Large Group Point of Service (POS) Plans for Employers with 51 or more employees

 

Due to various plan riders selected by Large Employer groups, the Statement of Out-of- Pocket Expenses cannot be displayed on this website.  Please contact Total Health Care’s Marketing Department at 1-800-826-2862 x7888 to request additional documents. You can also log in as a member to our member portal to view documents specific to your plan

 

> POS – 3VSL2T

> POS – 3VSM2T

> POS – 3VSH2T

> POS – 3VS20002T

> POS – 3VS30002T

> POS – 3VSHD2800

> POS – 3VSHD4000-20

 

MEMBER HANDBOOK

> Member Handbook

 

CERTIFICATE OF COVERAGE

> Certificate of Coverage – Grandfathered

> Certificate of Coverage – Non-Grandfathered

 

MEDICAL RIDERS

> $20 Office Visit Rider

> $30 Office Visit Rider

> $20-$40 Office Visit Large Group

> $100 ER Large Group

> $150 ER Large Group

> $200 ER Large Group

> $250 ER Large Group

> Office Visit

 

PHARMACY RIDERS

> THC4011B $0 RX Rider Grandfathered

> THC4012 $0-10 RX Rider Grandfathered

> THC4013 $5-15 RX Rider Grandfathered

THC4030THC48 RX 20 coins after ded

THC4031 65 Rx 7305020

THC40326610406025

THC403367RX10508030

THC403468RX10406025

 

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