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Provider Page

FM BANK

Tier 1

Provider Information

(Southeast Missouri Locations)

https://www.sehealth.org

bjccenterofexcellence.org/providers

https://www.pemiscot.org

https://www.missouridelta.com/

http://sftp.sharppho.com

https://www.stbernards.info

https://www.semohealthnetwork.org

Deductibles

$375

Employee

$750

Family

Max Out of Pocket

$3,000

Employee

$6,000

Family

Tier 2

Provider Information

https://www.multiplan.us **

Deductibles

$750

Employee

$1,500

Family

Max Out of Pocket

$6,000

Employee

$12,000

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

Deductibles

$1,500

Employee

$3,000

Family

Max Out of Pocket

UNLIMITED

Employee

UNLIMITED

Family

Other Services

Provider Information

Pre-certification
Vendor

Precedence

800-361-1492

Telehealth
Services

https://www.memd.net

Pharmacy
Networks

https://www.withmehealth.com

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