You’ll save significantly on out-of-pocket costs by selecting an in-network provider. Use the links below to start your provider search. THT does not require a referral to see a specialist, however, the specialist may require one. Local and Travel benefits are listed below.
Signature Plan
Find Your Doctors
Benefits Available at a $0 Copay
- 24/7 Nurse Advice Line – (866) 232-4490
- $0 Primary Care, Pediatric, Behavioral Health, and Physical Therapy Office Visits with a Health Investment Provider
- TeleHealth / TeleTherapy via MDLive
- In-Home / Mobile Urgent Care
- Nutrition Consultations and Classes
- Select Specialty Medications
- Tobacco Cessation Program
- Asthma Consultations with a Registered Nurse
Medical Plan Documents & Benefits
Summary of Benefits & Coverage (SBC)Review Full Summary Plan Description (SPD)
DentalVision
This page contains information specific to your medical plan. Looking for your other benefits?
| Local / Travel Network | |
|---|---|
| Plan Year Deductible (Individual/Family) |
$500/$1,500 |
| Out-of-Pocket Maximum Medical and Pharmacy combined. Includes deductible, copays, and coinsurance. |
$7,500/$15,000 |
| Preventive Care | THT pays 100% |
| Telehealth / Telemedicine | THT pays 100% |
| Physician Services | |
| • Primary Care Physician | $15 Copay |
| • Behavioral Health Office visits | $10 Copay |
| • Physical Therapy | $10 Copay |
| • Specialist | $30 Copay |
| • Urgent Care / CVS Minute Clinic | $30 Copay |
| • In-Home Urgent Care (Dispatch Health / Doctoroo) | $0 Copay |
| Labwork | |
| • Quest Diagnostics | $0 Copay |
| • All other facilities | No benefit |
| Diagnostic Imaging | |
| • Steinberg (SDMI) | $0 Copay |
| • All other facilities | 20% after deductible |
| Hospital Services (Inpatient & Outpatient) |
20% after deductible |
| Emergency room Copay is waived if admitted to the hospital. |
$300 copay (after deductible) for first visit + 20% of doctor bills. $750 copay (after deductible) for subsequent visits + 20% of doctor bills. |
Prescription Benefits
| Summary of Covered Prescription Drug Benefits¹ |
Retail Network Pharmacies See list here |
Delivery Service |
|---|---|---|
| Tier 1 — Generic | $40 copay per 35+ day supply³ |
|
| Tier 2 — Preferred Formulary Brand | 25% of the cost, copay max of $300 per 35+ day supply |
|
| Tier 3 — Non-Preferred Formulary Brand | 40% of the cost, copay per 35+ day supply |
|
| Formulary Diabetic Supplies | limited to a quantity of 200 per 30-day supply) |
|
| Summary of Covered Prescription Drug Benefits¹ |
(Up to a 30-day supply) |
|
| Tier 1 — Generic | ||
| Tier 2 — Preferred Formulary Brand | ||
| Tier 3 — Non-Preferred Brand | ||
(1) Select products are eligible for a coinsurance assistance program. There is no copay for these products and they do not accumulate toward the out-ofpocket maximum. For more information contact THT at 702-794-0272, Option 1. (2) Prescriptions filled at pharmacies other than THT’s Exclusive Network Retail Pharmacies will incur a $10 per prescription choice fee in addition to applicable copays. The pharmacy choice fee does not accumulate toward your out of-pocket maximum. (3) If the generic cost of the medication is less than the copay, the individual will be responsible for that lesser amount. (4) For more information about this service, please contact CerpassRX at 844-622-1797.
Exclusive Providers
As a Signature Plan member, you must utilize Quest for labwork to receive the $0 copay benefit. Any costs incurred by lab work by providers other Quest will be the member’s full responsibility. In the event Quest cannot perform the necessary service, have your provider submit a prior authorization request to UMR. If approved, the services will be covered at 80% after deductible.
Similarly, imaging services are available at Steinberg Diagnostic Medical Imaging (SDMI) at a $0 copay; however, you may choose to use another in-network facility, where imaging services will be covered at 80% after deductible.
Preventive Care
Preventive care is covered at 100% for when performed by an in-network provider. Preventive care services vary by age and gender. We recommend speaking with your provider to determine which are recommended for you and your family.
Annual Preventive Services Covered at 100%
- Physical examinations
- Pelvic examinations and pap smears
- Hearing and vision screenings
- Mammograms
- Cardiovascular screening blood tests
- Vaccinations and immunizations recommended by your physician
- BRCA1 and BRCA2 when medically indicated
- Prostate cancer screening (digital rectal examination)
- Nutritional Counseling
Colorectal Cancer Screenings
Cologuard is currently excluded on your plan. Quest offers an at-home colorectal cancer screening test called “InsureONE”. If opting for a non-invasive screening, Signature members must use Quest to receive the $0 benefit.
Flexible Spending Account (FSA)
Active employees on this plan are eligible for a Flexible Spending Account (FSA) through American Fidelity. Contact American Fidelity for more information and to open your Flexible Spending Account. Retirees on this plan are eligible for an FSA but must use an institution of their choice that is not American Fidelity.
