Insulin copayment
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Insulin obtained in-network will have no cost-share for a 30-day supply.
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Virtual mental health care
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aptihealth will follow the behavioral health cost-share for in-network services.
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Advanced imaging
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All in-network advanced imaging services (MRI, CT, PET, etc.) will now require prior authorization and will be subject to the advanced imaging benefit cost-share, regardless of provider status where performed.
The in-network advanced imaging benefit cost-share will be the member’s diagnostic radiology copayment plus an additional $100. Coinsurance plans will continue to be subject to their coinsurance percentage. Deductibles will apply, based on plan design.
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Minimum allowable deductible
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The Internal Revenue Service (IRS) has determined that the deductible for
HSA-qualified high deductible plans can be no less than $1,650 (individual) and $3,300 (family) for 2025.
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Out-of-pocket maximum
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The IRS has determined that the out-of-pocket maximum for HSA-qualified high deductible plans can be no more than $8,300 (individual) and $16,600 (family) for 2025. The Department of Health and Human Services has determined that the
out-of-pocket maximum for plans that are not high deductible can be no more than $9,200 (individual) and $18,400 (family) for 2025.
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Mandated regulatory changes
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Plan design changes have been made pursuant to state and federal requirements. Members will receive notification of any changes to their current plan.
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