Why Our Emblem Smart Share (InBalance) Plans Make Sense...
Q. What are Smart Share Plans?
A. They work like traditional EPO plans with only a copay for many services. The difference being the
addition of an In-Network deductible and coinsurance relating to services for which the copay or
covered in full does not apply.
Q. What kinds of services does the copay apply - making it outside the deductible?
A. Physician and Specialist Office Visits, Chiropractic, Diagnostic Lab and Radiology when performed in
the physicians office or a participating free standing facility, Outpatient Chemical Dependency, Outpatient
Mental Health, Allergy Care, Physical Therapy, Occupational Therapy and Osteopathic Manipulation are
all just a copay.
Q. Plus all plans have family friendly benefits. - What are they?
A. Dependents to 19 and dependent students to age 25 have no copays for any of the services listed
above whether those visits are sick or well visits.
Q. What about Annual Physicals and preventative services such as Mammography, Pap Smear,
Prostate Screening and Well Child Care?
A. These services are covered in full - they do not even have a copay.
Q. That is a lot of services for a copay or covered in full. What services are subject to the
deductible and coinsurance?
A. All services not listed above would be subject to the In-Network deductible and coinsurance. For
example: Hospital Inpatient Services, Surgery, Durable Medical Equipment, Lab and Radiology in the
outpatient part of a hospital, etc.
Q. How much is the deductible and coinsurance?
A. Our most popular plans have a $500 in network deductible and then coinsurance for an additional $500
at 90% / 10%. After you reach your $500 deductible, the carrier pays 90% of the bills and you pay 10%
until you have paid out $500 capping the maximum out of pocket at $1,000 per person. Other
deductibles and coinsurance choices are available at additional savings.
Q. What about Prescription options? Are there choices?
A. Yes, there are several options and some of the best designed plans in the market plus ALL generic
medications, regardless of plan chosen, have a $0 copay. Our most popular Rx plan is the $0/$30/$50
option which has a $50 annual deductible per person for brand only and includes unlimited mail order
prescriptions with two copays for a 90 day supply and a $3,000 annual maximum per person which
applies only to in pharmacy retail.
Families are particularly appreciative of no office copay for their dependent children whether sick or well
and since generic prescriptions are $0, a trip to the doctor with a sick child often results in no out of
pocket cost.
Note: The above is a brief summary. Please refer to plan benefit descriptions for complete details.