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PLAN OPTIONS
Population Science Management – Plan Options
Reference-Based Pricing (RBP) is a cost-saving approach to healthcare. Instead of paying the
full billed charges from a provider, RBP bases payments on a set percentage above Medicare rates. By using this
method, RBP offers a more predictable and often more affordable alternative to traditional insurance pricing,
helping you and your employer manage healthcare costs while still receiving quality care.
Limited Medical Plans help cover everyday healthcare costs like doctor visits and prescriptions.
They cost less than full coverage plans but also cover less. These plans use Reference-Based Pricing (RBP),
which means provider payments are based on Medicare rates to help keep costs lower.
GigCare – PPO & EPO Plans
A Preferred Provider Organization (PPO) Plan gives you flexibility when choosing healthcare
providers. You’ll save money by using in-network doctors and facilities, but you can also choose to see
out-of-network providers; just expect to pay more out of pocket for those services.
An Exclusive Provider Organization (EPO) Plan offers coverage only within a specific network
of providers. You must use in-network doctors and facilities for your care to be covered (except in emergencies).
This structure helps keep monthly contributions and out-of-pocket costs lower, making EPOs a cost-effective choice
for many people.
CHOOSING BETWEEN PPO, EPO, & RBP PLANS
Choosing Between PPO, EPO, & RBP Plans
The right plan for you depends on your personal healthcare needs, provider preferences, and budget.
Here are a few key factors to consider when deciding between RBP, PPO, and EPO options:
Flexibility with Providers:
- PPO plans offer the most flexibility, allowing both in- and out-of-network care.
- EPO plans require you to stay within a specific network (except in emergencies).
- RBP plans don’t rely on a traditional network. Providers are paid based on a set rate tied to Medicare pricing.
Monthly Cost:
- PPO plans often have higher monthly contributions due to greater provider flexibility.
- EPO and RBP plans typically have lower monthly contributions.
Out-of-Pocket Costs:
- PPO plans may cost more out of pocket when you go out-of-network.
- EPO plans can help keep out-of-pocket expenses lower if you stay in network.
- RBP plans can result in lower overall costs but may require additional support navigating provider billing.
Comfort with Navigating Care:
- PPO and EPO plans offer more traditional, network-based experiences.
- RBP members may need help navigating provider relationships or resolving balance bills, but support is available.
| Benefit | PSM THRIVE $1500 PPO 2026 | PSM THRIVE $2500 PPO 2026 | PSM THRIVE $5000 EPO 2026 | PSM THRIVE $7350 EPO 2026 | PSM THRIVE $5000 HDHP (HSA/PPO) 2026 |
|---|---|---|---|---|---|
| In-Network Deductible (Ind / Fam) | $1,500 / $3,000 | $2,500 / $5,000 | $5,000 / $10,000 | $7,350 / $14,700 | $5,000 / $10,000 |
| Out-of-Network Deductible (Ind / Fam) | $3,000 / $6,000 | $5,000 / $10,000 | N/A | N/A | $10,000 / $20,000 |
| In-Network Out-of-Pocket Max (Ind / Fam) | $8,500 / $17,000 | $8,500 / $17,000 | $7,350 / $14,700 | $9,200 / $18,400 | $8,500 / $17,000 |
| Out-of-Network Out-of-Pocket Max (Ind / Fam) | $20,000 / $40,000 | $20,000 / $40,000 | N/A | N/A | $20,000 / $40,000 |
| In-Network Primary Office Visit | $25 per visit | $25 per visit | $25 per visit | $25 per visit | Deductible & coinsurance |
| In-Network Specialty Visit | $40 per visit | $40 per visit | $40 per visit | $40 per visit | Deductible & coinsurance |
| In-Network Urgent Care | $60 per visit | $60 per visit | $75 per visit | $100 per visit | Deductible & coinsurance |
| Telemedicine (plan provider) | $0 | $0 | $0 | $0 | $0 |
| Specialty Medications | Not covered | Not covered | Not covered | Not covered | Not covered |
| Summary of Benefits (PDF) | Download Here | Download Here | Download Here | Download Here | Download Here |
| Age 30 – 44 Pricing* | EE: $910.77 EC: $1,537.02 ES: $1,691.03 EF: $2,476.83 |
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| Age 45 – 54 Pricing* | EE: $955.39 EC: $1,617.68 ES: $1,780.70 EF: $2,611.55 |
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| Age 55 – 64 Pricing* | EE: $1,068.28 EC: $1,820.89 ES: $2,006.49 EF: $2,950.24 |
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| Age 65+ | Not Available | Not Available | Not Available | Not Available | Not Available |
Pricing is calculated per month
EE = Employee || EC = Employee + Children || ES = Employee + Spouse || EF = Employee Family (Spouse + Children)
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