Medical Care Made Easy

Give Your Business an Advantage By Providing Your Employees With FREE Healthcare

 

Attract top talent by providing exceptional healthcare. Contribute a fixed price to give your employees excellent medical care that anyone can afford!

SIERRA PLAN

Connected Care

Connected Care – Non Emergent Telehealth 24/7
$0 Copay
Connected Virtual Urgent Care - 24/7 Unlimited Visits
$0 Copay
Mental Health AI Chatbot - 24/7 Unlimited Access
$0 Copay
Behavioral Health Telehealth Consultations (3 visits per calendar year)
$0 Copay

Deductible & Coverage Maximums

Deductible
(per plan year)
$2,500
Coinsurance
20%
Coinsurance Out-of-Pocket Maximum
(per plan year)
$2,500
Total Out-of-Pocket Maximum
(per plan year)
$5,000
Lifetime Coverage Maximum
$1,000,000

Outpatient Services

Networks
PHCS Practitioner and Ancillary Only PNOA Network
Preventive Services (waiting period applies)
Max coverage for mammograms is $1,000 and colonoscopies is $2,500. Waiting period of 1 month on all preventive care except colonoscopies which are subject to a 6 month waiting period.
In-Network: $0 copay1 then covered at 100%
Out-of-Network: $100 copay1 then covered at 100%
Deductible does not apply
PCP Visits
(5 visits per plan year combined with specialist)
$50 copay1 then 20% coinsurance
After 5 visits deductible must be met before services are covered
Specialist Visits
(5 visits per plan year combined with PCP)
$75 copay1 then 20% coinsurance
After 5 visits deductible must be met before services are covered
Urgent Care
$150 copay1 plus 20% coinsurance

Facility/Inpatient Services*

In / Outpatient Surgery
Hospital / Facility Services
Deductible then 20% coinsurance plus amounts exceeding the Reasonable and Allowed Amounts and/or the plan maximum
*Pre-Existing Condition limitations apply during initial 36-months of Plan.
Emergency Room
Additional $1,500 copay applies (waived if admitted)
Ambulance
Additional $1,500 copay applies

Maternity

Maternity coverage is subject to a $5,000 deductible, separate from plan deductible, for a normal delivery plus 20% coinsurance. Must have an expected due date for delivery at least 300 days after your plan effective date for bills to be covered.

Prescription Coverage

LEVEL 1
Medications under $50 for 30 Day Supply
$10 copay
LEVEL 2
Medications costing $50 - $149 for 30 Day Supply
$20 copay or 20% copay
LEVEL 3
Medications costing $150 - $400 for 30 Day Supply
40% copay (1 Fill Only)

High-Cost Medications

Members needing access to maintenance and specialty medications costing over $150 per month work with an advocate after registering online. Advocates access these medications using our proprietary program.

Additional Services

Chiropractic
6 month waiting period applies
$50 Copay (max 10 visits per plan year)
Outpatient Therapy – Physical, Speech, and Occupational
6 month waiting period applies
$75 Copay
(max 10 visits per plan year combined)
Mental Health/Substance Abuse Treatment
6 month waiting period applies
Subject to plan deductible and coinsurance
$10,000 Annual Max for each
Mental Health Therapy (In-Person Visits)
6 month waiting period applies
$75 Copay (max 10 visits per plan year)
Diagnostics: Basic Labs & X-rays not performed in office (Any labs performed in the office will be included in the office visit copay)
$50 Copay, then 20% Coinsurance
Diagnostics: Minor (Ultrasounds, Bone Density, Echography, etc.)
$100 Copay, then 20% Coinsurance
Diagnostics: Major (MRI, CT, PET, Nuclear Medicine, etc.)
$400 Copay, Deductible, then 20% Coinsurance

Recruit top talent. Better retention. Lower healthcare costs. Superior care.

Recruit Top Talent

Quality healthcare options help you attract the best talent. With Pivotal Health, medical care becomes a recruitment tool.

Increase Retention

Keep the best employees and increase job satisfaction by providing a free healthcare option.

Limit Out-of-Pocket Expenses

Nobody wants to get stuck with huge medical bills. Protect your employees with medical care that includes low deductibles and limited out-of-pocket costs.

Plan Features

Get instant access to a medical provider anywhere in the world

Virtual and in-office consultations

Mental health consultations are always available

Pediatric visits — in-office and virtual

Interconnected Care

Immediate access to medical care and providers helps your family save time and money!

Access medical care from anywhere across the world

Get treatment over the phone

Virtual Medical Consultations 24/7

Pediatric Visits Virtually

Request Information

    DISCLAIMER: ALL CONTENT, BENEFITS, PREMIUMS, COVERAGES, PLAN ASSUMPTIONS ARE FOR ILLUSTRATIVE PURPOSES ONLY. ALL GROUPS WILL BE REVIEWED, AND APPROPRIATELY QUOTED AFTER REVIEWING ALL REQUESTED CONTENT FROM EACH EMPLOYER/EMPLOYEE. AT THAT TIME ALL COVERAGES, AND ACTUAL PREMIUMS WILL BE PRESENTED.