Allegiance CDP with HRA |
Primary Care Visit |
$0 copay (in-network), $25 copay (out-of-network) |
HRA: $600 Individual/$1,200 Family |
Allegiance CDP with HRA |
Specialist Visit |
$40 copay (in-network), $40 copay (out-of-network) |
Annual deductible: $2,000 per person, $4,000 per family |
Allegiance CDP with HRA |
Wellness Visit |
$0 copay (in-network), $0 copay (out-of-network) |
Out-of-pocket max: $3,000 per person, $6,000 per family |
Allegiance OAP |
Primary Care Visit |
$0 copay (in-network), $30 copay (out-of-network), $30 copay (not covered) |
No HRA contribution |
Allegiance OAP |
Specialist Visit |
$50 copay (in-network), $50 copay (out-of-network), $50 copay (not covered) |
Annual deductible: $1,000 per person, $2,000 per family |
Allegiance OAP |
Wellness Visit |
$0 copay (in-network), $0 copay (out-of-network) |
Out-of-pocket max: $2,000 per person, $4,000 per family |
All Departments |
Self-Pay Services |
Discounted rates available |
Online estimate tool available |
All Departments |
Emergency and Medically Necessary Care |
AGB (Amounts Generally Billed) calculation applies |
Financial assistance programs available |
All Departments |
Hospital Fee Estimates |
300+ services with online estimates |
Request estimates online |
Insurance Plans |
CDP Bi-weekly Premium (Under $50,000 salary) |
Employee: $58.43, Employee & Child(ren): $98.99, Employee & Spouse: $129.53 |
Three-tier salary structure for premiums |
Insurance Plans |
CDP Bi-weekly Premium ($50,000-$119,999 salary) |
Employee: $59.89, Employee & Child(ren): $101.46, Employee & Spouse: $132.77 |
Three-tier salary structure for premiums |
Insurance Plans |
CDP Bi-weekly Premium ($120,000+ salary) |
Employee: $61.35, Employee & Child(ren): $103.94, Employee & Spouse: $136.01 |
Three-tier salary structure for premiums |
Insurance Plans |
OAP Bi-weekly Premium (Under $50,000 salary) |
Employee: $104.01, Employee & Child(ren): $185.58, Employee & Spouse: $220.68 |
Three-tier salary structure for premiums |
Insurance Plans |
OAP Bi-weekly Premium ($50,000-$119,999 salary) |
Employee: $106.61, Employee & Child(ren): $190.22 |
Three-tier salary structure for premiums |
Insurance Plans |
OAP Bi-weekly Premium ($120,000+ salary) |
Employee: $109.21, Employee & Child(ren): $194.86 |
Three-tier salary structure for premiums |