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Auto Tire & Parts – Missouri, Arkansas, & Illinois

Tier 1

Provider Information

https://www.sehealth.org

bjccenterofexcellence.org/providers

https://www.missouridelta.com/

https://www.pemiscot.org

http://sftp.sharppho.com

https://www.stbernards.info

https://www.semohealthnetwork.org

https://heartlandregional.com

Base

Deductibles

$4,800

Employee

$9,600

Family

Max Out of Pocket

$7,000

Employee

$14,000

Family

Buy Up

Deductibles

$2,000

Employee

$4,000

Family

Max Out of Pocket

$5,000

Employee

$10,000

Family

High Deductible

Deductibles

$7,000

Employee

$14,000

Family

Max Out of Pocket

$8,000

Employee

$16,000

Family

Tier 2

Provider Information

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

Base

Deductibles

$7,500

Employee

$12,000

Family

Max Out of Pocket

$8,700

Employee

$17,400

Family

Buy Up

Deductibles

$5,000

Employee

$10,000

Family

Max Out of Pocket

$8,500

Employee

$17,000

Family

High Deductible

Deductibles

$8,700

Employee

$17,400

Family

Max Out of Pocket

$8,700

Employee

$17,400

Family

** MultiPlan PHCS includes providers in their listings that could be in Tier 1 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

Base & High Deductible

Deductibles

$12,000

Employee

$24,000

Family

Max Out of Pocket

UNLIMITED

Employee

UNLIMITED

Family

Buy Up

Deductibles

$7,500

Employee

$15,000

Family

Max Out of Pocket

UNLIMITED

Employee

UNLIMITED

Family

Ancillary Benefits

Provider Information

https://myrenbenefitsmanager.com

https://www.coloniallife.com

Other Services

Provider Information

TPA (third-party
administrator)

https://consociate.veriben.net

Pre-Authorization Services

https://www.urmedwatch.com

800-432-8421

Telehealth
Services

https://wmthealth.com/
consociate

Pharmacy
Networks

empirxhealth.com

Specialty Drug
Provider

Focus Rx FAQs

888-902-5533

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