Know Your Medical Plan

Apex is a Self Funded Group
Apex has a self-funded group health plan where Apex assumes the financial risk associated with providing health care benefits to you. Rather than paying fixed premiums to an insurance company, Apex pays for medical claims out of pocket as they are incurred.

Example:

Managing Joe’s Type 2 Diabetes
Joe is going to the physician, receiving diagnostic blood tests, needing prescription drugs, and using a Glucose monitor.
The total cost of all these services is $7,400
Deductible$500n/a
Copayments (office visits, Rx
drugs and blood test)
$900n/a
Coinsurance $200$5,740
Limits and Exclusions $60n/a
What Joe would pay$1,660What Apex would pay$5,740

Joe would still have $6,340 to pay before he reaches his maximum out of pocket
responsibility for the year.