Medical
Medical coverage offers healthcare protection for you and your family. You may visit any medical provider you choose, but in-network providers offer the highest level of benefits and lower out-of-pocket costs. Network providers charge members reduced, contracted fees instead of their typical fees. Providers outside the plan’s network set their own rates, so you may be responsible for the difference if a provider’s fees are above the Reasonable and Customary (R&C) limits.
Preventive Care – like physical exams, flu shots, and screenings – is always covered 100% when you use in-network providers. The key difference between the plans is the amount of money you’ll pay each pay period and when you need care.
Each plan has different:
- Annual deductible amounts – The amount you pay each year for eligible in-network and out-of-network charges before the plan begins to pay.
- Out-of-pocket maximums – The most you will pay each year for eligible network services and/or prescriptions. After you reach your out-of-pocket maximum, the plan picks up the full cost of covered medical care for the remainder of the year.
- Copays – A copay is a fixed amount you pay for a health care service. Copays do not count toward your deductible but do count toward your annual out-of-pocket maximum.
- Coinsurance – Once you’ve met your deductible, you and the plan share the cost of care, which is called coinsurance. For example, you pay 20% for services and the plan will pay 80% of the cost until you have reached your out-of-pocket maximum.
HeathPartners Platinum PPO
Plan Information
Plan Name: HealthPartners Platinum PPO
Policy Number: 24163 (VRC); 26179 (VRS)
Effective Date: 01/01/2025
Network: HealthPartners
Benefit Highlights
In-Network | Out-of-Network |
|---|---|
| Deductible (Individual/Family) | Deductible (Individual/Family) |
| $1,500 / $4,500 | $3,000 / $9,000 |
| Out-of-Pocket Max (Individual/Family) | Out-of-Pocket Max (Individual/Family) |
| $4,500 / $9,000 | $9,000 / $27,000 |
| Preventive Care | Preventive Care |
| $0 | 50% coinsurance |
| Primary Care Visit | Primary Care Visit |
| $30 copay | 50% coinsurance |
| Specialist Visit | Specialist Visit |
| $60 copay | 50% coinsurance |
| Urgent Care | Urgent Care |
| $50 copay | $50 copay |
| Emergency Room | Emergency Room |
| $200 copay | $200 copay |
Retail Rx (Up to 31-Day Supply) | Retail Rx (Up to 31-Day Supply) |
|---|---|
| Generic | Generic |
| Formulary: 20% coinsurance, $15 max copay Non-formulary: 30% coinsurance, $125 max copay | Not covered |
| Formulary Brand | Formulary Brand |
| 25% coinsurance, $75 max copay | Not covered |
| Non-Preferred Brand | Non-Preferred Brand |
| 30% coinsurance, $125 max copay | Not covered |
| Non-formulary Brand | Non-formulary Brand |
| 30% coinsurance, $250 max copay | Not covered |
Mail-Order Rx (Up to 93-Day Supply) | Mail-Order Rx (Up to 93-Day Supply) |
|---|---|
| Generic | Generic |
| Formulary: 20% coinsurance, $15 max copay per prescription per month Non-formulary: 30% coinsurance, $125 max copay per prescription per month | Not covered |
| Formulary Brand | Formulary Brand |
| 25% coinsurance, $75 max copay per prescription per month | Not covered |
| Non-formulary Brand | Non-formulary Brand |
| 30% coinsurance, $125 max copay per prescription per month | Not covered |
| Specialty | Specialty |
| 30% coinsurance, $250 max copay per prescription per month | Not covered |
Plan Documents
Contact Information
HealthPartners Silver HDHP
Plan Information
Plan Name: HealthPartners Silver HDHP
Policy Number: 24163 (VRC); 26179 (VRS)
Effective Date: 01/01/2025
Network: HealthPartners
Benefit Highlights
In-Network | Out-of-Network |
|---|---|
| Deductible (Individual/Family) | Deductible (Individual/Family) |
| $3,500 / $7,000 | $7,000 / $14,000 |
| Out-of-Pocket Max (Individual/Family) | Out-of-Pocket Max (Individual/Family) |
| $6,900 / $13,800 | $14,000 / $28,000 |
| Preventive Care | Preventive Care |
| $0 | 50% coinsurance |
| Primary Care Visit | Primary Care Visit |
| 20% coinsurance | 50% coinsurance |
| Specialist Visit | Specialist Visit |
| 20% coinsurance | 50% coinsurance |
| Urgent Care | Urgent Care |
| 20% coinsurance | 20% coinsurance, applies to in-network deductible |
| Emergency Room | Emergency Room |
| 20% coinsurance | 20% coinsurance, applies to the in-network deductible |
Retail Rx (Up to 31-Day Supply) | Retail Rx (Up to 31-Day Supply) |
|---|---|
| Generic | Generic |
| Formulary: 20% coinsurance, $15 max copay Non-formulary: 30% coinsurance, $125 max copay | Not covered |
| Formulary Brand | Formulary Brand |
| 25% coinsurance, $75 max copay | Not covered |
| Non-formulary Brand | Non-formulary Brand |
| 30% coinsurance, $125 max copay | Not covered |
| Specialty | Specialty |
| 30% coinsurance, $250 max copay | Not covered |
Mail-Order Rx (Up to 93-Day Supply) | Mail-Order Rx (Up to 93-Day Supply) |
|---|---|
| Generic | Generic |
| Formulary: 20% coinsurance, $15 max copay per prescription per month Non-formulary: 30% coinsurance, $125 max copay | Not covered |
| Formulary Brand | Formulary Brand |
| 25% coinsurance, $75 max copay per prescription per month | Not covered |
| Non-formulary Brand | Non-formulary Brand |
| 30% coinsurance, $125 max copay per prescription per month | Not covered |
| Specialty | Specialty |
| 30% coinsurance, $250 max copay per prescription per month | Not covered |
Plan Documents
Contact Information
HealthPartners Gold HDHP
Plan Information
Plan Name: HealthPartners Gold HDHP
Policy Number: 24163 (VRC); 26179 (VRS)
Effective Date: 01/01/2025
Network: HealthPartners
Benefit Highlights
In-Network | Out-of-Network |
|---|---|
| Deductible (Individual/Family) | Deductible (Individual/Family) |
| $2,500 / $5,000 | $5,000 / $10,000 |
| Out-of-Pocket Max (Individual/Family) | Out-of-Pocket Max (Individual/Family) |
| $5,000 / $10,000 | $10,000 / $20,000 |
| Preventive Care | Preventive Care |
| $0 | 50% coinsurance |
| Primary Care Visit | Primary Care Visit |
| 20% coinsurance | 50% coinsurance |
| Specialist Visit | Specialist Visit |
| 20% coinsurance | 50% coinsurance |
| Urgent Care | Urgent Care |
| 20% coinsurance | 20% coinsurance, applies to the in-network deductible |
| Emergency Room | Emergency Room |
| 20% coinsurance | 50% coinsurance, applies to the in-network deductible |
Retail Rx (Up to 31-Day Supply) | Retail Rx (Up to 31-Day Supply) |
|---|---|
| Generic | Generic |
| Formulary: 20% coinsurance, $15 max copay Non-Formulary: 30% coinsurance, $125 max copay | Not covered |
| Formulary Brand | Formulary Brand |
| 25% coinsurance, $75 max copay | Not covered |
| Non-formulary Brand | Non-formulary Brand |
| 30% coinsurance, $125 max copay | Not covered |
| Specialty | Specialty |
| 30% coinsurance, $250 max copay | Not covered |
Mail-Order Rx (Up to 93-Day Supply) | Mail-Order Rx (Up to 93-Day Supply) |
|---|---|
| Generic | Generic |
| Formulary: 20% coinsurance, $15 max copay per prescription per month Non-Formulary: 30% coinsurance, $125 max copay | Not covered |
| Formulary Brand | Formulary Brand |
| 25% coinsurance, $75 max copay per prescription per month | Not covered |
| Non-formulary Brand | Non-formulary Brand |
| 30% coinsurance, $125 max copay per prescription per month | Not covered |
| Specialty | Specialty |
| 30% coinsurance, $250 max copay per prescription per month | Not covered |