The Boon Chapman Core plan was created specifically for Jordano’s employees. This plan utilizes the Aetna Signature Administrators Network, giving you access to a vast inventory of Network providers. You also have coverage for non-network providers. Claims processing, benefit eligibility, benefit administration provided by Boon Chapman.
Plan Changes for 2021
None
How the Core Plan works
- In Network care
Access to the Aetna Signature Administrators Network, nationwide.
- Health care provider copays from $20-$150.
- Pharmacy prescription copay coverage from $15-$45.
- Facility fee (e.g., ambulatory surgery center for outpatient surgical procedures) is a $1,000 individual/$3,000 family deductible with an additional 20% co-insurance.
- Facility admission fee (e.g., hospital room, treatment center)is a $1,000 individual/$3,000 family deductible with an additional 20% co-insurance.
- Advanced imaging copays of $100
- Plan year out of pocket max of $4,000 individual/$8,000 family. Once reached the plan will pay 100% of covered medical costs for the rest of the year.
- Emergency Room Services copay $400.
- Access to Teladoc at no cost. Teladoc Medical and Teladoc Behavior Health care, 24 hours/day, 365 days a year.
- You may choose any doctor or care facility nationwide, “referral” is not required.
- You may choose an Out of Network provider and pay a $2,500 individual/$6,000 family deductible plus an additional 40% coinsurance up to the plan year out of pocket max of $6,000 individual/$10,000 family.
- Access to several free services including zero cost Summit Surgery Center program, Copay waived US Imaging services, Maternity services, Virtual Physical Therapy, and more.
| Plan year3/1/21-2/28/22Premium Plan |
Core Plan
Bi-weekly contribution
|
Core Plan
Bi-weekly contribution w/wellness incentive
|
| Employee Only |
$55.32 |
$32.24 |
| Employee + Child |
$139.42 |
$104.80 |
| Employee + Spouse |
$162.49 |
$127.88 |
| Employee + Family |
$222.24 |
$187.63 |
Typical out-of-pocket costs
- Office visit: In Network: $20 primary care doctor, $40 specialist; out-of-network up to $2,500 deductible, then 40% co-insurance. (preventative care visits with in-network provider have no charge)
- Urgent care visits: In Network: $40 copay; out-of-network up to $2,500 deductible, then 40% co-insurance.
- Emergency Room visit not resulting in admission: $400 copay.
- Prescription drugs: $15 generic; $30 preferred brand; $45 non-preferred brand for a 30-day supply (In Network only).
ID cards
New members should receive ID card from Boon Chapman 8-12 business days from enrollment. For members enrolling two or more dependents, Boon Chapman will send two id cards with the only the employee’s name displayed. To order additional ID cards, contact a Member Advocate at 855-516-8531, group #650102, M-F, 7am-4pm MDT. Or at [email protected].
Current Members
For more information about your plan, contact a Boon Chapman Advocate at 855-516-8531, group #650102, M-F, 7am-4pm MDT. Or at [email protected]
Boon Chapman Core plan – link to pdf summary
Aetna Signature Administrators Network
Boon Chapman
Teladoc
Teladoc Medical -link to Teladoc Medical PDF (working on)
Teladoc Behavior Health -link to Teladoc Behavioral Health PDF (working on)
Summit Surgery Center -link to Summit PDF (working on)
US Imaging -link to US Imaging PDF (working on)
Maternity services -link to Maternity PDF (attached to email)
Virtual Physical Therapy -link to VPT PDF (working on)
