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Advantage Plan

Find Your Doctors

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.

Benefits Available at a $0 Copay

Medical Plan Documents & Benefits

Summary of Benefits & Coverage (SBC)Review Full Summary Plan Description (SPD)

This page contains information specific to your medical plan. Looking for your other benefits?

DentalVision
Local Network Travel Network
Plan Year Deductible (Individual/Family) $1,650/$3,300 $3,300/$6,600
Out-of-Pocket Maximum
Medical and Pharmacy combined.
Includes deductible, copays, and coinsurance.		 $7,500/$15,000 $9,200/$18,400
Preventive Care THT pays 100% 50% after deductible
Telehealth / Telemedicine 20% after deductible 50% after deductible
Physician Services
• Primary Care Physician 20% after deductible 50% after deductible
• Behavioral Health Office visits 20% after deductible 50% after deductible
• Physical Therapy 20% after deductible 50% after deductible
• Specialist 20% after deductible 50% after deductible
• Urgent Care / CVS Minute Clinic 20% after deductible 20% after local deductible
• In-Home Urgent Care (Dispatch Health / Doctoroo) $0 after deductible 50% after deductible
Labwork
• Outpatient Clinical Lab 20% after deductible 50% after deductible
• Hospital Lab 20% after deductible 50% after deductible
• All other lab facilities 20% after deductible 50% after deductible
Diagnostic Imaging
• Diagnostic X-Ray Imaging 20% after deductible 50% after deductible
• High Tech Services (CT, MRI, PET) 20% after deductible 50% after deductible
• All other imaging facilities 20% after deductible 50% after deductible
Hospital Services (Inpatient & Outpatient) 20% after deductible 50% after deductible
Emergency room 20% after deductible 20% after deductible

Prescription Benefits

Summary of Covered
Prescription Drug Benefits¹		 Retail Network Pharmacies
See list here
Home
Delivery Service
Tier 1 — Generic
$15 copay per 34-day supply after deductible³
$40 copay per 35+ day supply after deductible³
Tier 2 — Preferred Formulary Brand
25% of the cost, copay max of $100 per 34-day supply after deductible
25% of the cost, copay max of $300 per 35+ day supply after deductible
Tier 3 — Non-Preferred Formulary Brand
40% of the cost, copay per 34-day supply after deductible
40% of the cost, copay per 35+ day supply after deductible
Formulary Diabetic Supplies
$0 copay (includes syringes needles, lancets, and test strips;
limited to a quantity of 200 per 30-day supply)
Summary of Covered
Prescription Drug Benefits¹
Specialty Drugs⁴
(Up to a 30-day supply)
Tier 1 — Generic
25% of the cost, up to $500 max copay after deductible
Tier 2 — Preferred Formulary Brand
25% of the cost, up to $500 max copay after deductible
Tier 3 — Non-Preferred Brand
40% of the cost, copay, per 30-day supply after deductible

(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.

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”.

Health Savings Account (HSA)

Active employees on this plan are eligible for a Health Savings Account (HSA) through American Fidelity. Contact American Fidelity for more information and to open your Health Savings Account. Retirees on this plan are eligible for an HSA but must use an institution of their choice that is not American Fidelity.

Call: 702-433-5333Email: AFES-LasVegas@americanfidelity.com