Benefit Plan Information
Benefit Plan Information
Prime Healthcare is proud to offer you a comprehensive variety of benefits and programs to enrich your life. Please click on each bar below for information on each benefit plan offered along with more detailed information about the carriers.
Prime Healthcare EPO Plan
Tier 1 Prime Healthcare Network
Staying within the Tier 1 Prime Healthcare Network, you will receive your care from our award-winning Prime Healthcare hospitals and dedicated physicians, at little or no cost to you!
Advantages of the Tier 1 Prime Healthcare Network include:
- No annual deductible
- Minimal or no copays or coinsurance
- Easy access to the Tier 1 Prime Healthcare Network
- One of the best plans in the nation for quality, value and the least cost to members
- Award winning hospitals for quality
- Board certified physicians dedicated to your care, with more joining the Network every week
- Open access to any Prime inpatient or outpatient facility across the nation with no need for prior authorization for covered services
- All covered services provided at any Prime facility are 100% covered at no cost to the member
- No prior authorization is required to see a Tier 1 Prime Healthcare Network Specialist for the initial office visit or for any of the covered services (list available on company website https://www.primehealthcare.com/EHP)
Value Plan
The Prime Value Plan members have access to Tier 2 Blue Shield of CA Network/BCBS BlueCard Providers in addition to Tier 1 Prime Healthcare Network facilities and providers. No authorization is required for Tier 1 and Tier 2 Primary Care Provider (PCP). Initial consult to a Tier 1 Specialist doesn’t need an authorization but all follow up needs an authorization to be submitted by your provider. All Tier 2 Specialist will need an authorization submitted by the provider on your behalf.
• Forms are available on our website:
https://www.primehealthcare.com/Employee-Health-Plan.aspx
• Tier 1 Providers can be located at:
https://ehp.primehealthcare.com/find-a-provider/ (Note: Clear filters before searching)
• Tier 2 Providers can be located at:
https://blueshieldca.com/networkppo (California)
http://www.bcbs.com/find-a-doctor (Outside of California)
The Prime Value Plan offers essential health benefits as specified under the Affordable Care Act.
Medical Expense Reimbursement Plan (MERP)
MERP is a voluntary plan available to employees who have access to alternate group medical and prescription drug coverage through a spouse or other source. It can be a powerful way to avoid the impact of unexpected medical costs.
Prescription Drugs
Prescription drug coverage provides a benefit that is important to your overall health, whether you need a prescription for a short-term health issue like bronchitis or an ongoing condition like high blood pressure. If you enroll in medical coverage, you will automatically receive coverage for prescription drugs. Express Scripts is the Pharmacy Benefits Manager.
Eligibility
Please refer to the benefits guides for eligibility waiting period.