What you need to know
What’s in a name? The SimplePay Health Plan is called that because—surprise!—it makes health insurance easier to understand and simpler to pay for. No matter how many times you need to visit a doctor or pharmacy each month, you’ll get one bill at the end of the month. And if you need time to pay off the bill, 0% financing is available. Easy as 1-2-3.
Plan Highlights
- You can’t beat the price! $0 premiums for 2024.
- It has a $0 deductible, which means the plan starts sharing costs with you immediately.
- You can go to any provider you like; however, your care is much more cost-effective when you use network doctors in the highest quality tier.
- Providers are ranked by three tiers: tier 1 (green), tier 2 (yellow), and tier 3 (red). Tier 1 providers meet the highest quality standards and have the lowest copays.
- To find a network provider, or to see your current providers’ quality tier, visit the SimplePay Health member portal.
- At the end of each month, you’ll get one bill for all medical and prescription drug expenses you incurred during that month.
- If you need more time to pay off your bill, you can get 0% financing on up to your yearly out-of-pocket maximum in medical and prescription drug expenses.
What you pay for care
Calendar-year out-of-pocket maximum
| Coverage | Out-of-Pocket Maximum |
|---|---|
| Individual | $2,000 |
| Individual in Family | $2,000 |
| Entire Family | $4,000 |
Select medical services
This is what you pay for care for certain services. For other medical expenses and more information, review the medical plan comparison chart.
| Service | In-Network Tier 1 (Green) | In-Network Tier 2 (Yellow) | In-Network Tier 3 (Red) | Out-of-Network* |
|---|---|---|---|---|
| Preventive Care | $0 | $0 | $0 | $0 |
| Office Visits | $15 PCP / $30 Specialist | $20 PCP / $40 Specialist | $30 PCP / $65 Specialist | $35 PCP / $80 Specialist |
| Emergency Room (ER) | $115 | $115 | $115 | $115 |
| Urgent Care | $30 | $40 | $65 | $80 |
| Outpatient Surgery | $465 | $615 | $1,030 | $1,235 |
| Behavioral Health | Office Visits: $15 | Office Visits: $20 | Office Visits: $30 | Office Visits: $35 |
| Physical Therapy | $30 | $40 | $65 | $80 |
| Family Planning Services | Infertility coverage available.** | Infertility coverage available.** | Infertility coverage available.** | Infertility coverage available.** |
* When you use an in-network provider, you’ll know your copay in advance. Keep in mind that some services, like experimental treatments, aren’t covered. However, if you receive care from an out-of-network provider, you’re responsible for a copay, PLUS any amount your provider may bill you above the usual and customary rate—an average of what providers usually charge insurance companies for the service in that region. Since the cost of care varies among providers, you won’t always know ahead of time how much you’d pay out of pocket for out-of-network services. The SimplePay Health plan does NOT have an annual out-of-pocket maximum for out-of-network services, therefore, it’s strongly recommended that you stay in-network (except in emergencies).
** Please contact SimplePay Health for coverage details. Family planning benefits are administered for Workday by Maven Wallet and include a $25,000 lifetime reimbursement allowance for IVF or IUI, egg freezing, adoption, or surrogacy.
Pick a doctor, any doctor
SimplePay Health lets you use any provider you want. But you'll save some major moolah (and avoid balance billing) if you visit doctors in the Aetna network. If you'd like to nominate your provider to join the SimplePay Health/Aetna network, contact a SimplePay Health Valet.
Sign on the dotted line
If you enroll in the SimplePay Health Plan, even for midyear changes after a qualifying life event, you'll need to complete the Member Financial Onboarding Form. Since the plan covers all payments to your in-network providers (even at the pharmacy), and you have the option at the end of the month to either pay your copay balance in full or spread the payment out, we're required to establish a line of credit up to your annual out-of-pocket maximum. There is no credit check, and there is no impact to your credit report.
After enrolling, you'll receive a required task in your Workday inbox with an external link to the financial agreement. Review and submit the Member Financial Onboarding Form to get things situated with SimplePay Health.
Get help from a human
No maze of automatic responses when you make a phone call for help. Your SimplePay Health Valet is only an email or phone call away. Contact them at 800-606-3564, Monday–Friday 8 a.m. to 8 p.m. Central time and navigate your health care with confidence.
Premise Health
Being a Workmate comes with some great perks. Like Premise Health. It costs you $0 and you can connect 24/7/365 with a board-certified primary care doctor via your computer, tablet, or smartphone. How convenient is that? It’s great for non-emergency issues, or when you can’t see your regular doctor.
Register by visiting Premise Health online.
FYI
Learn more about your plan by reviewing the SimplePay Health Benefits Summary and the FAQ on the SimplePay Health website. And don't forget to download the app (no, you're not seeing things, it's the Virgin Pulse one).