Medical plan
Example Plan HMO 1000
- Carrier
- Harvard Pilgrim / Point32Health
- Network
- Massachusetts HMO Network
- Plan year
- January 1, 2026 – December 31, 2026
What you pay
| Deductible | $1,000Family: $2,000 |
|---|---|
| Out-of-pocket maximum | $5,000Family: $10,000 |
| Primary care visit | $25 copay, deductible waived |
| Specialist visit | $50 copay, deductible waived |
| Urgent care | $50 copay, deductible waived |
| Emergency room | $250 copay after deductible |
| Inpatient hospital | $500 copay per admission after deductible |
| Outpatient surgery | $250 copay after deductible |
| Lab work | $0 copay |
| Advanced imaging (MRI, CT, PET) | $100 copay after deductible |
| Telehealth visit | $0 copay |
| Preventive care | $0 copay, no deductible |
Prescriptions
| Tier | Retail | Mail order |
|---|---|---|
| Tier 1 — Generic | $10 (30-day) | $20 (90-day) |
| Tier 2 — Preferred brand | $40 (30-day) | $80 (90-day) |
| Tier 3 — Non-preferred brand | $75 (30-day) | $150 (90-day) |
| Tier 4 — Specialty | $200 (30-day) | Not available |
Your cost per paycheck
Placeholder values for this demo.
Employee only
of $312.00 total
$62.40
Employee + spouse
of $686.00 total
$148.60
Employee + child(ren)
of $618.00 total
$131.20
Family
of $934.00 total
$204.80
Other benefits
If offered.
Dental
If offered$50 individual deductible, preventive covered at 100%, $1,500 annual maximum.
Vision
If offered$10 exam copay each plan year, $150 frame and lens allowance.
Life & AD&D
If offeredEmployer-paid basic life at 1x salary, up to $50,000.
Disability
If offeredShort-term at 60% of weekly pay for 12 weeks; long-term at 60% to age 65.