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Provider Page

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Tier 1

Provider Information

https://www.missouridelta.com/

https://www.semohealthnetwork.org/

Deductibles

$TBD

Employee

$TBD

Family

Max Out of Pocket

$TBD

Employee

$TBD

Family

Tier 2

Provider Information

(Southeast Missouri Locations)

https://www.sehealth.org/

stegenevievehospital.org

bjccenterofexcellence.org/

Deductibles

$TBD

Employee

$TBD

Family

Max Out of Pocket

$TBD

Employee

$TBD

Family

NOTE:

This page is just a demo. Although it shows some of our current partners, it is not a guarantee that your plan will look like this. We are always working to enhance provider relationships and create new ones. The actual providers, tiers, deductibles, OOP limits, and additional services will vary depending on your unique plan configuration.

Tier 3

Provider Information

https://www.multiplan.us/ **

Deductibles

$TBD

Employee

$TBD

Family

Max Out of Pocket

$TBD

Employee

$TBD

Family

** MultiPlan PHCS includes providers in their listings that could be in Tier 1 or Tier 2 and may include out-of-network providers for your group or out of network for your plan. When selecting a provider from the multiplan search, please refer to your summary of benefits to verify the tier for the provider chosen to avoid out-of-network charges.

Non-Network

Provider Information

Deductibles

$TBD

Employee

$TBD

Family

Max Out of Pocket

$TBD

Employee

$TBD

Family

NOTE:

This page is just a demo. Although it shows some of our current partners, it is not a guarantee that your plan will look like this. We are always working to enhance provider relationships and create new ones. The actual providers, tiers, deductibles, OOP limits, and additional services will vary depending on your unique plan configuration.

Ancillary Benefits

Provider Information

Other Services

Provider Information

TPA (third-party
administrator)

Pre-Authorization Services

Precedence

888-555-1212

Telehealth
Services

Pharmacy
Networks

Specialty Drug
Provider

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