We provide a comprehensive medical plan option to help you and your family take charge of your health care.
This plan includes prescription drug coverage.
Medical plans are administered by United Healthcare – Surest.
Evaluate Your Needs. Consider your prior health care usage and opt into our comprehensive medical plan that is designed to support your lifestyle and needs. Review this benefits website to learn about your medical plan option.
Everyone has different medical benefit needs. Leaf Home offers medical benefits through United Healthcare – Surest. You are eligible for this benefit after completing 30 days of employment.
In order to receive the highest benefit level and reduce your potential out-of-pocket expenses, please be sure to use an in-network provider whenever possible. If you choose to use an out-of-network provider, you may be responsible for balance billing.
Network Annual Deductible
$0 (individual) / $0 (family)
Note: While the plan year runs July 1 through June 30, the deductible year runs from January 1 through December 31.
Network Annual Out-of-Pocket Maximum
$5,000 (individual) / $10,000 (family)
(Includes your annual deductible, coinsurance, and copays)
Medical Plan Comparison
| Surest Plan | In-Network | Out-of-Network | ||
|---|---|---|---|---|
| Overall Provisions | ||||
| Deductible | $0 | |||
| Coinsurance (Plan Paid) | 100% | |||
| OOP Limit Individual | $5,000 | $10,000 | ||
| OOP Limit Family | $10,000 | $20,000 | ||
| Medical Coverage | ||||
| Office Visit | $15 to $100 | $300 | ||
| Virtual Health | ||||
| Virtual Health (Primary and Urgent) | $0 | Not Covered | ||
| Virtual Health (Specialty) | $0 to $100 | Not Covered | ||
| Preventive Care | $0 | $150 | ||
| Routine Diagnostic Test (e.g. X-ray, Lab, Ultrasound) | $0 | $0 | ||
| Complex Imaging (MRI, CT, etc.) | $100 to $700 | $1,875 to $2,100 | ||
| Emergency Room | $500 | $500 | ||
| Observation Stay | $500 | $500 | ||
| Ambulance | $250 | $250 | ||
| Urgent Care | $50 | $150 | ||
| Procedures (Office, Outpatient and Inpatient) | $40 to $3,000 | Up to $9,000 | ||
| Procedures (Inpatient and some Outpatient) | $200 to $3,000 | Up to $9,000 | ||
| Other Outpatient Hospital Services | $125 to $800 | $2,400 | ||
| Other Inpatient Stay (inc. admission from ER) | $2,000 | $6,000 | ||
| Bariatric Surgery | Covered | Covered | ||
| Gender Dysphoria Surgery | Covered | Covered | ||
| Gender Dysphoria Reconstructive Services | Covered | Covered | ||
| Mental Health & Substance Use Disorder | ||||
| In an office setting | $15 | $150 | ||
| Mental Health Telehealth | $15 | $150 | ||
| Intensive Outpatient Treatment Program | $70 | $210 | ||
| Partial Hospitalization Program | $125 | $375 | ||
| In an outpatient setting | $125 | $375 | ||
| In an inpatient setting | $2,000 | $6,000 | ||
| Maternity | ||||
| Prenatal and Postnatal Care | $0 | $150 | ||
| Delivery | $900 to $2,000 | $6,000 | ||
| Home Health Care | $45 | $135 | ||
| Rehabilitative Therapies | $15 to $95 | Up to $285 | ||
| Acupuncture | $45 | $135 | ||
| Chiropractic | $25 | $75 | ||
| Occupational Therapy | $15 to $90 | $270 | ||
| Physical Therapy | $15 to $70 | $210 | ||
| Speech Therapy | $15 to $90 | $270 | ||
| Skilled Nursing Facility | $1,500 | $4,500 | ||
| Durable Medical Equipment | $0 to $1,000 | Up to $2,000 | ||
| Hospice | ||||
| Home Hospice Visit | $45 | $135 | ||
| Inpatient Hospice Care | $2,000 | $6,000 | ||
| Advanced Tests1 | $10 to $1,100 | Up to $3,300 | ||
| Medical Infusions And Chemotherapy | $30 to $2,450 | Up to $7,350 | ||
| Therapeutic Treatments2 | $40 to $2,100 | Up to $6,300 | ||
| Fertility Treatment | $100 to $1,500 | Not Covered | ||
| Pharmacy Coverage | ||||
| Retail Pharmacy - 30 Days Supply | ||||
| Tier 1 | $10 | Not Covered | ||
| Tier 2 | $60 | Not Covered | ||
| Tier 3 | $90 | Not Covered | ||
| Retail Pharmacy - 90 Days Supply | ||||
| Tier 1 | $25 | Not Covered | ||
| Tier 2 | $150 | Not Covered | ||
| Tier 3 | $225 | Not Covered | ||
| Specialty Retail Pharmacy | ||||
| Tier 1 | $240 | Not Covered | ||
| Tier 2 | $270 | Not Covered | ||
| Tier 3 | $300 | Not Covered | ||
[1] Advanced Test are complex medical tests your doctor may order to learn more about your health; typically planned and separately Examples include EKG or a Facility Based Sleep Study.
[2] Therapeutic Procedures are treatments for complex diseases and health needs that do not involve Examples include radiation therapy or dialysis.
