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New Madrid Schools

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PPO
HSA
Ancillary Services
Other Services

PPO

Tier 1

Provider Information

(Southeast Missouri Locations)

https://www.sehealth.org

https://www.missouridelta.com/

bjccenterofexcellence.org/providers

https://www.semohealthnetwork.org

Deductibles

$500

Employee

$1,000

Family

Max Out of Pocket

$1,500

Employee

$3,000

Family

Tier 2

Provider Information

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

Deductibles

$3,500

Employee

$7,000

Family

Max Out of Pocket

$5,500

Employee

$11,000

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.

† The PHCS network is Physician and Ancillary ONLY for your group.  No Hospitals.

Non-Network

Provider Information

Deductibles

$7,900

Employee

$15,800

Family

Max Out of Pocket

UNLIMITED

Employee

UNLIMITED

Family

HSA

Tier 1

Provider Information

(Southeast Missouri Locations)

https://www.sehealth.org

https://www.missouridelta.com/

bjccenterofexcellence.org/providers

https://www.semohealthnetwork.org

Deductibles

$4,000

Employee

$8,000

Family

Max Out of Pocket

$4,000

Employee

$8,000

Family

Tier 2

Provider Information

https://www.multiplan.us/ **†

Deductibles

$6,000

Employee

$12,000

Family

Max Out of Pocket

$7,000

Employee

$14,000

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.

† The PHCS network is Physician and Ancillary ONLY for your group.  No Hospitals.

Non-Network

Provider Information

Deductibles

$7,900

Employee

$15,800

Family

Max Out of Pocket

UNLIMITED

Employee

UNLIMITED

Family

Ancillary Benefits

Provider Information

https://login.sunlifeconnect.com

Other Services

Provider Information

TPA (third-party
administrator)

https://consociate.veriben.net

Pre-certification
Vendor

https://www.urmedwatch.com

888-293-3340

Telehealth
Services

https://wmthealth.com/
consociate

Pharmacy
Networks

https://www.withmehealth.com

Specialty Drug
Provider

Focus Rx FAQs

888-902-5533

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