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 $7,250 | |||
| Deductible | $300 | n/a | |
| Copayments (office visits, Rx drugs and blood test) | $900 | n/a | |
| Coinsurance | $200 | $5,790 | |
| Limits and Exclusions | $60 | n/a | |
| What Joe would pay | $1,460 | What Apex would pay | $5,790 |
Joe would still have $7,250 to pay before he reaches his maximum out of pocket responsibility for the year.
Because Apex assumes the financial risk of providing you with health care benefits, we can either save or lose money depending on the level of claims incurred. We want to be able to provide you with high-quality health benefits, but as the cost of providing health care rises, you too must do your part to keep benefits high and costs low.
Some ways that you can help save money for yourself and our company are:
- Eliminate unnecessary visits to your doctor.
- Discuss healthy living and preventive care with your doctor.
- Follow prescription drug directions precisely, and be sure to take all of your medication, even if you feel better.
- Go to in-network doctors, hospitals, and providers as much as possible.
To help keep your health care costs down, do your best to be a wise health care consumer and always ask questions if you do not understand the benefits available to you.
Know where to go!
Check out the list below to see if you’ve made the right choice:
| Teladoc | Primary Care Physician | Urgent Care/Dispatch Health | ER |
|---|---|---|---|
| $0 copay | $0 – $15 Copay | $35 copay | 20% after $300 copay |
| Available 24/7 | 20 minutes | 15-45 minute wait | 2-4 hour average wait |
| Bronchitis/Allergies, Cold & Flu, Ear Infection, Respiratory Conditions, Sinus Infections, Urinary Tract Infection, Poison Ivy, Pink Eye, and more… | Checkups, Preventive Services ($0 Copay), Minor Skin Conditions, Vaccinations, General Health Management | X-Rays & Lab Tests, Flu or Cold, Fever, Setting & Casting Broken Bones, Cuts Requiring Stitches, Headaches and Chills, Sprains and Strains, Minor Burns, Immunizations, Flu Shots, Foreign Objects in Eye | Heart Attacks or Chest Pain, Stroke or Stroke Symptoms, Unconscious Patients, Serious Accidents, Uncontrollable Bleeding, Head Trauma, Serious Abdominal Pain |
Make sure you and your family make the right choice for the problem at hand