacy Mail Service if authorized. Note that any specialty drug discounts through copay cards or coupons will not apply towards the calendar year deductible our out-of-pocket maximum.
- A $10 copay will be added to the cost for any prescriptions filled at Walgreens.
- Applies to certain brand-name preventive drugs not covered under the Affordable Care Act.