Medical

Get to Know the Plans

Your health matters and so does having the right coverage. That’s why we offer several medical plan options so you can choose what works best for you and your family. Every plan includes medical and prescription drug coverage, and some options also give you access to special tools and accounts that help you save money and get quality care.

FREE In-Network Preventive Care

Annual checkups help you stay healthy. Take care of yourself and your family by using your FREE in-network preventive care benefits each year! Preventive care visits allow you to take action early and keep treatable health issues from becoming chronic conditions.

Personify Health Plan Options

Available nationwide, using the Blue Shield provider network:

Value Copay Plan	Choice HSA Plan	Premier EPO Plan
This plan uses in-network doctors and facilities only, and offers the lowest paycheck deductions. Employees living in High Performance Network (HPN) zip codes are automatically enrolled in HPN and do not have access to the broad network.	This plan lets you see in- or out-of-network doctors without a referral, though staying in-network usually costs less. You have the option to pair this plan with a Health Savings Account (HSA) that you can fund with pre-tax dollars to help cover your share of costs.	This plan gives you access to in-network doctors and facilities only, with a lower deductible than the other options. However, with the exception of an emergency situation, you’ll pay the full cost for any out-of-network care you’ll receive.

Personify Health Plan Details

Need help deciding? Nayya makes it easier by guiding you to benefits that best fit your needs.

Plan Features	Personify Health Medical Plans
	Value Copay Plan	Choice HSA Plan	Premier EPO Plan
	In-Network Only	In-Network¹	In-Network Only
	You pay:	You pay:	You pay:
Calendar Year Deductible² Individual/Family In-Network Individual/Family Out-of-Network	$5,000 / $10,000 Not covered	$2,000³ / $4,000³ $4,000³ / $8,000³	$1,000 / $2,000 Not covered
Calendar Year Out-of-Pocket Maximum Individual/Family In-Network Individual/Family Out-of-Network	$7,000 / $14,000 Not covered	$6,000³ / $12,000³ $12,000³ / $24,000³	$2,000 / $4,000 Not covered
Preventive Care	Covered in full	Covered in full	Covered in full
Telemedicine Teladoc 98point6	$5 copay FREE	$55 copay then 10%⁴ $8 copay, then FREE⁴	$5 copay FREE
Primary Care Office Visit	$20 copay	20%⁴	$30 copay
Specialist Office Visit	$75 copay	20%⁴	$50 copay
Lab & X-ray	20%⁴	20%⁴	20%⁴
Urgent Care	$75 copay	20%⁴	$50 copay
Emergency Room (copay waived if admitted)	$500 copay + 30%⁴	$500 copay + 30%⁴	$500 copay + 20%⁴
Outpatient Treatment PT, OT, SP Hinge Health Virtual PT	20%⁴ FREE	20%⁴ FREE	0%⁴ FREE
Hospitalization Inpatient Semi-Private Room Inpatient Physician	20%⁴ 20%⁴	20%⁴ 20%⁴	$500 copay (copay does not apply to deductible) + 20%⁴ 20%⁴
Mental Health Inpatient Outpatient	20%⁴ 20%⁴	20%⁴ 20%⁴	$500 copay + 20%⁴ $250 copay + 20%^4,5
Prescription Drugs: Retail (up to a 30-day supply)⁶
Specified Preventive Drugs⁷	FREE or $10 copay⁸	FREE or $10 copay⁸	FREE or $10 copay⁸
Generic	$10 copay	$10 copay⁴	$10 copay
Brand Formulary	$25 copay⁴	$25 copay⁴	$25 copay
Brand Non-Formulary	$40 copay⁴	$40 copay⁴	$40 copay
Specialty⁹	20%⁴ up to $125	20%⁴ up to $125	20% up to $125
Prescription Drugs: Mail Order (up to a 90-day supply)
Specified Preventive Drugs⁷	FREE or $20 copay⁸	FREE or $20 copay⁸	FREE or $20 copay⁸
Generic	$20 copay	$20 copay⁴	$20 copay
Brand Formulary	$50 copay⁴	$50 copay⁴	$50 copay
Brand Non-Formulary	$80 copay⁴	$80 copay⁴	$80 copay

¹Out-of-network coverage is available.
²Non-embedded deductible, therefore, the family deductible must be met before an individual receives benefits.
³In- and out-of-network deductibles and out-of-pocket maximums are separate and do not cross-accumulate.
⁴After deductible.
⁵Outpatient facility: $250 copay per visit plus 20% after calendar year deductible.
⁶A $10 copay will be added to the cost for any prescriptions filled at Walgreens.
⁷As specified in the essential drug list.
⁸Applies to certain brand-name preventive drugs not covered under the Affordable Care Act.
⁹May be available at CerpassRx retail pharmacy or Pharmacy Mail Service if authorized. Note that any specialty drug discount coupons will not apply towards the calendar year deductible or out-of-pocket maximum.

Find a Personify Health Plan Provider

Value Copay Plan	Choice HSA Plan	Premier EPO Plan
Go to healthcomp.com/ensign. Click Find Care. Select your network from the dropdown (with or without High Performance Network). Enter your location (city/state or zip code). Add filters or use Quick Search. Click Search to view providers.	Go to healthcomp.com/ensign. Click Find Care. Select your network from the dropdown: Choice HSA PPO – Utah Choice HSA PPO – All other states Enter your location (city/state or zip code). Add filters or use Quick Search. Click Search to view providers.	Go to healthcomp.com/ensign. Click Find Care. Select your network: Premier EPO – Utah Premier EPO – All other states Enter your location (city/state or zip code). Add filters or use Quick Search. Click Search to view providers.

Find Top Providers & Save Money with Garner

Garner: Extra Support & Savings

If you’re enrolled in the Premier EPO, Choice HSA, or Value Copay plan, you get Garner, a FREE benefit that connects you to top-performing, in-network providers and helps pay your costs. When you choose a “Top Provider” through Garner, you can also earn free Health Reimbursement Account (HRA) dollars—up to $1,000 for an employee or $2,000 for a family—just for picking a recommended provider before your visit.

How It Works

Download the Garner app or go to getgarner.com.
Find a “Top Provider” (look for the green badge) and add them to your Care Team before your appointment.
Then, when you see that provider, Garner will reimburse eligible out-of-pocket costs like deductibles, copays, and coinsurance.

Note: Expenses paid with HSA or FSA funds are not eligible for reimbursement through Garner.

Why Use Garner?

It connects you with top-performing, in-network providers.
It pays your share of costs when you use them.
It reimburses up to $1,000 – $2,000 a year, depending on your plan.
It’s simple, FREE, and really saves you money!

All you have to do is pick one of these plans, and Garner helps pay your costs when you see top-rated doctors.

Plan	Max Incentive
Premier EPO	$1,000 Employee / $2,000 Family
Choice HSA	$1,000 Employee / $2,000 Family
Value Copay	$1,000 Employee / $2,000 Family

Note: If you are enrolled in the Choice HSA, IRS provisions require you to meet the $1,700 (employee only) or $3,400 (family) deductible before out-of-pocket expenses from services by Top Providers can be reimbursed through the Garner HRA. Expenses paid with HSA or FSA funds are not eligible for reimbursement through Garner.

Questions?

Contact Garner at 866-761-9586.

Need help? Once you create an account, you can message the Concierge via in-app chat, phone, or email concierge@getgarner.com.

Get FREE Personify Health Concierge Services

Insurance coverage can be complicated. If you’re enrolled in the Value Copay, Choice HSA, or Premier EPO, Personify Health can help you navigate the healthcare system when you need it most.

How It Works

Their customer service team can help you:

Understand and use your benefits with confidence
Submit claims
Find in-network doctors and providers

You can manage your benefits anytime through the member portal or the HCOnline mobile app!

Questions?

Contact Personify Health at 833-549-2867.

Regional Health Plan Options

Depending on where you live, you may have additional options:

Centivo PCP Partnership Plan	Kaiser HMO with HSA	SIMNSA Baja CA Premier Access HMO
(Southern CA, Denver, Dallas, Houston, Kansas City, Seattle, Spokane, and Phoenix)	(CA, CO, OR, and WA residents in Kaiser service areas)	(San Diego County only)
Benefit from free primary care visits and predictable copays with referrals from your PCP. You’ll also have access to high-quality, in-network specialists.	All care is provided through Kaiser Permanente doctors and facilities. You also have the option to pair this plan with a Health Savings Account (HSA).	Many services are covered at 100%, with affordable copays for others. Unlike many HMOs, you don’t need to choose a primary care physician. Care can be provided in Mexico.

Regional Health Plan Details

Need help deciding? Nayya makes it easier by guiding you to benefits that best fit your needs.

Plan Features	Centivo (Southern CA, Denver, Dallas, Houston, Kansas City, Seattle, Spokane, and Phoenix)	Kaiser Permanente (California, Colorado, Oregon, and Washington)	SIMNSA (San Diego County)
	PCP	HMO with HSA	HMO
	In-Network Only	In-Network Only	In-Network Only
	You pay:	You pay:	You pay:
Calendar Year Deductible Individual/Family	$1,000 / $2,000	$3,000 / $3,400 (individual within a family) / $6,000¹	Not covered
Calendar Year Out-of-Pocket Maximum Individual/Family	$4,000 / $8,000	$4,425 / $8,850	$6,350 / $12,700
Preventive Care	Covered in full	Covered in full	Covered in full
Telemedicine	FREE	20%²	Not covered
Primary Care Office Visit	FREE	20%²	$7 copay
Specialist Office Visit	$50 copay	20%²	$7 copay
Lab & X-ray	$20 copay	20%²	FREE
Urgent Care	$75 copay	20%²	$25 copay (in Mexico) $50 copay (outside Mexico)
Emergency Room (copay waived if admitted)	$500 copay	20%²	$250 copay
Outpatient Treatment PT, OT, SP Hinge Health Virtual PT	$50 copay FREE	20%² (30 visits/yr) Not covered	$10 copay Not covered
Hospitalization	$900 copay²	20%²	FREE
Mental Health Inpatient Outpatient	$900 copay²$50 copay	20%² 20%²	FREE $5 copay
Prescription Drugs: Retail	Up to a 30-day supply³	Up to a 30-day supply	Up to a 30-day supply
Specified Preventive Drugs	FREE or $10 copay⁴	FREE	FREE
Generic	$10 copay	$10 copay²	$10 copay
Brand Formulary	$25 copay²	$30 copay²	$10 copay
Brand Non-Formulary	$40 copay²	$30 copay²	$10 copay
Specialty	20%² up to $125⁵	20%² up to $125	$10 copay
Prescription Drugs: Mail Order	Up to a 90-day supply	Up to a 100-day supply	Up to a 90-day supply
Specified Preventive Drugs	FREE or $20 copay⁴	FREE	Not covered
Generic	$20 copay	$20 copay²	Not covered
Brand Formulary	$50 copay²	$60 copay²	Not covered
Brand Non-Formulary	$80 copay²	Not covered	Not covered

¹Non-embedded deductible, therefore, the family deductible must be met before an individual receives benefits.
²After deductible.
³A $10 copay will be added to the cost for any prescriptions filled at Walgreens.
⁴Prescription may bypass deductible or be FREE if it is included on the Preventive Drug or Affordable Care Act list or if the medication is a low cost generic.
⁵May be available at CerpassRx retail pharmacy or Pharmacy Mail Service if authorized. Note that any specialty drug discount coupons will not apply towards the calendar year deductible or out-of-pocket maximum.

Find a Regional Health Plan Provider

Centivo PCP Partnership Plan	Kaiser HMO with HSA	SIMNSA Baja CA Premier Access HMO
(Southern CA, Dallas TX, Denver CO, Kansas City KS/MO, Seattle WA, Spokane WA) Go to centivo.com. Click Find a doctor or facility. Select Doctor. Choose a specialty or enter a doctor/facility name. Enter your address or zip code. Click Search to see available providers.	(CA, CO, OR, and WA residents in Kaiser service areas) Go to kaiserpermanente.org/ doctors-locations. Select your geographic location. Enter your search criteria (doctor/location, zip code, keywords). Click Search to see results.	(San Diego County only) Go to the SIMNSA provider search page on simnsaee.net. Select network, type, and specialty from dropdowns. Click Start Search. Click Search to view providers.

Centivo
PCP Partnership Plan

Kaiser
HMO with HSA

SIMNSA
Baja CA Premier Access HMO

(Southern CA, Dallas TX, Denver CO, Kansas City KS/MO, Seattle WA, Spokane WA)

Go to centivo.com.
Click Find a doctor or facility.
Select Doctor.
Choose a specialty or enter a doctor/facility name.
Enter your address or zip code.
Click Search to see available providers.

(CA, CO, OR, and WA residents in Kaiser service areas)

Go to kaiserpermanente.org/
doctors-locations.
Select your geographic location.
Enter your search criteria (doctor/location, zip code, keywords).
Click Search to see results.

(San Diego County only)

Go to the SIMNSA provider search page on simnsaee.net.
Select network, type, and specialty from dropdowns.
Click Start Search.
Click Search to view providers.

Which Medical Plan Is Right for You?

When deciding which medical plan is right for you and your family, it is important to consider the total cost of coverage. This includes what you pay in premiums and what you pay for services. While each medical plan covers in-network preventive screenings in full, the plans vary on annual deductibles, copays, levels of coinsurance, and whether they’re eligible for an HSA or Flexible Spending Accounts (FSAs).

Benefit	Personify Health			Centivo	Kaiser	SIMNSA
Benefit	Value Copay	HDHP Plan	Premier EPO	PCP	HMO with HSA	HMO
Region	Nationwide	Nationwide	Nationwide	SoCal, Phoenix, Dallas, Houston, Denver, Kansas City, Seattle, Spokane	CA, CO, OR, WA (Kaiser areas only)	San Diego County only
Premium rates	$	$$	$$$	$	$$$	$
Annual deductible	$$$$	$$	$	$	$$$	–
Copay for services¹	✓	–	✓	✓	–	✓
Coinsurance for services	20%	20%	20%	–	20%	✓
Primary Care Physician required	–	–	–	✓	✓	✓
Referrals needed for specialists	–	–	–	–	✓	✓
Out-of-network coverage	–	✓	–	–	–	–
Eligible for HSA	–	✓	–	–	✓	–
Eligible for Health Care FSA	✓	–	✓	✓	–	✓
Eligible for Limited Purpose FSA	–	✓	–	–	✓	–
Eligible for Dependent Care FSA	✓	✓	✓	✓	✓	✓

¹Copays may vary by plan. Some plans may charge a copay after the deductible is met, or have different copay structures depending on the type of service.

Remember: Your health plan choice affects your paycheck, your providers, and how you access care. Take a few minutes to explore your options and pick the plan that fits your life best.