Medical & Prescription Drugs

We are committed to providing comprehensive coverage to ensure that our employees have access to the care they need to stay healthy and productive.

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At Monochrome Health, we believe that taking care of your body should be simple and empowering. To help you stay ahead of your health, both of our plans cover 100% of your preventive care in-network.

Routine physicals, annual wellness checks, recommended vaccines, and age-based screenings are always fully paid by the company—no deductibles, no copays, and no surprises.

This plan is designed for peace of mind and predictability. If you prefer knowing exactly what you will pay at the doctor’s office ahead of time, this is the right path for you.

Low Deductibles
The annual deductible is kept low at $500 for individuals and $1,000 for families. Once you meet your out-of-pocket safety limit ($3,000 individual / $6,000 family), the plan pays for 100% of your covered medical needs for the rest of the year.

Simple Copays
You pay a small, fixed copay for regular doctor visits and specialist care, while Monochrome Health handles the rest.

No Restrictions
You never need a referral from a primary doctor to see an in-network specialist. You have total freedom to book appointments directly with the care experts you trust.

If you prefer lower monthly premium deductions and want to build a rainy-day fund for your future healthcare needs, this path offers incredible financial freedom.

Free Money from Monochrome
To give you a helpful head start, Monochrome Health will automatically drop a lump-sum cash gift directly into your HSA the moment you enroll: $500 for individuals or $1,000 for families.

Lower Paycheck Cost
You keep more money in your regular paycheck every single month.

A Tax-Free Nest Egg
This plan connects with a personal Health Savings Account (HSA) managed by Fidelity. The money you put in is tax-free, grows tax-free, and comes out tax-free for medical expenses. Plus, the money features an unlimited year-over-year rollover provision—it never expires, and it stays with you even if you move on from the company.

If you want maximum predictability with zero out-of-pocket deductibles for everyday visits, the Exclusive Provider Organization (EPO) plan is built for you.

Zero Deductible Care
Pay simple, flat copays from day one for primary care, specialist visits, and urgent care without needing to satisfy an annual deductible first.

In-Network Simplicity
Coverage is focused exclusively within our preferred Monochrome Health network, keeping costs low while delivering top-tier care. (No primary care physician referrals required to see an in-network specialist!)

Ultra-Low Out-of-Pocket Cap
Enjoy our lowest out-of-pocket maximum ($2,000 Individual / $4,000 Family), giving you absolute financial security for any major medical events.

Keeping your family healthy requires easy, affordable access to essential medications. Monochrome Health partners with Rx Solutions to deliver a comprehensive prescription drug program built around convenience, predictability, and savings. Whether you need a short-term antibiotic from your local pharmacy, a maintenance medication delivered right to your door, or specialized clinical support, our tiered network ensures you receive high-quality care at a price that fits your household budget.

Tier 1: Preferred Generics
Identical in active ingredients, safety, and effectiveness to brand-name counterparts, generic medications offer the lowest out-of-pocket cost for everyday treatments like antibiotics, allergy relief, and blood pressure control.

Tier 2: Preferred Brands
Trusted, brand-name drugs included on our Rx Solutions formulary list when a generic equivalent is unavailable or clinically unsuitable.

Tier 3: Non-Preferred & Specialty Drugs
High-cost or complex brand-name formulations, biological therapies, and specialized medications for chronic or severe medical conditions. (Specialty medications include personalized clinical management and home delivery via temperature-controlled, thermal packaging).

Preventive Medications ($0 Copay)
Select preventive health drugs—including prenatal vitamins, generic statins, aspirin, and contraceptive options—are covered at 100% with $0 copay across all plans, completely exempt from deductibles.

90-Day Home Delivery Mail Order
Save time and money on long-term maintenance prescriptions. Get a full 3-month supply shipped directly to your front door with free standard shipping and discounted copays.

Choice PPO Plan

  • Preventive Medications: $0 Copay
  • Tier 1 (Generics): $10 Flat Copay (Deductible waived)
  • Tier 2 (Preferred Brands): $35 Flat Copay (Deductible waived)
  • Tier 3 (Specialty): $75 Copay + Prior Authorization (Deductible waived)
  • 90-Day Mail Order: Pay 2x the copay for a 3-month supply (Get 1 month free!)

Premier Copay EPO Plan

  • Preventive Medications: $0 Copay
  • Tier 1 (Generics): $10 Flat Copay (Deductible waived)
  • Tier 2 (Preferred Brands): $35 Flat Copay (Deductible waived)
  • Tier 3 (Specialty): $75 Copay + Prior Authorization (Deductible waived)
  • 90-Day Mail Order: Pay 2x the copay for a 3-month supply (Get 1 month free!)

Savings HDHP Plan

  • Preventive Medications: $0 Copay (Deductible waived)
  • Tier 1 (Generics): 20% Coinsurance (After medical deductible)
  • Tier 2 (Preferred Brands): 20% Coinsurance (After medical deductible)
  • Tier 3 (Specialty): 30% Coinsurance + Prior Authorization (After medical deductible)
  • Tax-Free HSA Eligibility: Pay for all out-of-pocket prescription costs using your pre-tax Health Savings Account funds.

The 100% In-Network Rule: Regardless of which plan you select, 100% of routine preventive care is covered by Monochrome Health. Routine physicals, immunizations, annual eye/well-woman exams, and age-based screenings never require copays or deductibles when using in-network doctors.

Plan Comparison at a Glance

Choice PPO Plan

Best for: Team members who want complete freedom of choice and predictable copays.

  • Specialist Access: Direct access (No PCP referral required)
  • Out-of-Network Care: Covered (At higher out-of-pocket rates)
  • Daily Doctor Visits: Fixed copays from Day 1

Premier Copay EPO Plan

Best for: Predictable budgets with zero deductible surprises for routine care.

  • Specialist Access: Direct access (No PCP referral required)
  • Out-of-Network Care: Emergency services only
  • Daily Doctor Visits: Low, fixed copays (No annual deductible to meet first)

Savings HDHP Plan

Best for: Lower paycheck deductions & long-term tax-free health savings.

  • Specialist Access: Direct access (No PCP referral required)
  • Out-of-Network Care: Covered (At higher out-of-pocket rates)
  • Daily Doctor Visits: Free $500 (Individual) / $1,000 (Family) cash deposited on Day 1

How Care Services Work Across Plans

Care Category

Choice PPO Plan

Premier Copay EPO

Savings HDHP

Primary Care Visit

$25 Copay

$20 Copay

20% Coinsurance
(after deductible)

Specialist Visit

$45 Copay

$40 Copay

20% Coinsurance
(after deductible)

Urgent Care Center

$50 Copay

$40 Copay

20% Coinsurance
(after deductible)

Virtual MD (Telehealth)

$10 Copay

$10 Copay

$45 Fee
(applies to deductible)

Emergency Room

$250 Copay

$200 Copay

20% Coinsurance
(after deductible)

Inpatient Hospital Stay

20% Coinsurance

20% Coinsurance

20% Coinsurance
(after deductible)

Managing Your Medications with Rx Solutions

Your prescription benefits are integrated directly into your medical plan. Whether you need a short-term prescription or ongoing maintenance medicine, our tiered system keeps out-of-pocket costs predictable.

Prescription Coverage Details

Understanding Tiers & Formulary Options
  • Preventive Drugs ($0 Copay): Select generic statins, blood pressure medications, and prenatal vitamins are fully covered at $0 out-of-pocket across all three plans.
  • Tier 1 (Preferred Generics): High-quality generic equivalents providing the exact same clinical benefits as brand names at the lowest cost.
  • Tier 2 (Preferred Brands): Brand-name medications listed on the Rx Solutions formulary when no generic alternative exists.
  • Tier 3 (Non-Preferred & Specialty): Advanced biological or complex specialty treatments. All Tier 3 specialty prescriptions include personalized clinical management and home delivery in temperature-controlled packaging.
Mail-Order & 90-Day Supply Discounts
  • Choice PPO & Premier EPO: Order a 90-day supply of ongoing maintenance medications through our mail-order service and pay only 2x your standard monthly copay (effectively giving you 1 month free every quarter!).
  • Savings HDHP: Enjoy discounted bulk pricing on 90-day supplies, payable with tax-free funds directly from your HSA.

Protecting Your Household Financial Health

Two main numbers determine your financial safety net each calendar year: your Deductible and your Out-of-Pocket Maximum.

What is a Deductible?
The amount you pay out-of-pocket for major medical care (like hospital stays, surgeries, or advanced imaging) before your plan begins sharing costs via coinsurance.

What is an Out-of-Pocket Maximum?
Your absolute financial safety cap. Once your copays, deductibles, and coinsurance add up to this threshold in a calendar year, Monochrome Health covers 100% of all remaining covered medical expenses.

Plan Limits & Company Contributions

Choice PPO Plan

Annual Deductible
$500 Individual / $1,000 Family

Out-of-Pocket Max
$3,000 Individual / $6,000 Family

Summary
Low deductible with moderate out-of-pocket exposure for total peace of mind.

Premier Copay EPO Plan

Annual Deductible
$0 Individual / $0 Family
(Zero Deductible)

Out-of-Pocket Max
$2,000 Individual / $4,000 Family

Summary
Our lowest financial risk option—skip the deductible entirely and enjoy our lowest safety cap.

Savings HDHP Plan

Annual Deductible
$1,650 Individual / $3,300 Family

Out-of-Pocket Max
$3,500 Individual / $7,000 Family

Company HSA Seed Money
Monochrome Health automatically deposits $500 for Individuals or $1,000 for Families directly into your HSA on your first day of coverage!

2026 Bi-Weekly Paycheck Contributions

All medical premiums are deducted pre-tax from your bi-weekly paycheck, lowering your overall taxable annual income.

Coverage Level

Savings
HDHP Plan

Premier Copay
EPO Plan

Choice
PPO Plan

Employee Only

$32.00

$65.00

$85.50

Employee + Spouse / Partner

$78.50

$130.00

$165.00

Employee + Child(ren)

$64.00

$110.00

$142.00

Employee + Full Family

$110.00

$175.00

$220.50

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