Medical Plan Quick Guide

The medical plan chart below illustrates the differences in costs for Emory's POS medical plan within the three networks:

2024-25 Medical Plan
POS Plan
Earned Incentives$425/$8251
Tier 1Tier 2Tier 32
Annual Deductible - Single$850$1,000$2,000
Annual Deductible - Family$2,550$3,000$6,000
Out-of-Pocket Maximum3 - Single$3,000$4,500$11,250
Out-of-Pocket Maximum3 - Family$6,000$9,000$22,500
Out-of-Pocket Maximum3 - AggregateYesYesYes
Primary Care Office Visits4$25 copay$35 copay50% after deductible
Pediatrician Office Visits$25 copay$25 copay50% after deductible
Specialist Office Visits5$35 copay$50 copay50% after deductible
Diagnostic Labs15% coinsurance25% coinsurance50% coinsurance
X-Ray15% after deductible25% after deductible50% after deductible
Durable Medical Equipment15% coinsurance25% coinsurance50% after deductible
Routine Preventive Care6$0 copay$0 copay50% after deductible
Emergency Room Visits7$250 copay$250 copay$250 copay
Hospitalizations: Inpatient/Outpatient
Coverage
15% after deductible25% after deductible50% after deductible
Behavioral Health Inpatient15% after deductible25% after deductible50% after deductible
Behavioral Health Outpatient$25 copay$25 copay$25 copay
  • 1 An annual maximum of $425 in incentives can be earned (for Single level coverage) or $825 (for Employee+Spouse or Family level coverage).
  • 2 Amounts applied to deductible and out-of-pocket maximums are limited to the Reasonable and Customary charges.
  • 3 Out-of-Pocket maximum includes copays.
  • 4 Includes services of an internist, general physician, family practitioner, dermatologist, and/or allergist.
  • 5 An additional facility fee may be charged for your specialist visit which may apply to your deductible or co-insurance.
  • 6 Routine Preventive Care services ONLY are covered at 100% under the plan at the Tier 1 and Tier 2 Network levels. Diagnostic services are subject to the deductible and co-insurance.
  • 7 Copay waived if admitted.
Disclaimer

Every attempt has been made to ensure the chart and information above accurately reflects the details of the plan. Should there be any errors, the terms and conditions of the Summary Plan Description (SPD) prevail.