Modern benefits,
finally within reach.
Select from a wide range of major medical plans, limited benefit plans, dental, and supplemental options as a Working Limited Partner of Trident BPO.
Medical
Major medical plans
| FEATURES* | PPO 3500 | PPO 5000 | PPO 7500 | HSA PPO 10K | MVP PPO 10K |
|---|---|---|---|---|---|
| Annual Deductible | $3,500 Ind / $7,000 Fam | $5,000 Ind / $10,000 Fam | $7,500 Ind / $15,000 Fam | $10,000 Ind / $20,000 Fam | $10,000 Ind / $20,000 Fam |
| Annual Out of Pocket Maximum | $7,000 Ind / $14,000 Fam | $10,000 Ind / $20,000 Fam | $10,000 Ind / $20,000 Fam | $10,000 Ind / $20,000 Fam | $10,000 Ind / $20,000 Fam |
| Preventative Care Screening | No Cost | No Cost | No Cost | No Cost | No Cost |
| Primary Care Visit | $25 copay | $25 copay | $50 copay | No cost after deductible | $50 copay |
| Specialist Visit | $50 copay | $75 copay | $100 copay | No cost after deductible | $100 copay |
| Urgent Care Visit | $75 copay | $100 copay | $100 copay | No cost after deductible | $100 copay |
| Emergency Room Visit | Subject to deductible, then 20% coinsurance | Subject to deductible, then 30% coinsurance | Subject to deductible, then 30% coinsurance | No cost after deductible | No cost after deductible |
| Outpatient Services | Subject to deductible, then 20% coinsurance | Subject to deductible, then 30% coinsurance | Subject to deductible, then 30% coinsurance | No cost after deductible | No cost after deductible |
| Inpatient Services | Subject to deductible, then 20% coinsurance | Subject to deductible, then 30% coinsurance | Subject to deductible, then 30% coinsurance | No cost after deductible | No cost after deductible |
| Pharmacy Coverage | $0 copay (Generic, Brand, Limited Specialty) | $0 copay (Generic, Brand, Limited Specialty) | $0 copay (Generic, Brand, Limited Specialty) | $0 copay (Generic, Brand, Limited Specialty) | $0 copay (Generic, Brand, Limited Specialty) |
| Provider Network | Cigna PPO or Open Network^ | Cigna PPO or Open Network^ | Cigna PPO or Open Network^ | Cigna PPO or Open Network^ | Cigna PPO or Open Network^ |
| Telehealth | Yes | Yes | Yes | Yes | Yes |
| CareGuide Advocate | Yes | Yes | Yes | Yes | Yes |
Monthly Premium
| Coverage Tier | PPO 3500 | PPO 5000 | PPO 7500 | HSA PPO 10K | MVP PPO 10K | |||||
|---|---|---|---|---|---|---|---|---|---|---|
| Cigna | Open | Cigna | Open | Cigna | Open | Cigna | Open | Cigna | Open | |
| Self Only | $665.86 | $596.85 | $646.05 | $588.88 | $629.80 | $564.58 | $630.23 | $559.17 | $614.44 | $551.81 |
| Self + Spouse | $1,272.41 | $1,120.60 | $1,228.84 | $1,103.06 | $1,193.10 | $1,049.60 | $1,194.04 | $1,037.71 | $1,159.30 | $1,021.52 |
| Self + Child(ren) | $1,091.01 | $966.79 | $1,055.36 | $952.44 | $1,026.10 | $908.70 | $1,026.87 | $898.97 | $998.45 | $885.73 |
| Self + Family | $1,749.97 | $1,542.93 | $1,690.55 | $1,519.02 | $1,641.79 | $1,446.12 | $1,643.08 | $1,429.90 | $1,595.71 | $1,407.83 |
*All illustrated benefits are for in-network services and may be subject to certain exclusions and limitations. ^All benefits apply to covered services under the plan's reimbursement guidelines.
Medical
Limited benefit plans
| FEATURES* | PRO+ | MVP VALUE |
|---|---|---|
| Annual Deductible | $0 Individual / $0 Family | $0 Individual / $0 Family |
| Annual Out of Pocket Maximum | $1,200 Individual / $2,400 Family | $8,700 Individual / $17,400 Family |
| Preventative Care Screening | No Cost | No Cost |
| Primary Care Visit | $25 copay — 10 combined utilizations per year | $25 copay |
| Specialist Visit | $35 copay — 10 combined utilizations per year | $35 copay |
| Urgent Care Visit | $50 copay — 10 combined utilizations per year | $50 copay |
| Lab Services | $75 copay, x-rays included — 3 utilizations per year | **$75 copay |
| Imaging | $75 copay — 1 utilization per year | **Minor $60 copay, 5 utilizations/yr | **Major $80 copay, 3 utilizations/yr |
| Emergency Room Visit | $400 copay — 1 utilization per year | $400 copay — 2 utilizations per year |
| Outpatient Services | Not Covered | $1,000 copay — 1 per plan year |
| Inpatient Services | Not Covered | 0% Coinsurance — 1 surgery per plan year / 2 days per plan year |
| Pharmacy Coverage | Discounts Available | Tiered copays + discounts |
| Pharmacy Out of Pocket Maximum | $5,000 Individual / $10,000 Family | $5,000 Individual / $10,000 Family |
| Provider Network | Open Access^ | PHCS (Value-Driven Health Plans) |
| Telehealth | Yes | Yes |
| CareGuide Advocate | No | Yes |
Monthly Premium
| Coverage Tier | PRO+ | MVP VALUE |
|---|---|---|
| Self Only | $129.00 | $405.44 |
| Self + Spouse | $220.90 | $751.48 |
| Self + Child(ren) | $196.10 | $637.89 |
| Self + Family | $288.00 | $984.18 |
*All illustrated benefits are for in-network services and may be subject to certain exclusions and limitations. **Amounts shown reflect services provided by non-hospital-based laboratories and imaging centers. Rates for hospital-based versions of these services are listed in the Summary of Benefits and Coverage (SBC). ^All benefits apply to covered services under the plan's reimbursement guidelines. There is no distinction between in-network and out-of-network providers in an open access model. IMPORTANT NOTE: Please refer to the official Summary of Benefits & Coverage (SBC) and Summary Plan Description (SPD) for a full description of benefits provided under the available plans. In the event of a discrepancy between the information illustrated above and the official Plan Documents, the official Plan Documents will prevail.
Dental
Dental Pro plan
Dental Pro provides affordable dental services through doctors in the DenteMax network. You will have access to covered preventative procedures at no charge. No waiting period applies before benefits can be used. Deductible waived for preventive services.
| In-Network | Out-of-Network | |
|---|---|---|
| Network | DenteMax | |
| Individual / Family Annual Deductible | $50 / $150 | |
| Preventive/Diagnostic (x-rays, cleanings, etc.) | 100% | |
| Basic Restorative (fillings, root canals, etc.) | 80% (after deductible) | |
| Major Restorative (crowns, bridges, etc.) | 50% (after deductible) | Not Covered |
| Orthodontia (dependents under age 19) | 50% (after deductible) | |
| Orthodontia Lifetime Max | $1,000 | |
| Max Benefit Paid / Calendar Year (dental & orthodontia) | $1,500 | |
| Reimbursement Level | Based on reduced contracted fees |
Monthly Premium
| Coverage Tier | Self Only | Self + Spouse | Self + Child(ren) | Self + Family |
|---|---|---|---|---|
| Monthly Premium | $38.00 | $63.20 | $54.80 | $80.00 |
Dental
Dental + Vision reimbursement plan
Dental + Vision is a direct reimbursement combination plan that pays for dental and vision expenses. With no waiting period, the tiered reimbursement structure begins at the first dollar and allows you to maximize your potential benefits. Choose to go to any dentist or vision specialist and receive any medically necessary procedure.
| Procedure Cost | Reimbursement |
|---|---|
| Up to $150.00 | 100% |
| $150.01 – $250.00 | 75% |
| $250.01 – $1,800.00 | 50% |
| $1,801.01 – up | 0% |
| Orthodontia | $500 Lifetime Maximum of Covered Charges |
Benefits for Dental and Vision are combined. *Benefit is based on an aggregate total of accumulated expenses per Covered Person during the calendar year.
Monthly Premium
| Coverage Tier | Self Only | Self + Spouse | Self + Child(ren) | Self + Family |
|---|---|---|---|---|
| Monthly Premium | $27.00 | $37.80 | $34.20 | $45.00 |
Supplemental
Accident plans
Accidents happen. The Accident Plan pays up to the scheduled maximum amount, after the deductible, for medical charges resulting from a covered accident. Both individual and family coverage is available, and no medical exam or underwriting is required.
| Coverage Tier | Self Only | Self + Spouse | Self + Child(ren) | Self + Family |
|---|---|---|---|---|
| Monthly Premium — $5,000 Max Benefit | $19.99 | $35.01 | $35.01 | $35.01 |
| Monthly Premium — $10,000 Max Benefit | $26.99 | $45.23 | $45.23 | $45.23 |
Supplemental
Critical illness plans
The Critical Illness Plan provides additional coverage for medical emergencies like heart attack, stroke, invasive cancer or ESRD. Critical Illness will pay a lump sum benefit as shown in the schedule upon the first diagnosis of a covered condition for each incident (including re-occurrence). Benefits are paid directly to the primary member and can be used however they choose.
| Coverage Tier | Self Only | Self + Spouse | Self + Child(ren) | Self + Family |
|---|---|---|---|---|
| Monthly Premium — $10,000 Max Benefit | $17.91 | $36.06 | $22.53 | $40.02 |
| Monthly Premium — $20,000 Max Benefit | $31.16 | $64.16 | $39.57 | $71.41 |
Supplemental
Hospital indemnity plans
Hospital Indemnity supplemental benefit provides additional coverage for admission and confinement in a hospital facility. Hospital Indemnity will pay a flat benefit as shown in the schedule upon an in-patient stay for a covered injury or sickness. Benefits are paid directly to the primary member and can be used however they choose.
| Coverage Tier | Self Only | Self + Spouse | Self + Child(ren) | Self + Family |
|---|---|---|---|---|
| Monthly Premium — $1,000 Per Admission | $20.77 | $39.26 | $33.10 | $51.58 |
| Monthly Premium — $2,000 Per Admission | $37.28 | $72.46 | $60.64 | $95.81 |
You can access your enrollment resources and basic plan information by visiting www.wpsenroll.com/tridentBPO under the Forms Library section. Access to your full plan benefits/services and ID cards will be available on your coverage effective date.
IMPORTANT NOTICE: The opinions and statements herein are intended for general informational purposes only and should not be viewed as a substitute for any legal, regulatory or other advice on any particular issue or for any particular reason. All limited partnership interests are solely offered through Trident BPO. Any health benefits available are powered by Acrisure, LLC or its affiliates ("Acrisure"). Trident BPO and Acrisure are not affiliates. The advice of a professional should always be obtained before purchasing any product or service, and you should not rely on the information provided herein for the prevention or mitigation of risks or as a full and complete explanation of terms and conditions of any products or services described. While the information provided herein has been compiled from sources that are believed to be reliable, no warranty, guarantee or representation, either expressed or implied, is made as to the correctness, sufficiency, or adequacy of such information.