2016 Idaho Large Group Plans

The information on this page is for plans beginning January 1, 2016, and July 1, 2016.

Medical Plans


 

Plan

Deductible*

OOP*

Co-insurance

HSA-eligible?

SBCs and Handbooks
by Network
Summaries
by Network
  Balance 1000+30-45_20
$1,000
$5,000
20%
No
BIN / PSNSAN / SCN / SHN
BIN / PSNSANSCN / SHN
Balance 1000+30-45_30
$1,000
$5,000
30%
No
BIN / PSNSAN / SCN / SHN
BIN / PSNSANSCN / SHN
Balance 1500+30-45_20
$1,500
$5,500
20%
No
BIN / PSNSAN / SCN / SHN
BIN / PSNSAN / SCN / SHN
Balance 1500+30-45_30
$1,500
$5,500
30%
No
BIN / PSNSAN / SCN / SHN
BIN / PSNSAN / SCN / SHN
Balance 2000+30-45_20
$2,000
$6,000
20%
No
BIN / PSNSAN / SCN / SHN
BIN / PSNSAN / SCN / SHN
Balance 2000+30-45_30
$2,000
$6,000
30%
No
BIN / PSNSANSCN / SHN
BIN / PSNSAN / SCN / SHN
Balance 2500+30-45_20
$2,500
$6,000
20%
No
BIN / PSNSAN / SCN / SHN
BIN / PSNSAN / SCN / SHN
Balance 2500+30-45_30
$2,500
$6,000
30%
No
BIN / PSNSAN / SCN / SHN
BIN / PSNSAN / SCN / SHN
Balance 3000+30-45_20
$3,000
$6,000
20%
No
BIN / PSNSAN / SCN / SHN
BIN / PSNSAN / SCN / SHN
Balance 3000+30-45_30
$3,000
$6,000
30%
No
BIN / PSNSAN / SCN / SHN
BIN / PSNSANSCN / SHN
Balance 4000+30-45_20
$4,000
$6,000
20%
No
BIN / PSNSAN / SCN / SHN
BIN / PSNSANSCN / SHN
Balance 4000+30-45_30
$4,000
$6,000
30%
No
BIN / PSNSAN / SCN / SHN
BIN / PSNSANSCN / SHN
Balance 5000+30-45_20 (7/1/16)
$5,000
$6,850
30%
No
BIN / PSNSAN / SCN / SHN
BIN / PSNSANSCN / SHN
Balance 5000+30-45_30 (7/1/16)
$5,000
$6,850 
30%
No
BIN / PSNSAN / SCN / SHN
BIN / PSNSANSCN / SHN
  Value 1500_20+Rx 
Non-embedded
 (7/1/16)
$1,500
$4,500
20%
Yes
BIN / PSNSAN / SCN / SHN
BIN / PSNSAN / SCN / SHN
Value 3000_50+Rx
$3,000
$6,350
50%
Yes
BIN / PSNSAN / SCN / SHN
BIN / PSNSAN / SCN / SHN
Value 3000+Rx
$3,000
$3,000
0%
Yes
BIN / PSNSAN / SCN / SHN
BIN / PSNSAN / SCN / SHN
Value 4000+Rx
$4,000
$4,000
0%
Yes
BIN / PSNSAN / SCN / SHN
BIN / PSNSAN / SCN / SHN
Value 5000+Rx
$5,000
$5,000
0%
Yes
BIN / PSNSAN / SCN / SHN
BIN / PSNSAN / SCN / SHN

*Deductible and out-of-pocket limit amounts shown below are the costs for individuals. Amounts for families are twice the individual amounts.

Dental Plans


  Dental Advantage Plus 0-20-50 50-1000 Dental Choice Plus 0-20-50 25-1000
Dental Advantage Plus 0-20-50 50-1500 Dental Choice Plus 0-20-50 25-1500
Dental Advantage Plus 20-20-50 50-1000 Dental Choice Plus 0-20-50 50-1000
Dental Advantage Plus 20-20-50 50-1500 Dental Choice Plus 0-20-50 50-1500
  Kids Dental Advantage 0/20/50 Kids Dental Advantage 20-40-50
  Ortho 1000 Ortho 1500

Voluntary Dental Option Plans

Our Voluntary Dental option is available to businesses with ten or more enrolled employees. For information and requirements, please see our Voluntary Dental flier.

  Dental Advantage 0-20-50 50-1000 Voluntary Dental Choice 0-20-50 25-1500 Voluntary
Dental Advantage 0-20-50 50-1500 Voluntary Dental Choice 0-20-50 50-1500 Voluntary

Pharmacy Plans


   ID 3000D IDL ID 20P IDL (7/1/16) 
ID 4000D IDL ID 50P IDL  
ID 5000D IDL ID 7-25-50 250D IDL
  ID 7-25-50 IDL

Chiropractic Manipulation and Acupuncture


  Summary

Vision Plans


   Vision 100 Vision Plus
Vision 200 Vision Exam Only

Brochure and Forms


Visit our Idaho Forms and Materials page for more sales materials.

 Network Availability


Plan availability varies depending on geographic location. All network plans are available direct with PacificSource.

PacificSource Network (PSN)

 
 

Available in the following counties:

  • All counties

Notable features:

  • Access to participating PSN providers in Oregon, Idaho, Montana, and southern counties in Washington, as well as access to a nationwide travel network of providers
  • Referrals not required for specialty care
  • Some plans qualified for health savings accounts
 

SmartChoice Network (SCN)

 
 

Available in the following counties:

  • Bannock
  • Bear Lake
  • Benewah
  • Bingham
  • Bonner
  • Bonneville
  • Boundary
 
  • Butte
  • Caribou
  • Cassia
  • Clark
  • Clearwater
  • Custer
  • Franklin
 
  • Fremont
  • Idaho
  • Jefferson
  • Kootenai
  • Latah
  • Lemhi
  • Lewis
  • Madison
 
  • Nez Perce
  • Oneida
  • Power
  • Shoshone
  • Teton
 

Notable features:

  • Partner with a primary care provider (PCP)
  • Referrals not required for specialty care
  • Some plans qualified for health savings accounts
 

SmartAlliance Network (SAN)

 
 

Available in the following counties:

  • Ada
  • Boise
 
  • Canyon
  • Gem
 
  • Owyhee
  • Payette
 
  • Washington
 

Notable features:

  • Referrals not required for specialty care
  • Some plans qualified for health savings accounts
  • Includes the only Level II Trauma Center in the region

Network includes:

  • All hospitals and clinics in the Saint Alphonsus Health System
  • Primary Health Medical Group
  • West Valley Medical Center and Providers
  • Weiser Memorial Hospital and Providers
  • Walter Knox Memorial Hospital
 

BrightIdea Network (BIN)

 
 

Available in the following counties:

  • Ada
  • Adams
  • Blaine
  • Boise
  • Camas
 
  • Canyon
  • Elmore
  • Gem
  • Gooding
 
  • Jerome
  • Lincoln
  • Minidoka
  • Owyhee
 
  • Payette
  • Twin Falls
  • Valley
  • Washington
 

Notable features:

  • Referrals not required for specialty care
  • Some plans qualified for health savings accounts

Network includes:

  • St. Luke's Health System
  • West Valley Medical Center
  • Walter Knox Medical Center
  • Weiser Memorial Hospital
  • Minidoka Memorial Hospital
  • North Canyon Medical Center