The Boon Chapman Premium 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, and all benefit administration provided by Boon Chapman.
Plan Changes for 2021
Premium plan: Out of Network Deductible increased to $1,500/individual and $3,000/family.
How the Premium 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 $250 individual/$750 family deductible with an additional 20% co-insurance.
- Facility admission fee (e.g., hospital room, treatment center)is a $250 individual/$750 family deductible with an additional 20% co-insurance.
- Advanced imaging copays of $100
- Plan year out of pocket max of $1,500 individual/$3,000 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 deductible up to $1,500 individual/$3,000 family, plus an additional 40% coinsurance up to the plan year out of pocket max of $4,500 individual/$9,000 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.
Biweekly Premium plan costs
|Plan year3/1/21-2/28/22Premium Plan
Bi-weekly contribution w/wellness incentive
|Employee + Child
|Employee + Spouse
|Employee + Family
Typical out-of-pocket costs
- Office visit: In Network: $20 primary care doctor, $40 specialist; out-of-network up to $250 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 $250 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).
- Outpatient Surgery & Outpatient Hospital: In Network up to $250 deductible, then 20% co-insurance, Out of Network up to $250 deductible, then 40% co-insurance.
- In Patient Surgery and In Patient Hospital: In Network up to $250 deductible, then 20% co-insurance, Out of Network up to $250 deductible, then 40% co-insurance.
New members should receive ID card from Boon Chapman 7-10 business days from enrollment. For members enrolling two or more dependents, Boon Chapman will send two ID cards with only the employee’s name displayed. To order additional ID cards, contact a Boon Chapman Member Advocate at 855-516-8531, group #650102, M-F, 7am-4pm MDT. Or at [email protected].
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 Premium plan -link to PDF Summary of Benefits
Premium Plan-link to PDF Summary of Benefits
Aetna Signature Administrators Network
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)