Group plan documents
Below are group plan documents for our medical plans.
2023
2022
2023 Small group benefit summaries
Vision plan benefits summaries
2023 Large group benefit summaries
Connexus PPO Medical Plan Options
- PPO-250-2500-20-10-SOB
- PPO-250-3000-25-10-SOB
- PPO-500-3000-25-10-SOB
- PPO-500-3000-25-20-SOB
- PPO-500-5000-30-20-SOB
- PPO-500-3000-20-20-SOB
- PPO-500-3500-20-20-SOB
- PPO-500-4000-25-20-SOB
- PPO-500-5000-25-20-SOB
- PPO-500-5000-35-30-SOB
- PPO-500-7150-25-20-SOB
- PPO-500-7150-35-30-SOB
- PPO-1000-3000-25-20-SOB
- PPO-1000-5000-25-20-SOB
- PPO-1000-3000-30-20-SOB
- PPO-1000-5000-30-20-SOB
- PPO-1000-3500-25-20-SOB
- PPO-1000-4500-25-20-SOB
- PPO-1000-5500-25-20-SOB
- PPO-1000-5500-35-30-SOB
- PPO-1000-7150-25-20-SOB
- PPO-1000-7150-35-30-SOB
- PPO-1500-3000-25-20-SOB
- PPO-1500-3000-30-20-SOB
- PPO-1500-5000-30-20-SOB
- PPO-1500-4000-25-20-SOB
- PPO-1500-5000-25-20-SOB
- PPO-1500-6000-25-20-SOB
- PPO-1500-6000-35-30-SOB
- PPO-1500-7150-25-20-SOB
- PPO-1500-7150-35-30-SOB
- PPO-2000-4000-25-20-SOB
- PPO-2000-6000-25-20-SOB
- PPO-2000-4000-30-20-SOB
- PPO-2000-6000-30-20-SOB
- PPO-1500-3000-30-30-SOB
- PPO-1500-5000-30-30-SOB
- PPO-2000-4000-30-30-SOB
- PPO-2000-6000-30-30-SOB
- PPO-2000-4500-25-20-SOB
- PPO-2000-5500-25-20-SOB
- PPO-2000-5500-35-30-SOB
- PPO-2000-7150-25-20-SOB
- PPO-2000-7150-35-30-SOB
- PPO-2500-5000-25-20-SOB
- PPO-2500-5000-35-30-SOB
- PPO-2500-7500-25-20-SOB
- PPO-2500-7500-35-30-SOB
- PPO-3000-5000-30-20-SOB
- PPO-3000-7000-30-20-SOB
- PPO-3000-5000-25-30-SOB
- PPO-3000-7000-25-30-SOB
- PPO-3000-5000-30-30-SOB
- PPO-3000-7000-30-30-SOB
- PPO-3000-5500-25-20-SOB
- PPO-3000-5500-35-30-SOB
- PPO-3000-7150-25-20-SOB
- PPO-3000-7150-35-30-SOB
- PPO-3000-8900-25-20-SOB
- PPO-3000-8900-35-30-SOB
- PPO-3500-7150-25-20-SOB
- PPO-3500-7150-35-30-SOB
- PPO-3500-8900-25-20-SOB
- PPO-3500-8900-35-30-SOB
- PPO-4000-7150-25-20-SOB
- PPO-4000-7150-35-30-SOB
- PPO-4000-8900-25-20-SOB
- PPO-4000-8900-35-30-SOB
- PPO-4500-7150-25-20-SOB
- PPO-4500-7150-35-30-SOB
- PPO-4500-8900-25-20-SOB
- PPO-4500-8900-35-30-SOB
- PPO-5000-8550-25-30-SOB
- PPO-5000-7150-25-20-SOB
- PPO-5000-7150-35-30-SOB
- PPO-5000-8900-25-20-SOB
- PPO-5000-8900-35-30-SOB
- PPO-6000-7150-25-20-SOB
- PPO-6000-7150-35-30-SOB
- PPO-6000-8900-25-20-SOB
- PPO-6000-8900-35-30-SOB
- PPO-7000-8900-25-20-SOB
- PPO-7000-8900-35-30-SOB
- PPO-8000-8900-25-20-SOB
- PPO-8000-8900-35-30-SOB
Connexus VBC Medical Plan Options
- VBC-250-2500-20-40-10-SOB
- VBC-250-3000-25-45-10-SOB
- VBC-500-3000-25-45-10-SOB
- VBC-500-3000-25-40-20-SOB
- VBC-500-5000-30-45-20-SOB
- VBC-500-3000-20-40-20-SOB
- VBC-500-3500-20-40-20-SOB
- VBC-500-4000-25-45-20-SOB
- VBC-500-5000-25-45-20-SOB
- VBC-500-5000-35-55-30-SOB
- VBC-500-7150-25-45-20-SOB
- VBC-500-7150-35-55-30-SOB
- VBC-1000-3000-25-40-20-SOB
- VBC-1000-5000-25-40-20-SOB
- VBC-1000-3000-30-45-20-SOB
- VBC-1000-5000-30-45-20-SOB
- VBC-1000-3000-35-50-20-SOB
- VBC-1000-5000-35-50-20-SOB
- VBC-1000-3500-25-45-20-SOB
- VBC-1000-4500-25-45-20-SOB
- VBC-1000-5500-25-45-20-SOB
- VBC-1000-5500-35-55-30-SOB
- VBC-1000-7150-25-45-20-SOB
- VBC-1000-7150-35-55-30-SOB
- VBC-1500-3000-25-40-20-SOB
- VBC-1500-5000-25-40-20-SOB
- VBC-1500-3000-30-45-20-SOB
- VBC-1500-5000-30-45-20-SOB
- VBC-1500-3000-35-50-20-SOB
- VBC-1500-5000-35-50-20-SOB
- VBC-1500-4000-25-45-20-SOB
- VBC-1500-5000-25-45-20-SOB
- VBC-1500-6000-25-45-20-SOB
- VBC-1500-6000-35-55-30-SOB
- VBC-1500-7150-25-45-20-SOB
- VBC-1500-7150-35-55-30-SOB
- VBC-2000-4000-25-40-20-SOB
- VBC-2000-6000-25-40-20-SOB
- VBC-2000-4000-30-45-20-SOB
- VBC-2000-6000-30-45-20-SOB
- VBC-2000-4000-35-50-20-SOB
- VBC-2000-6000-35-50-20-SOB
- VBC-2000-4500-25-45-20-SOB
- VBC-2000-5500-25-45-20-SOB
- VBC-2000-5500-35-55-30-SOB
- VBC-2000-7150-25-45-20-SOB
- VBC-2000-7150-35-55-30-SOB
- VBC-2500-5000-25-45-20-SOB
- VBC-2500-5000-35-55-30-SOB
- VBC-2500-7500-25-45-20-SOB
- VBC-2500-7500-35-55-30-SOB
- VBC-3000-5000-25-40-20-SOB
- VBC-3000-7000-25-40-20-SOB
- VBC-3000-5000-30-45-20-SOB
- VBC-3000-7000-30-45-20-SOB
- VBC-3000-5000-35-50-20-SOB
- VBC-3000-7000-35-50-20-SOB
- VBC-3000-5000-30-45-30-SOB
- VBC-3000-5000-35-50-30-SOB
- VBC-3000-7000-35-50-30-SOB
- VBC-3000-5500-25-45-20-SOB
- VBC-3000-5500-35-55-30-SOB
- VBC-3000-7150-25-45-20-SOB
- VBC-3000-7150-35-55-30-SOB
- VBC-3000-8900-25-45-20-SOB
- VBC-3000-8900-35-55-30-SOB
- VBC-3500-7150-25-45-20-SOB
- VBC-3500-7150-35-55-30-SOB
- VBC-3500-8900-25-45-20-SOB
- VBC-3500-8900-35-55-30-SOB
- VBC-4000-7150-25-45-20-SOB
- VBC-4000-7150-35-55-30-SOB
- VBC-4000-8900-25-45-20-SOB
- VBC-4000-8900-35-55-30-SOB
- VBC-4500-7150-25-45-20-SOB
- VBC-4500-7150-35-55-30-SOB
- VBC-4500-8900-25-45-20-SOB
- VBC-4500-8900-35-55-30-SOB
- VBC-5000-8150-30-45-20-SOB
- VBC-5000-8550-35-50-20-SOB
- VBC-5000-8550-30-45-30-SOB
- VBC-5000-8550-35-50-30-SOB
- VBC-5000-7150-25-45-20-SOB
- VBC-5000-7150-35-55-30-SOB
- VBC-5000-8900-25-45-20-SOB
- VBC-5000-8900-35-55-30-SOB
- VBC-6000-7150-25-45-20-SOB
- VBC-6000-7150-35-55-30-SOB
- VBC-6000-8900-25-45-20-SOB
- VBC-6000-8900-35-55-30-SOB
- VBC-7000-8900-25-45-20-SOB
- VBC-7000-8900-35-55-30-SOB
- VBC-8000-8900-25-45-20-SOB
- VBC-8000-8900-35-55-30-SOB
Connexus HDHP Medical Plan Options
- HDHP-3000-3000-0-SOB
- HDHP-2800-5000-20-SOB
- HDHP-2800-5000-30-SOB
- HDHP-3000-5000-20-SOB
- HDHP-5000-5000-0-SOB
- HDHP-3000-7000-30-SOB
Moda Select POS Medical Plan Options
- POS-250-2500-20-40-10-SOB
- POS-250-3000-25-45-10-SOB
- POS-500-3000-25-45-10-SOB
- POS-500-3000-20-40-20-SOB
- POS-500-3500-20-40-20-SOB
- POS-500-4000-25-45-20-SOB
- POS-500-5000-25-45-20-SOB
- POS-500-5000-35-55-30-SOB
- POS-500-7150-25-45-20-SOB
- POS-500-7150-35-55-30-SOB
- POS-1000-3500-25-45-20-SOB
- POS-1000-4500-25-45-20-SOB
- POS-1000-5500-25-45-20-SOB
- POS-1000-5500-35-55-30-SOB
- POS-1000-7150-25-45-20-SOB
- POS-1000-7150-35-55-30-SOB
- POS-1500-4000-25-45-20-SOB
- POS-1500-5000-25-45-20-SOB
- POS-1500-6000-25-45-20-SOB
- POS-1500-6000-35-55-30-SOB
- POS-1500-7150-25-45-20-SOB
- POS-1500-7150-35-55-30-SOB
- POS-2000-4500-25-45-20-SOB
- POS-2000-5500-25-45-20-SOB
- POS-2000-5500-35-55-30-SOB
- POS-2000-7150-25-45-20-SOB
- POS-2000-7150-35-55-30-SOB
- POS-2500-5000-25-45-20-SOB
- POS-2500-5000-35-55-30-SOB
- POS-2500-7500-25-45-20-SOB
- POS-2500-7500-35-55-30-SOB
- POS-3000-5500-25-45-20-SOB
- POS-3000-5500-35-55-30-SOB
- POS-3000-7150-25-45-20-SOB
- POS-3000-7150-35-55-30-SOB
- POS-3000-8900-25-45-20-SOB
- POS-3000-8900-35-55-30-SOB
- POS-3500-7150-25-45-20-SOB
- POS-3500-7150-35-55-30-SOB
- POS-3500-8900-25-45-20-SOB
- POS-3500-8900-35-55-30-SOB
- POS-4000-7150-25-45-20-SOB
- POS-4000-7150-35-55-30-SOB
- POS-4000-8900-25-45-20-SOB
- POS-4000-8900-35-55-30-SOB
- POS-4500-7150-25-45-20-SOB
- POS-4500-7150-35-55-30-SOB
- POS-4500-8900-25-45-20-SOB
- POS-4500-8900-35-55-30-SOB
- POS-5000-7150-25-45-20-SOB
- POS-5000-7150-35-55-30-SOB
- POS-5000-8900-25-45-20-SOB
- POS-5000-8900-35-55-30-SOB
- POS-6000-7150-25-45-20-SOB
- POS-6000-7150-35-55-30-SOB
- POS-6000-8900-25-45-20-SOB
- POS-6000-8900-35-55-30-SOB
- POS-7000-8900-25-45-20-SOB
- POS-7000-8900-35-55-30-SOB
- POS-8000-8900-25-45-20-SOB
- POS-8000-8900-35-55-30-SOB
Moda Select HDHP Medical Plan Options
- HDHP-POS-3000-3000-0-SOB
- HDHP-POS-2800-5000-20-SOB
- HDHP-POS-2800-5000-30-SOB
- HDHP-POS-3000-5000-20-SOB
- HDHP-POS-5000-5000-0-SOB
- HDHP-POS-3000-7000-30-SOB
Pharmacy is Embedded in the Medical Rates for HDHP Plans
Pharmacy Tiers: Value/Select/Preferred/Non Preferred/Preferred Specialty/Non Preferred Specialty
HDHP Plans: All plans include HSA administration services through Benefit Help Solutions at no additional charge.
✝ All tiers except Value are $15 or 50% (whichever is greater). This Rx plan is not Medicare Part D creditable.
2022 Small group benefit summaries
2023 Small group benefit summaries
Plan name | In-network/Tier-1 benefit (per person) | Benefit Summary (SB) | SBC | ||
---|---|---|---|---|---|
Deductible | Out-of-pocket max | PCP office visit copay/coinsurance | |||
Gold | |||||
Endeavor Select Gold No-Deductible | $0 | $8,550 | 30% | ![]() |
![]() |
Endeavor Select Gold 500 | $500 | $7,500 | $30* | ![]() |
![]() |
Endeavor Select Gold 1000 | $1,000 | $6,700 | $25* | ![]() |
![]() |
Endeavor Select Gold 1500 | $1,500 | $6,000 | $25* | ![]() |
![]() |
Endeavor Select Gold 2000 | $2,000 | $6,000 | $30* | ![]() |
![]() |
Endeavor Select Gold HDHP 1500 | $1,500 | $3,500 | 20% | ![]() |
![]() |
Pioneer Gold 500 | $500 | $6,400 | $25* | ![]() |
![]() |
Pioneer Gold 1000 | $1,000 | $6,400 | $25* | ![]() |
![]() |
Pioneer Gold 1500 | $1,500 | $6,000 | $25* | ![]() |
![]() |
Pioneer Gold 2000 | $2,000 | $5,000 | $20* | ![]() |
![]() |
Pioneer Gold 1500 HDHP | $1,500 | $3,500 | 20% | ![]() |
![]() |
Silver | |||||
Endeavor Select Silver 2500 | $2,500 | $8,900 | $40* | ![]() |
![]() |
Endeavor Select Silver 3000 | $3,000 | $8,900 | $40* | ![]() |
![]() |
Endeavor-Select-Silver 4000 | $4,000 | $8,900 | $50* | ![]() |
![]() |
Endeavor Select Silver HDHP 2500 | $2,500 | $7,150 | 25% | ![]() |
![]() |
Endeavor Select Silver HDHP 3250 | $3,250 | $7,000 | 25% | ![]() |
![]() |
Pioneer Silver 2200 | $2,200 | $8,800 | $50* | ![]() |
![]() |
Pioneer Silver 2500 | $2,500 | $8,550 | $35* | ![]() |
![]() |
Pioneer Silver 3500 | $3,500 | $9,100 | $60* | ![]() |
![]() |
Pioneer Silver 4000 | $4,000 | $8,900 | $40* | ![]() |
![]() |
Pioneer Silver 2800 HDHP | $2,800 | $6,900 | 25% | ![]() |
![]() |
Pioneer Silver 3500 HDHP | $3,500 | $6,900 | 20% | ![]() |
![]() |
Bronze | |||||
Endeavor Select Bronze 8150 | $8,150 | $8,150 | 0% | ![]() |
![]() |
Endeavor Select Bronze 8550 | $8,550 | $8,550 | 0% | ![]() |
![]() |
Pioneer Bronze 6700 | $6,700 | $9,100 | $85* | ![]() |
![]() |
Pioneer Bronze 7500 | $7,500 | $9,100 | $85* | ![]() |
![]() |
Pioneer Bronze 8550 | $8,550 | $8,550 | 0% | ![]() |
![]() |
Pioneer Bronze 5950 HDHP | $5,950 | $7,000 | 40% | ![]() |
![]() |
Pioneer Bronze 6900 HDHP | $6,900 | $6,900 | 0% | ![]() |
![]() |
Endeavor Select Bronze HDHP 7000 | $7,000 | $7,000 | 0% | ![]() |
![]() |
2023 Large group benefit summaries
Endeavor Select medical plan options
- Value-500-6500-20-50-20 SOB
- Value-1000-7000-25-50-20 SOB
- Value-1500-7500-25-50-20 SOB
- Value-2000-8150-25-60-20 SOB
- Value-2500-8550-30-60-20 SOB
- Value-3000-8550-30-60-20 SOB
- Value-4000-8550-30-65-20 SOB
- Value-5000-8550-40-80-30 SOB
- Value-6000-8550-45-80-30 SOB
- Value-7000-8550-50-100-30 SOB
- Value-8550-8550-50-100-0 SOB
- PPO-0-8700-20 SOB
- PPO-500-3500-20-20 SOB
- PPO-1000-4500-25-20 SOB
- PPO-1500-4500-25-20 SOB
- PPO-2000-4500-25-20 SOB
- PPO-2500-6000-30-20 SOB
- PPO-3000-6000-30-20 SOB
- PPO-4000-6000-30-20 SOB
- PPO-5000-8550-40-30 SOB
- PPO-6000-8550-45-30 SOB
- PPO-7000-8550-50-30 SOB
- PPO-8550-8550-50-0 SOB
- HDHP-1500-3000-20 SOB
- HDHP-2000-5000-20 SOB
- HDHP-2500-5000-20 SOB
- HDHP-3000-5000-20 SOB
- HDHP-4000-6000-20 SOB
- HDHP-5000-7000-20 SOB
- HDHP-6000-7000-20 SOB
- HDHP-7000 SOB
Pioneer medical plan options
2021 Small group benefit summaries
|
2021 Small group benefit summaries
Plan Tier | Plan Type | 2021 Alaska small group plans (1-50) | In-network benefit (per person) | ||||
---|---|---|---|---|---|---|---|
Deductible | Out-of-pocket max | PCP office visit copay/coinsurance | SB | SBC | |||
Gold Plans | |||||||
1-Gold | Select | Endeavor Select Gold No Deductible | $0 | $8,550 | 30% | ![]() |
![]() |
1-Gold | Select | Endeavor Select Gold 500 | $500 | $6,750 | $30/visit | ![]() |
![]() |
1-Gold | Select | Endeavor Select Gold 1000 | $1,000 | $6,750 | $30/visit | ![]() |
![]() |
1-Gold | Select | Endeavor Select Gold 1500 | $1,500 | $6,750 | $30/visit | ![]() |
![]() |
1-Gold | Select | Endeavor Select Gold 2000 | $2,000 | $6,750 | $30/visit | ![]() |
![]() |
1-Gold | Select | Endeavor Select Gold HDHP 1500 | $1,500 | $3,500 | 20% after deductible | ![]() |
![]() |
1-Gold | Select | Pioneer Gold 750 (Tier 1) | $750 | $5,000 | $25/visit | ![]() |
![]() |
1-Gold | Select | Pioneer Gold 1500 (Tier 1) | $1,500 | $5,000 | $25/visit | ![]() |
![]() |
1-Gold | Select | Pioneer Gold 1500 HDHP (Tier 1) | $1,500 | $3,500 | 20% after deductible | ![]() |
![]() |
Silver Plans | |||||||
2-Silver | Select | Endeavor Select Silver 2500 | $2,500 | $8,550 | $40/visit | ![]() |
![]() |
2-Silver | Select | Endeavor Select Silver 3000 | $3,000 | $8,550 | $40/visit | ![]() |
![]() |
2-Silver | Select | Endeavor Select Silver 4000 | $4,000 | $8,550 | $40/visit | ![]() |
![]() |
2-Silver | Select | Endeavor Select Silver HDHP 2500 | $2,500 | $6,000 | 25% after deductible | ![]() |
![]() |
2-Silver | Select | Endeavor Select Silver HDHP 3250 | $3,250 | $7,000 | 25% after deductible | ![]() |
![]() |
2-Silver | Select | Endeavor Select Silver HDHP 4000 | $4,000 | $7,000 | 25% after deductible | ![]() |
![]() |
2-Silver | Select | Endeavor Select Silver HDHP 5000 | $5,000 | $6,400 | 25% after deductible | ![]() |
![]() |
2-Silver | Select | Pioneer Silver 2500 (Tier 1) | $2,500 | $6,000 | 25% after deductible | ![]() |
![]() |
2-Silver | Select | Pioneer Silver 4000 (Tier 1) | $4,000 | $7,000 | 25% after deductible | ![]() |
![]() |
2-Silver | Select | Pioneer Silver 2500 HDHP (Tier 1) | $2,500 | $8,550 | $35/visit | ![]() |
![]() |
2-Silver | Select | Pioneer Silver 4000 HDHP (Tier 1) | $4,000 | $8,550 | $35/visit | ![]() |
![]() |
Bronze Plans | |||||||
3-Bronze | Select | Endeavor Select Bronze 4000 | $4,000 | $8,550 | 50% after deductible | ![]() |
![]() |
3-Bronze | Select | Endeavor Select Bronze 5000 | $5,000 | $8,550 | 50% after deductible | ![]() |
![]() |
3-Bronze | Select | Endeavor Select Bronze 6000 | $6,000 | $8,550 | $55/visit | ![]() |
![]() |
3-Bronze | Select | Endeavor Select Bronze 8550 | $8,550 | $8,550 | $55/visit | ![]() |
![]() |
3-Bronze | Select | Endeavor Select Bronze HDHP 7000 | $7,000 | $7,000 | 0% after deductible | ![]() |
![]() |
3-Bronze | Select | Pioneer Bronze 5000 (Tier 1) | $5,000 | $8,550 | $50/visit | ![]() |
![]() |
3-Bronze | Select | Pioneer Bronze 6500 (Tier 1) | $6,500 | $8,550 | $50/visit | ![]() |
![]() |
3-Bronze | Select | Pioneer Bronze 8550 (Tier 1) | $8,550 | $8,550 | $50/visit | ![]() |
![]() |
3-Bronze | Select | Pioneer Bronze 7000 HDHP (Tier 1) | $7,000 | $7,000 | 0% after deductible | ![]() |
![]() |