| Individuals | Families |
| Self-Employed | 1099 Independent Contractors |
Get practical healthcare benefits for routine visits, virtual care, prescriptions and preventive services, plus additional support for hospital, emergency and maternity needs.
Explore the benefitsAnnual Deductible
Annual Deductible
For in-network care
Part A & Part B
Essential MV combines predictable copays for common healthcare needs with defined benefits for more serious events.
Connect with board-certified doctors 24/7 for urgent medical concerns and schedule virtual behavioral health visits.
Use straightforward in-network copays for primary care, specialists, urgent care, labs and common radiology services.
Access defined hospital, emergency, outpatient surgery, maternity, therapy and prescription benefits.
The amounts below summarize selected benefits. Pre certification, annual limits, reference-based pricing and other plan terms may apply.
Benefit | In-network | Out-of-network/plan terms |
| Preventive & wellness | Covered at 100% - no copay | 40% coinsurance after deductible |
| Primary care & specialist visits | Covered at 100% - after copay | 40% coinsurance after deductible |
| Urgent care | Covered at 100% - after copay | 40% coinsurance after deductible |
| Labs & common radiology X-ray and ultrasound |
Covered at 100% | 40% coinsurance after deductible |
| Advanced imaging MRI, CT/PET; limit 1 per year |
30% coinsurance after deductible or Covered at 100% when arranged through Medmo, subject to limits | |
| Outpatient surgery Limit 1 per year; pre certification required |
30% coinsurance after deductible - subject to reference based pricing | |
| Inpatient hospitalization & surgery Limit 5 days and 2 surgeries per year; pre certification required | 30% coinsurance after deductible - subject to reference based pricing | |
| Emergency services Limit 1 per year |
30% coinsurance after deductible - subject to reference based pricing | |
| Maternity professional services Pre certification required |
$350 copay | 40% coinsurance after deductible |
| Generic prescriptions Tier 1; formulary and quantity rules apply |
$10 copay. Higher tiers and brand/specialty drugs: discount only. | |
| Unlimited telehealth with behavioral health | $0 copay. Provided through Recuro Health. | |
Certain services are reimbursed using a percentage of Medicare as the reference point (REFERRENCE BASED PRICING - RBP). The plan pays up to 125% of the Medicare allowable amount for applicable services. The following services are not provided as part of this plan.
| Chemotherapy and radiation therapy | Dialysis |
| Transplant services | Hospice, skilled nursing and private-duty nursing |
| Durable medical equipment, prosthetics and orthotics | Dental and vision care |
| Infertility services and family planning | Preferred/non-preferred brand, specialty, self-injectable and GLP-1 drugs |
| Other exclusions and limitations apply. Review the full plan materials before enrolling. | |
Have a question we haven't covered?
We're here to help, speak with a SHC Benefits advisor -
The annual deductible is $2,500 individual / $5,000 family. The out-of-pocket maximum is $9,100 individual / $18,200 family for covered services only. Reference-based pricing balances may fall outside that maximum.
Yes. The plan includes both inpatient mental health benefits; and unlimited telehealth with behavioral health through Recuro Health is available at a $0 copay.
Your personalized quote will confirm the monthly amount for the people enrolling. The brochure does not provide a monthly rate table. Ask your advisor to review all applicable premiums, fees and surcharges. Get my personalized quote
Yes, pre-existing conditions are covered under this plan.
Yes. SmartHealth supports small business employers with less than 50 full-time equivalent employees (FTE), subject to applicable eligibility. Many SmartHealth plans can be utilized by small business employer groups.
Yes. Advanced imaging, outpatient surgery, inpatient hospitalization and surgery, maternity professional services and certain other services require pre certification. Failure to obtain it can result in denial of benefits.Yes. Advanced imaging, outpatient surgery, inpatient hospitalization and surgery, maternity professional services and certain other services require pre certification. Failure to obtain it can result in denial of benefits.
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