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Plans & Rates
Our menu of standard plans is shown here
Customized programs are available as well.
To design and quote a customized plan, please call us at 877-673-9797.
 

GS200 Plan Pays:GS350 Plan Pays:GS500 Plan Pays:GS1000 Plan Pays:

   
Physician Office Visits
For medically necessary treatment of injury or sickness up to five visits per covered person per Plan Year*.
$40
Per Visit		$50
Per Visit		$65
Per Visit		up to $100
Per Visit
Outpatient Lab & X-ray
3 visits per Plan Year for diagnostic tests and x-rays which are ordered by a doctor and performed in an outpatient setting.
$40
Per Visit		$50
Per Visit 		$65
Per Visit 		up to $100
Per Visit 
Wellness Visits
1 visit per Plan Year for a routine examination or well-child care.
$40
Per Visit		$50
Per Visit 		$65
Per Visit 		up to $100
Per Visit 
    
Regular Inpatient Accident & Sickness Stay
A maximum of 30 days per Plan Year.
$200
Per Day		$350
Per Day		$500
Per Day		$1000
Per Day
Intensive Care Unit/Critical Care Unit
Up to 10 days per Plan Year.
$400
Per Day 		$700
Per Day 		$1000
Per Day 		$2000
Per Day 
Mental/Nervous
A maximum of 10 days per Plan Year.
$100
Per Day		$175
Per Day		$250
Per Day		$500
Per Day
Substance Abuse
A maximum of 10 days per Plan Year.
$100
Per Day		$175
Per Day		$250
Per Day		$500
Per Day
Skilled Nursing Facility
A maximum of 20 days per Plan Year. Confinement must begin within 3 days of a hospital stay.
$100
Per Day		$175
Per Day 		$250
Per Day 		$500
Per Day 
up to $500 up to $1000 up to $2000 up to $2500
Inpatient surgery. Plan pays up to the indicated maximum surgery benefit per Plan Year.
Outpatient surgery. Plan pays up to the indicated maximum surgery benefit per Plan Year.
up to $200 up to $400 up to $800 up to $1000
Anesthesia
25% of surgery benefit paid, up to the indicated maximum per Plan Year.
up to $125 up to $250up to $500up to $625
Accident Medical Expenses
Includes Emergency Room, Urgent Care Centers and other expenses related to an accidental injury.
up to $300
Per Accident 		up to $500
Per Accident 		up to $750
Per Accident 		up to $1000
Per Accident
Emergency Room(Sickness Only)
Applicable for emergency room visits for a medical emergency caused by sickness. 1 visit per Plan Year.
$100
Per Visit		$100
Per Visit		$250
Per Visit		$250
Per Visit
$5,000$5,000$10,000$10,000
 Spouse
$2,500$2,500$5,000$5,000
Each Child
$1,000$1,000$1,000$1,000
Vision Benefit
Benefits are $25 for 1 eye exam per Plan Year and $50 toward eyeglasses or contact lenses every 2 Plan Years.
$25$25$25$25
$50$50$50$50
  Non-Insured Features Included In The Plan
Prescription Drug Discount
Discount Card - Up to 40% savings on generic & brand name prescriptions.
IncludedIncludedIncludedIncluded
24-hour Nurse Line
24-hour access to a toll-free number for health consultations and basic health information.
IncludedIncludedIncludedIncluded
Doctor & Hospital Discounts
Access to reduced rate, negotiated fees with doctors and hospitals in the Beech Street network.
IncludedIncludedIncludedIncluded
  Optional Insured Benefits
Insured Generic Prescription Drug Benefit Available
Optional at the group level, not by individuals.
Copay $15 Retail / $45 Mail. Up $2,500/Plan Year.
Requires additional premium.
OptionOptionOptionOption
Insured Dental Plan Available
Optional at the group or employee level. Scheduled amounts are payable up to $1,500 per covered person per Plan Year. Some services require a 12 month waiting period before benefits are available. Requires additional premium.
OptionOptionOptionOption
 
Blanket Monthly Costs
Employer contributes 100% of Employee Only cost
 GS200 Plan GS350 PlanGS500 PlanGS1000 Plan
Employee Only$52.00$66.00$85.00$124.00
Employee & Spouse$97.00$128.00$166.00$247.00
Employee & Child(ren) $76.00$99.00$127.00$189.00
Employee & Family$127.00$168.00$219.00$329.00
 
Contributory Monthly Costs
Employer contributes at least 50% of Employee Only cost
 GS200 Plan GS350 PlanGS500 PlanGS1000 Plan
Employee Only$59.00$76.00$98.00$143.00
Employee & Spouse$112.00$148.00$193.00$289.00
Employee & Child(ren) $87.00$114.00$148.00$220.00
Employee & Family$148.00$196.00$256.00$385.00
 
Prescription drug benefit Monthly Costs
If the Insured Prescription Drug Benefit is elected for the group, add the premium shown here to the appropriate amount above.
  Blanket CostsContributory Costs
Employee Only$11.00 $12.00
Employee & Spouse$23.00  $26.00
Employee & Child(ren)  $20.00 $23.00
Employee & Family $34.00  $37.00
 
Dental Plan Monthly Costs
If the Dental Plan is added at the group level (i.e., automatically added to a GS Plan), add the Contributory Costs shown below to the appropriate amount(s) above. If the Dental Plan is available as an employee option, the Voluntary Costs shown below would be added to the appropriate amount(s) above.
  Contributory CostsVoluntary Costs
Employee Only$21.00 $24.00
Employee & Spouse$41.00  $48.00
Employee & Child(ren)  $55.00  $64.00
Employee & Family $75.00   $88.00
A modal billing fee of up to $9 depending on group size will be reflected on each bill.
* Plan Year, wherever referenced, means the 12 consecutive month period beginning on each group’s effective date and each anniversary date thereafter.
 
 
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