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HealthPays™ HSA Premiums | HealthPays™ HSA Benefits 

HealthPays HSA 2750/5500 Catastrophic Benefits
Alliant Plus
In-network
Alliant Plus
Out-of-network
Annual Deductible  
$2,750 per Individual or $5,500 Family
Member Coinsurance  
20%
40%
Out-of-Pocket Limit+  
$5,100 per member or $10,200 per family
Benefits
After deductible, member pays
Office Visits
Including mental health outpatient services.
20%
40%
Manipulative therapy
Limit total visits PCY† to 10 combined for both in- and out-of-network.
20%
40%
Acupuncture
20%, up to 8 visits PCY
40%
Naturopathy
20%, up to 3 visits PCY
40%
Maternity care
Not covered
Not covered
Lab/X-ray Services
20%
40%
Hospital Visits - Inpatient
Hospital room and board; inpatient surgery; anesthesia, intensive and coronary care; laboratory tests; radiology services; drugs while in hospital. Includes mental health inpatient treatment. Maternity care not covered.
20%
40%
Devices, equipment & supplies
(DME and prosthetics.)
Covered up to 50%
Prescription drugs
Not covered
Not covered
Emergency care
20%
40%
Vision Care
Not covered
Not covered
 
Deductible does not apply
Preventive care visits 
For children and adults, including physicals and immunizations, as established in GroupHealth’s preventive care schedule.
Covered in full
40%
$300 individual/$600 family
annual benefit maximum

+ Member coinsurance and annual deductible apply to out-of-pocket limit.
† PCY = per calendar year
‡ Western Washington counties: King, Kitsap, Pierce, Snohomish, Island, Thurston, Whatcom, Skagit, San Juan, Mason, Lewis, and Gray’s Harbor (ZIP codes: 98541, 98557, 98559, & 98568). Central/Eastern Washington counties: Kittitas, Yakima, Benton, Franklin, Walla Walla, Columbia, Whitman, and Spokane.

NOTE: This is a summary of benefits. The contents are not to be accepted or construed as a substitute for the provisions of the master policy or agreements. Other terms and conditions apply. All plans cover on-the-job-injury-related health care costs for partners, proprietors, or corporate officers who are not covered by a workers’ compensation act, subject to the plan’s cost shares and benefit limitations

Coverage provided by Group Health Cooperative

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