Guided Plans
Guided Care.
Serious Protection.
The Guided Plans are limited medical expense insurance policies designed to help protect Members from significant covered medical expenses, subject to the terms of the applicable Policy.
Protection that helps you navigate your care and get the most from your benefits—for less. Guided plans protect you from the big stuff—surgeries, hospitalizations, and serious illness—with a dedicated Care Coordination team in your corner.
Before any non-emergency service, the Care Coordination team helps you find quality providers and arrange care. Coordinated care can mean dramatically lower costs or even $0 out of pocket with Guided Ethos.
What's Covered
Guided plans are subject to a 12-month waiting period for preexisting conditions, with a 24-month look-back period.
Surgery
Inpatient and outpatient surgical procedures, including related facility and anesthesia costs.
Hospitilazation
Inpatient hospital stays, room and board, and associated services during an approved medical event.
Illness
Diagnosis and treatment of serious illness, including related services tied to the same medical event.
Injury
Accidental injuries requiring medical care, including follow-up treatment for the same condition.
Maternity
Vaginal up to $25,000 · C-section up to $50,000. Complications are covered up to the plan limits ($2M). Member + Spouse or Family tier required.
Emergency
No prior approval needed. Deductible + coinsurance apply.
Guided Ethos
Guided Align
With Coordination
$0
Deductible + coinsurance can be waived when care is coordinated in advance
With Coordination
Deductible + coinsurance apply
Care Coordination helps reduce overall costs and
surprise billing
Without Coordination
$5,000 deductible + 20% coinsurance per medical event
Without Coordination
$5,000 deductible + 20% coinsurance per medical event
ACA
Pair with a preventive health plan for ACA compliance (MEC)
ACA
Pair with a preventive HSA health plan for ACA compliance (MEC) and HSA compatibility
Get benefits that get you.
Employee benefits designed with you in mind.