Medical Plans

You have options when it comes to your medical and pharmacy benefits, each with different levels of coverage. When you visit ECU Health providers and facilities, your cost is less. When going outside of the network, you will pay an increased portion of the costs.

You will find it easier to manage costs when you stay in-network.

Our plans are administered by an outside company that specializes in managing claims, MedCost. If you need to request an ID card, print or view an explanation of benefits (EOB) or find a provider, visit www.medcost.com. The ECU Health group number for MedCost is 7488.

Key Terms to Know

Before you review your medical plan options, you should understand how they work. Start with these terms.

Coinsurance: A set percentage you pay of the cost of the care you receive, for example 20%.

Copay: A set dollar amount you pay when you
receive health care, for example $35 when you see a specialist.

Deductible: A set amount you must pay out of your pocket before the plan starts paying part of the cost, unless a copay applies.

Out-of-pocket maximum: The most you will pay in a calendar year for doctor visits, prescriptions, etc., for covered expenses and includes your deductible, copays and coinsurance. This “safety net” provides peace of mind for those who have a serious condition or illness.

Comparing the 2023 Options

ECU HealthNow

You can use ECU HealthNow to connect with a doctor 24/7 by phone or online. If you enroll in the Basic or Choice medical plans, use the group code “Vidant” to receive services at no cost. If you are enrolled in the Medical Savings Plan, there is a $55 fee for service until your deductible has been met.

Visit ECU HealthNow or download the ECU HealthNow app from your app store.

Tier 1
ECU Health Alliance/In-Network
Tier 2
MedCost/In-Network
Tier 3
Out-of-Network
Wellness Covered at 100% Covered at 100% Plan pays 50%, you pay 50%
Plan Coinsurance Ded., then 15% coins. Ded., then 25% coins. Ded., then 50% coins.
PCP Visit Ded., then 5% coins. Ded., then 25% coins. Ded., then 50% coins.
Specialty Visit Ded., then 10% coins. Ded., then 25% coins. Ded., then 50% coins.
Behavioral Health Office Visit Ded., then 5% coins. Ded., then 5% coins. Ded., then 50% coins.
ECU HealthNow Ded., then $0 Ded., then $0 Ded., then $0
Med Deductible (Single/Family) $2,000/$4,000 $2,500/$5,000 $6,000/$12,000
Med Max OOP (Single/Family) $6,000/$12,000 $6,750/$13,500 $12,500/$25,000
Rx Max OOP (Single/Family) Included with medical OOP max Included with medical OOP max Included with medical OOP max
Combined OOP Max (Med + Rx) $6,000/$12,000 $6,750/$13,500 $12,500/$25,000
Emergency Room Ded., then 15% coins. Tier 1 ded., then 15% coins. 1 Tier 1 ded., then 15% coins. 1
Urgent Care Ded., then 15% coins. Ded., then 25% coins. Ded., then 50% coins.
Inpatient/Outpatient Hospital Ded., then 15% coins. Ded., then 25% coins. Ded., then 50% coins.

1For these services, you first pay the Tier 1 deductible, and then the coinsurance.

Tier 1
ECU Health Alliance/In-Network
Tier 2
MedCost/In-Network
Tier 3
Out-of-Network
Preventive Covered at 100% Covered at 100% Ded., then 50% coins.
Plan Coinsurance Plan pays 85%, you pay 15% Plan pays 75%, you pay 25% Plan pays 50%, you pay 50%
PCP Visit $10 copay $50 copay Ded., then 50% coins.
Specialty Visit $25 copay $60 copay Ded., then 50% coins.
Behavioral Health Office Visit $10 copay $10 copay Ded., then 50% coins.
ECU HealthNow Ded., then $0 Ded., then $0 Ded., then $0
Med Ded. (Single/Family) $1,200/$2,400 $1,500/$3,000 $4,500/$9,000
Med Max OOP (Single/Family) $4,000/$8,000 $5,000/$10,000 $10,000/$20,000
Rx Max OOP (Single/Family) $2,500/$5,000 $2,500/$5,000 $2,500/$5,000
OOP Max (Med + Rx) $6,500/$13,000 $7,500/$15,000 $12,500/$25,000
Emergency Room $250 copay + ded./15% coins. $250 copay + Tier 1 ded./15% coins. 1 $250 copay + Tier 1 ded./15% coins. 1
Urgent Care $50 copay $60 copay Ded., then 50% coins.
In/Outpatient Hospital Ded., then 15% coins. Ded., then 25% coins. Ded., then 50% coins.

1For these services, you first pay the Tier 1 deductible, and then the coinsurance.

Tier 1
ECU Health Alliance/In-Network
Tier 2
MedCost/In-Network
Tier 3
Out-of-Network
Wellness Covered at 100% Covered at 100% Ded., then 50% coins.
Plan Coinsurance Plan pays 85%, you pay 15% Plan pays 75%, you pay 25% Plan pays 50%, you pay 50%
PCP Visit $10 copay $30 copay Ded., then 50% coins.
Specialty Visit $15 copay $50 copay Ded., then 50% coins.
Behavioral Health Office Visit $10 copay $10 copay Ded., then 50% coins.
ECU HealthNow Ded., then $0 Ded., then $0 Ded., then $0
Med Ded. (Single/Family) $850/$1,700 $1,250/$2,500 $3,500/$7,000
Med Max OOP (Single/Family) $3,300/$6,600 $4,500/$9,000 $8,000/$16,000
Rx Max OOP (Single/Family) $2,500/$5,000 $2,500/$5,000 $2,500/$5,000
OOP Max (Med + Rx) $5,800/$11,600 $7,000/$14,000 $10,500/$21,000
Emergency Room $200 copay + ded./15% coins. $200 copay + Tier 1 ded./15% coins. 1 $200 copay + Tier 1 ded./15% coins. 1
Urgent Care $40 copay $50 copay Ded., then 50% coins.
In/Outpatient Hospital Ded., then 15% coins. Ded., then 25% coins. Ded., then 50% coins.

1For these services, you first pay the Tier 1 deductible, and then the coinsurance.