MEDICAL

The following is a summary of your medical benefits. For a more detailed explanation of benefits, please refer to your Summary Plan Description (SPD), certificate of coverage or SBC. You may access a list of participating providers through the carrier’s website.

www.ebms.com
866-326-7598

Provider Network Care Navigation Video

Find a Provider

To access the list of contracted providers through Partners Direct Health and HealthSmart, please refer to the Find A Provider tool in miBenefits.

Need help logging in or registering? Review the instructions here.

Helpful Resources

Check out these learning resources below to help you understand RBP.

Health Plan Access To Care Scenarios

Watch Video | Download PDF

Process Technology Reference Based Pricing Education (RBP)

Watch Video | Download PDF

How to Find a Provider & Maximize Your Member Experience

Watch Video | Download PDF

HDHP Plan

	In-Network	Out-of-Network
Deductibles
Per plan participant	$2,500	$3,000
Per family unit	$5,000	$6,000
Coinsurance
Plan pays	100%	60%
You pay	0%	40%
Out-of-Pocket Maximum
Per plan participant	$2,500	$4,500
Per family unit	$5,000	$9,000
Covered Services
Office visit Primary care Specialist	100% after deductible 100% after deductible	60% after deductible 60% after deductible
Preventive care	No charge	No charge
Urgent care Facility Physician	100% after deductible 100% after deductible	100% after deductible 60% after deductible
Emergency room	100% after deductible, then $500 copay per visit	100% after deductible, then $500 copay per visit
Diagnostic lab & x-ray Facility Physician	100% after deductible 100% after deductible	100% after deductible 60% after deductible
Inpatient stay Facility Physician	100% after deductible 100% after deductible	100% after deductible 60% after deductible

PPO Plan

	In-Network	Out-of-Network
Deductibles
Per plan participant	$300	$600
Per family unit	$900	$1,800
Coinsurance
Plan pays	80%	60%
You pay	20%	40%
Out-of-Pocket Maximum
Per plan participant	$2,000	$4,000
Per family unit	$6,000	$12,000
Covered Services
Office visit Primary care Specialist	80%, no deductible applies 80%, no deductible applies	60% after deductible 60% after deductible
Preventive care	No charge	No charge
Urgent care Facility Physician	80% after deductible 80% after deductible	80% after deductible 60% after deductible
Emergency room	$500 copay per visit, then 80% after deductible	$500 copay per visit, then 80% after deductible
Diagnostic lab & x-ray Facility Physician	80% after deductible 80% after deductible	80% after deductible 60% after deductible
Inpatient stay Facility Physician	80% after deductible 80% after deductible	80% after deductible 60% after deductible

Care Navigation

Get help finding the right care for you

Healthcare Navigator
866-326-7598
[email protected]

Finding the right healthcare provider is an important step when it comes to taking care of your health. Your health plan offers Care Navigation Services, which can make it easy to find a provider that fits your needs and works well with your benefits.

With the latest information on more than 200,000 doctors and facilities nationwide, our team of experts can help you:

Find physicians or facilities near you.
Compare providers based on quality scores and costs.
Determine if they have historically accepted your plan’s reimbursement.
Help you select the provider that works best for you.

Getting this information can help you feel more confident in your choice of provider before you schedule a visit.

Personalized Customer Service

If you have any questions at any stage of your care, our team is here for you. Whether you have specific questions about your health plan, or need help finding a provider, give us a call.

Call the Number on Your Benefits ID Card today to Get Started!

Our team can walk you through the process of selecting a healthcare partner from the beginning, so you have fewer issues later. Your health plan may also include online access to this provider research at your convenience. Just ask about this option when you call.

Repricing Partner

Imagine360 (ELAP) – Balance Bill Assistance

Imagine360 (ELAP)
866-326-7598
www.elapservices.com

Behind the scenes, Imagine360 (ELAP) examines every facility bill line-by-line to catch over-charging. Facilities may include skilled nursing facilities as well as hospitals. Most of the time you should have no issue with your bill, but Imagine360 (ELAP) will provide advocacy & support for balance bills that you may receive. Please refer to the information below for details.

Please note that participants are still responsible for all co-pays and deductibles.

IMPORANT: Watch your mail for any balance bills and send them to Imagine360 (ELAP) as soon as possible.

Members should submit balance bills to [email protected] or via miBenefits.