Benefit

Bronze

Platinum

Physicians Office
visit

$50 per visit

$75 per visit

Diagnostic X Ray
and lab tests

$100 per test

$100 per test

Wellness/Health Screening

$50 per test

$50 per test

Well Baby Care

$50 per visit per
insured baby

$50 per visit per
insured baby

Emergency Room

$50 per visit

$75 per visit

Hospital Admission

$250
per admission

$1,000
per admission

Daily Hospital Confinement

$200 per day
(max of $6,000
per confinement)

$1,000 per day
(max of $30,000
per confinement)

Intensive Care

$250 per day
(max of $7,500
per confinement)

$1,000 per day
(max of $30,000
per confinement)

Surgery

N/A

Maximum of $2,000
for surgery per
scheduled amount

Anesthesia

N/A

Maximum of $250

Accidental Death

$5,000

$5,000

Participating Beech Street Network Providers offer LBHP participants up to a 40% discount on their standard rates or fees.

Example:
Standard Doctor's visit rate: $100
40% Beech Street Discounted rate :$60
LBHP Plan Benefit Paid: $50
Out of Pocket expense for LBHP Participant: $10

For more information, please visit Beech Street's Network Services page.

Flex Shield Monthly Rates

Mandatory
Rates available when employer pays 50% to 100% of monthly premium

Voluntary
Rates available when employer pays 0% of monthly premium

1. As an employer, can I just pay only for a portion of my employee’s individual monthly premium even if they want to cover their spouse and/or family?

A. Yes, we can set up the premiums so that the Employer pays the Employed Enrollee coverage and the Employed Enrollee pays for spouse or dependent coverage.

2. As an employer, can I adjust the amount I’m contributing to my employee’s premium either annually or based on length of service?

A. You can change your percentage of contribution to the plan on an annual basis at policy renewal but not during the term of the policy or per employee. 

3. The maximum for daily hospital confinement is $30K.  A surgery and subsequent 3 day hospital confinement can often exceed $75K.  Is there another plan that would cover the difference? 

A. LBHP has a limit of $1,000 p/day for hospital confinement with a maximum of $30K.  In order to receive the full $30K the patient would have to be in the hospital for 30 days at $1,000 p/day.  There is coverage for surgery of up to $2,000 per scheduled amount as well.  In this scenario benefits would be paid for up to $5,000 ($3,000 per hospital confinement at $1,000 p/day for 3 days plus up to $2,000 for surgery).

4. If I am an enrollee in LBHP through my employer and have a comprehensive health plan through my employer as well, would LBHP still pay benefits in addition to my comprehensive plan?

A. Yes, LBHP would pay in addition to your comprehensive plan.  For example if you go to the doctor through your comprehensive plan and pay a $25 co-pay for that visit, LBHP would pay $50 for that visit, so you would get your $25 co-pay back plus an additional $25.

5. If I am an enrollee in LBHP through my employer, can I also open a Heath Savings Plan (HSA)?

A. An individual is eligible to have an HSA if they DO have a high-deductible health plan (HDHP) and they DO NOT have certain other kinds of coverages in addition to that HDHP. 

6. As an employer, what is the minimum group size for eligibility?

A. The program requires a minimum of 10 enrolled employees in order to be eligible.  Employer organizations with less than 10 enrolled employees can still participate in the program as a participating organization in a Master Policy we’ve created, however, the employer must contribute at least 50% of the enrolled employee’s monthly premium in this circumstance.

In NY there is a requirement for a minimum of 10 enrolled employees.  In addition, the organization MUST have at least 50 eligible employees to participate in LBHP. NY employers that do not meet the above requirements are ineligible for coverage and cannot participate in the Master Policy option.