Copay 4500

PHCS / Multiplan Network

The Copay 4500 plan is a PPO that gives you predictable copays for everyday doctor visits — $40 for primary care, $75 for specialists, and $90 for urgent care — before you even touch your deductible. It's a solid fit for working individuals and families who want broad access to the national PHCS network and straightforward costs for routine care, but are willing to take on a higher deductible for major medical events. This plan also includes $20,000 in Humana life insurance and prescription drug coverage at flat copay rates.

Enroll Now

Monthly premiums

member_only: $708.45/mo
child: $1,248.39/mo
spouse: $1,362.48/mo
family: $1,805.85/mo

The Copay 4500 is a PPO plan built around affordable, predictable copays for the care you use most often. When you visit a primary care doctor, you pay a flat $40 copay. Specialist visits are $75, and urgent care is $90 — all without needing to meet your deductible first. Preventive care is covered at no cost, and telemedicine is available at $0 per visit, making it easy and inexpensive to get routine care. Prescriptions are covered through a tiered structure: $0 for preventive generics, $20 for non-preventive generics, $65 for preferred brands, $95 for non-preferred brands, and $200 for specialty drugs — all at participating pharmacies nationwide including CVS, Walgreens, and Walmart. For bigger medical needs, the plan has a $4,500 individual deductible for in-network services, after which you pay 30% coinsurance until you reach the $8,150 individual out-of-pocket maximum. There is also a helpful first-dollar benefit for outpatient lab work, radiology, and scans — the plan covers 100% of those costs up to $500 combined before your deductible kicks in. Advanced imaging like CT scans and MRIs requires a $300 copay plus prior authorization. Hospital stays, outpatient surgery, mental health care, and maternity services are all covered after the deductible and coinsurance, but most of these services require prior authorization — failing to get it can reduce your benefit by 50%, so it's important to call MBA TPA at 844-462-6334 before scheduling those services. This plan includes $20,000 of Humana life insurance for the primary member at no extra cost, and covers both mental health and pregnancy, including childbirth and delivery. You do not need a referral to see a specialist, and the PHCS network gives you access to providers in all 50 states. Keep in mind that applicants must be actively working to qualify, and the plan is not guaranteed issue, meaning health questions may be part of the application process. Out-of-network care is significantly more expensive, with a separate $8,500 deductible and 50% coinsurance, so staying in-network is strongly recommended. This plan is best suited for working individuals or families who regularly see doctors and want low, flat copays for everyday care, but can manage the financial risk of a $4,500 deductible if something major happens. It's less ideal for those who anticipate frequent hospitalizations or major procedures, since those costs can add up quickly before the out-of-pocket maximum is reached. Services like dental, adult vision, acupuncture, skilled nursing facilities, and sleep apnea treatment are not covered, so you may want to consider supplemental coverage for those needs.

Plan details

Deductible (Individual): $4,500
Deductible (Family): $9,000
Out-of-Pocket Max (Individual): $8,150
Out-of-Pocket Max (Family): $16,300
Coinsurance (In-Network): 30%
Primary Care Copay: $40
Specialist Copay: $75
Urgent Care Copay: $90

Benefits

Deductible
$4,500 / $9,000
OON: $8,500 / $17,000
Max Out of Pocket
$8,150 / $16,300
OON: $20,000 / $40,000
Copay
$40 / $75 / $90
PCP / Specialist / Urgent Care
Coinsurance
30% after deductible
Rx Coverage
$0 / $20 / $65 / $95 / $200
Preventive / Generic / Preferred / Non-Preferred / Specialty
Pregnancy
Covered
Mental Health
Covered
Inpatient & outpatient — 30% after deductible
Life Insurance
$20,000 Humana
Primary Member Only
Work Requirement
Must be working

Copay 4500

Monthly premiums

Plan details

Benefits

Plan documents

Available in

Ready to see your rate?