Shiloh offers employees the choice of two Medical / Rx plans – a PPO Plan and a High Deductible Health Plan (HDHP), combined with a Health Savings Account (HSA). The Plans have embedded deductibles, which, if you cover dependents, means that each covered individual’s deductible is embedded within the Family deductible. Claims are applied to each member’s deductible separately and each member moves to coinsurance once the individual’s portion of the Family deductible is satisfied. You do not have to satisfy the full, family deductible before any coinsurance begins.
The HDHP is a Consumer Driven Health Plans with an attached HSA, which allows you to put dollars away on a pre-tax basis to pre-fund your health care costs.
Monthly Contributions*:
| Coverage Tier | PPO Plan | HDHP w/HSA Plan |
| Employee | $220 | $35 |
| Employee + Spouse | $451 | $120 |
| Employee + Child | $330 | $100 |
| Employee + Children | $429 | $115 |
| Family | $550 | $150 |
Tobacco/nicotine users will be charged a tobacco/nicotine surcharge of an additional $75 per month.
Non-Union and VC-Steel Union rates only.
PPO
| Benefit | Network | Non-Network |
| Dependent Age Limit | End of Month Up to age 26 | |
| Lifetime Maximum | Unlimited | |
| Annual Deductible Embedded deductible |
$1,500 EE / $2,000 EE +1 / $2,500 Family | $3,000 EE / $4,000 EE + 1 / $5,000 Family |
| Out-of-Pocket Maximum Embedded OOP |
$4,000 EE / $6,000 EE + 1 / $8,000 Family | $8,000 EE / $12,000 EE + 1 / $16,000 Family |
| INPATIENT SERVICES | ||
| Room and Board | 70% after deductible | 50% after deductible |
| Emergency Use of ER (copay waived if admitted) (Diagnostic treatment and or service subject to deductible) |
100% after $300 copay |
100% after $300 copay |
| Lab, X-ray & Ancillary Services | 70% after deductible | 50% after deductible |
| Mental Health & Substance Abuse | 70% after deductible | 50% after deductible |
| OUTPATIENT SERVICES | ||
| Office Visit (Diagnostic treatment and or service subject to deductible |
$25.00 copay | 50% after deductible |
| Specialist (Diagnostic treatment and or service subject to deductible) |
$50.00 copay | 50% after deductible |
| Urgent Care (Diagnostic treatment and or service subject to deductible) |
$75.00 copay | 50% after deductible |
| Wellness/Routine Physicals | Covered at 100% | 50% coinsurance after deductible |
| Routine Pap & Mammogram Tests | Covered under Wellness/Routine Physicals Benefits | Covered under Wellness/Routine Physicals Benefit |
| Physical or Occupational Therapy Office Visits (60 day limit) | $50.00 copay | 50% after deductible |
| Chiro/Spinal Manipulations (25 day limit) |
$50.00 copay | 50% after deductible |
| Speech Therapy Office Visits (20 day limit) |
$50.00 copay | 50% after deductible |
| Outpatient Surgery | 70% after deductible | 50% after deductible |
| Dietician Services (3 day limit) | $50.00 copay | 50% after deductible |
| OTHER SERVICES | ||
| Ambulance Services | 70% after deductible | 70% after deductible |
| Hospice Care | 70% after deductible | 50% after deductible |
| Home Health Care, 60 visits per calendar year | 70% after deductible | 50% after deductible |
| Skilled Nursing, 60 days per calendar year | 70% after deductible | 50% after deductible |
| Telehealth Services |
FREE |
Not covered |
| Prescription Drugs | Retail | Mail Order |
| Generic (Mandatory) Tier 1 | $10.00 copay – 30-day supply 90-day supply can be filled for $30.00 |
$30.00 copay – 90-day supply |
| Brand Name – Formulary Tier 2 | $30.00 copay – 30-day supply 90-day supply can be filled for $90.00 |
$90.00 copay – 90-day supply |
| Brand Name – Non-Formulary Tier 3 | $60.00 copay – 30-day supply 90-day supply can be filled for $180.00 |
$180.00 copay – 90-day supply |
| Specialty Medication | 25% of drug cost to a maximum of $250 | N/A |
| Benefit | Network | Non-Network |
| Dependent Age Limit | End of Month Up to age 26 | |
| Lifetime Maximum | Unlimited | |
| Annual Deductible Embedded deductible |
$3,500 EE / $5,000 EE +1 / $6,500 Family | $7,000 EE / $10,000 EE + 1 / $13,000 Family |
| Out-of-Pocket Maximum Embedded OOP |
$6,000 EE / $9,000 EE + 1 /$12,000 Family | $12,000 EE / $18,000 EE + 1 / $24,000 Family |
| INPATIENT SERVICES | ||
| Room and Board | 80% after deductible | 50% after deductible |
| Emergency Use of ER (copay waived if admitted) (Diagnostic treatment and or service subject to deductible) |
100% after $300 copay |
100% after $300 copay |
| Lab, X-ray & Ancillary Services | 80% after deductible | 50% after deductible |
| Mental Health & Substance Abuse | 80% after deductible | 50% after deductible |
| OUTPATIENT SERVICES Copays Apply After Deductible Has Been Met | ||
| Office Visit (Diagnostic treatment and or service subject to deductible) |
$25.00 copay | 50% after deductible |
| Specialist (Diagnostic treatment and or service subject to deductible) |
$50.00 copay | 50% after deductible |
| Urgent Care (Diagnostic treatment and or service subject to deductible) |
$75.00 copay | 50% after deductible |
| Wellness/Routine Physicals | Covered at 100% | 50% coinsurance after deductible |
| Routine Pap & Mammogram Tests | Covered under Wellness/Routine Physicals Benefits | Covered under Wellness/Routine Physicals Benefit |
| Physical or Occupational Therapy Office Visits (60 day limit) | $50.00 copay | 50% after deductible |
| Chiro/Spinal Manipulations (25 day limit) |
$50.00 copay | 50% after deductible |
| Speech Therapy Office Visits (20 day limit) |
$50.00 copay | 50% after deductible |
| Outpatient Surgery | 80% after deductible | 50% after deductible |
| Dietician Services (3 day limit) | $50.00 copay | 50% after deductible |
| OTHER SERVICES | ||
| Ambulance Services | 80% after deductible | 50% after deductible |
| Hospice Care | 80% after deductible | 50% after deductible |
| Home Health Care, 60 visits per calendar year | 80% after deductible | 50% after deductible |
| Skilled Nursing, 60 days per calendar year | 80% after deductible | 50% after deductible |
| Telehealth Services | $55.00 copay (FREE once deductible is met) |
Not covered |
| Prescription Drugs | Retail | Mail Order |
| Deductible must be met; then move to schedule below | Deductible must be met; then move to schedule below | |
| Generic (Mandatory) Tier 1 | $10.00 copay – 30-day supply 90-day supply can be filled for $30.00 |
$30.00 copay – 90-day supply |
| Brand Name – Formulary Tier 2 | $30.00 copay – 30-day supply 90-day supply can be filled for $90.00 |
$90.00 copay – 90-day supply |
| Brand Name – Non-Formulary Tier 3 | $60.00 copay – 30-day supply 90-day supply can be filled for $180.00 |
$180.00 copay – 90-day supply |
| Specialty Medication | 25% of drug cost to a maximum of $250 | N/A |
Use In-Network Providers
Did you know that if you use an In-Network provider, you can save yourself and your family money? Our plan uses a preferred provider organization (PPO) which means that services provided to you and your family in this PPO network are provided at a significantly discounted rate.
Telehealth Connection
Choice is good. More choice is even better. We partner with MDLIVE as our telehealth provider. MDLive lets you get the care you need – including most prescriptions – for a wide range of minor conditions. Now you can connect with a board-certified doctor via video chat or phone, without leaving your home or office. When, where and how it works best for you!
Choose when: Day or night, weekdays, weekends and holidays.
Choose where: Home, work or on the go.
Choose how: Phone or video chat.
Choose who: MDLIVE doctors (download the MDLive app)
Say it’s the middle of the night and your child is sick. Or you’re at work and not feeling well. If you pre-register with MDLIVE, you can speak with a doctor for help with: sore throat, fever, rash, headache, cold and flu, acne, stomach ache, allergies, UTIs and more
THE COST SAVINGS ARE CLEAR.
Televisits with MDLIVE are FREE for those enrolled in the PPO and subject to your deductible for those enrolled in the HDHP. MDLive is a cost-effective alternative to a convenience care clinic or urgent care center, and cost less than going to the emergency room. And the cost of a phone or online visit is the same or less than with your primary care provider. Remember, your telehealth services are only available for minor, non-life threatening conditions. In an emergency dial 911 or go to the nearest hospital.
CHOOSE WITH CONFIDENCE.
MDLive is a quality national telehealth provider, so you can choose your care confidently.
Use Convenience Care Clinics or Pharmacy Take Care Clinics
Without an appointment, you can quickly access medical care for screenings or vaccines, minor illness or injuries, or to get a quick prescription.
Convenience Care Clinics includes exam, diagnosis and treatment of many non-emergency conditions including:
- Bronchitis
- Ear Infection
- Ear Wax Removal
- Female Bladder Infection
- Influenza
- Insect Stings
- Minor Rashes
- Mononucleosis
- Motion Sickness
- Pink Eye
- Poison Ivy
- Ringworm
- Seasonal Allergies
- Sinus Infection
Have a Primary Care Physician
A PCP (Primary Care Physician) is a doctor who is a family practice physician, pediatrician, general practice, or an internal medicine doctor. Other than using a Convenience Care clinic, your PCP is the lowest cost option for MD provided treatment for your healthcare needs. Most people who self-refer to a specialist choose the wrong type of specialist more than 60% of the time. You receive the most efficient and effective healthcare when you have a PCP. As a PCP gets to know you and your medical conditions over time, they are better equipped to evaluate you and direct you to the right specialist who leads to the correct diagnosis and treatment quicker. Studies show that patients who use a PCP spend an average of 33% less than patients who self-refer to specialists.
Urgent Care
Using Urgent Care is less expensive than the Emergency Room. Urgent care facilities provide triage management and treatment of patients with minor complaints of illness that may be treated in a rapid efficient manner. If the clinics and your PCP are not available at the time of your minor medical need, using an Urgent Care facility is a good alternative.
Emergency Room (ER)
This is the most expensive provider option. Emergency rooms should be used for life threatening conditions (such as shortness of breath, chest pains, intense abdominal pain, symptoms of a stroke or blood clot, etc.). Remember, in an emergency time is of the essence! If not life-threatening, you may save money by using Telehealth, Convenience Care clinics, your PCP or an area Urgent Care facility.
Use the Most Cost-Effective Provider for Radiology Services
MRIs and CT Scans can range anywhere from $1,000 to $3,500 in hospital facilities. Independent radiology centers cost on average 25-30% less than hospital-based MRI services and can be as low as $600.