Core of the design

Engineered plans encourage access to physicians. Even at the highest utilization, physicians are the least expensive and most effective component of a health plan.  A comprehensive network of physicians is crucial.  

These benefits are covered at 100% after small co-payments. 

These situations are the main reason employees need health insurance. Catastrophic events include all treatments and testing during any inpatient hospitalization. It also includes cancer, cardiac care, or stroke treatments that may be performed on an outpatient basis. These are services where the patient has the least discretion for provider and treatment selection.  

Coinsurance for Catastrophic Care is typically covered at 90% after the deductible.

Care and services provided on an outpatient basis are typically identified as non-catastrophic. Many minor surgeries and diagnostic tests are performed outpatient. While all are still medically necessary, the provider, treatment options, and timing are heavily influenced by the participant.  

The co-insurance under this category is 70% after the deductible.  

All care and services required to be covered at 100% in network under ACA will still apply in the Engineered Plan.