- Monthly Rates
- Plan Name
- Plan Summary
- Deductible
- Network
- Office Visits
- Co-insurance
- Maximum Out of Pocket
(includes Deductible)
- Preventive coverage
- X-ray and Lab Coverage
- Complex Outpatient Imaging
Subject to Deductible
(MRI, CAT, PET, etc)
- Maternity Coverage
- Rx Coverage
- Vision Coverage
- Lifetime Maximum
- On the Job Coverage
- % of clients choose
HSA
Eligible for HSA Account
Plan Not
Available in
your County
- HSA Qualified
- apply
- (rate)
- Evolve HSA
- Detailed Info
- $3,500
Individual
- $7,000
Family
- Any Doctor or Hospital
- You pay 50% after deductible
- You pay 50%
- $5,000
Individual
- $10,000
Family
- Covered at 100%
no annual max
- You pay 50%
after deductible
- You pay 50%
pre-authorization
required
- No
- Generic drugs
only after
deductible is met
- No
- No annual max
- For subscriber only
- 60%
Catastrophic
High Deductible with Office Visits
covered immediately
Plan Not
Available in
your County
-
- apply
- (rate)
- (rate)
- WiseEssentials Rx
- Detailed Info
- $1,880
- $2,500
- PPO
- *6 per person
covered at 75%
- You pay 25%
- $6,850
- $7,500
- covered at 100%
no annual max
- You pay 25%, covered
Immediately only
on $1,850 plan
- You pay 25%
- No
- $15 co-pay generic drugs, brand name drugs are not covered
- No
- No annual max
- For subscriber only
- 20%
Plan Not
Available in
your County
-
- apply
- (rate)
- Evolve Core
- Detailed Info
- $2,500
- PPO
- *4 per person
Covered at 100%
with $35 co-pay
- You pay 30%
- $10,000
- covered at 100%
no annual max
- 100% coverage up
to $200*
- You pay 50%
$1,500 annual maximum
- No
- Discount Plan
for formulary drugs
- No
- No annual max
- For subscriber/spouse
when exempt from L&I
- 5%
Comprehensive
Includes coverage for Rx, Maternity, Vision and Office Visits
Plan Not
Available in
your County
-
- apply
- (rate)
- (rate)
- Wise Advantage
- Detailed Info
- $1,800
- PPO
- Covered at 100%
with $30 co-pay
- You pay 35%
- $8,300
- covered at 100%
no annual max
- You pay 35% after
deductible
- You pay 35%
- Yes
- Generic Only
$15 or 50%
Brand name drugs
not covered
Per calendar year (PCY)
- Exam with $30 co-pay
$200 hardware
every 2 years
- No annual max
- For subscriber only
- 5%
Plan Not
Available in
your County
-
- apply
- (rate)
- (rate)
- Balance
- Detailed Info
- $1,250
- $1,750
- Any Doctor or Hospital
- You pay 40% after
deductible
- 40%
- You pay 40%
- $6,250
- $7,750
plus hospital co-pays
see summary
- 60% coverage up to
$300 per person
- 20%
- 40%
- after deductible
- 20%
- 40%
- Yes
- Pref. generic $15
Non-Pref. Generic 50%
Brand names not covered
- Exam with $30 co-pay
$200 hardware
every 12 months
- No annual max
- For subscriber only
- 5%
Plan Not
Available in
your County
-
- apply
- (rate)
- (rate)
- Evolve Plus
- Detailed Info
- $1,000
- $2,500
- PPO
- *4 per person
covered at 100%
with $25 co-pay
- You pay 20%
- $6,500
- $8,000
- covered at 100%
no annual max
- 100% coverage up
to $400*
- You pay 50%
- Yes
- $15 co-pay generic,
$500 Rx deductible for
Preferred brand, then 50%
covered to $2,500 PCY
(3rd tier brand not covered)
- You pay 20% for
Exam and hardware
$150 max per year
- No annual max
- For subscriber/spouse
when exempt from L&I
- 5%