Health Maintenance Organization (HMO) Plans
Saint Mary’s Health Plans has a variety of HMO plans with low out-of-pocket expenses and no lifetime maximum for medical services. Products are comprehensive medical and hospital insurance plans with various plan combinations for employers and their employees.
The HMO network offers access to some of the highest quality hospitals in Nevada including Saint Mary's Regional Medical Center in northern Nevada and St. Rose Dominican hospitals in southern Nevada.
For a complete list of medical plan summaries, click here and select your group size.
Preferred Provider Organization (PPO) Plans
Our fully insured PPO product plans range in price depending on the deductible level, the coinsurance level and the physician copay that your group chooses. A Saint Mary’s PPO plan provides access to a statewide network of providers and hospitals including both Saint Mary's Regional Medical Center in Reno and St. Rose Dominican Hospitals in Las Vegas.
Saint Mary’s Health Plans is contracted with First Health to serve as the national PPO network with a customized hospital network for use outside of Nevada. First Health features an expansive national network that includes more than 5,000 hospitals, 550,000 physicians and 64,000 ancillary providers.
As with other PPO networks, it is the member’s responsibility to validate that a provider they are seeing is in the SMHP First Health Network. For a customized SMHP First Health provider listing click here.
For a complete list of medical plan summaries, click here and select your group size.
Point of Service (POS) Plans - Available in northern Nevada only
Saint Mary’s Health Plans POS plans combine the convenience and low out-of-pocket expenses of an HMO, greater freedom to choose a PPO provider from a larger panel of health care professionals and complete flexibility to choose any licensed care provider – all in one benefit package.
HMO Level - Members have access to comprehensive health care for copays and no lifetime maximum for medical services.
PPO Level - Members receive care from our statewide PPO network of providers that can be accessed without a referral from their PCP. Unlimited lifetime maximum benefits for In- and Out-of-Network medical services.
Out-of-Network Provider Level - Members are free to seek medical services from licensed providers who are not part of Saint Mary’s HMO or Preferred Health Care Networks. Benefits will be paid at the appropriate coinsurance rate once members have paid their annual deductible. Out-of-pocket expenses under this benefit plan will be greater than under the HMO or PPO plans and some services are covered under the HMO benefit only.
For a complete list of medical plan summaries, click here and select your group size.
FlexFit Plans
FlexFit PPO plans are a unique approach to health care and the most cost-effective options we have to offer. FlexFit plans are ideal for businesses of all sizes who want the most affordable plan combined with comprehensive coverage and access to Saint Mary’s Regional Medical Center and St. Rose Dominican Hospitals. Members can visit any doctor, specialist or therapist within the PPO network up to five combined times per year for a copay, then deductibles and coinsurance apply.
For a complete list of medical plan summaries, click here and select your group size.
PPO Beyond Plans
Offering the best of both worlds, Beyond plans are a unique series of Saint Mary’s Health Plans PPO plans – designed to provide the first dollar benefits of an HMO plan and the choice and flexibility of a PPO plan. Beyond PPO plans have first dollar copays for most commonly accessed medical services, including Primary care and Specialist visits, radiology and lab tests, and emergency room and urgent care visits. Some plans are even structured with copays for outpatient surgeries. Coupled with these valuable first dollar benefits, Beyond plans are genuinely affordable and also provide access to our statewide PPO network.
For a complete list of medical plan summaries, click here and select your group size.
HMO Beyond Plans
Thanks to the popular demand of the PPO Beyond plans, Saint Mary’s Health Plans is excited to launch our newest product line of health plans, HMO Beyond. Members have first dollar benefits for the most commonly accessed medical services including PCP and specialty visits, radiology and lab tests, emergency room and urgent care visits. By balancing deductible and coinsurance amounts for other services and benefits, a more cost-effective plan can be offered to members.
For a complete list of medical plan summaries, click here and select your group size.
Consumer Driven (HDHP) Plans
Consumer Driven health plans (HDHP Plans) are next-generation coverage options designed to help members appreciate the value of health care, maintain control of their finances and make more confident decisions.
Health Savings Account (HSA) – Excellent tools for member engagement in wise and cost-conscious health care utilization. HSA’s are an ideal method to save for medical expenses on a pre-tax basis. Contributions are not subject to FICA or FUTA taxes. HSA’s must be used in conjunction with a high deductible health plan.
Health Reimbursement Account (HRA) – By customizing HRA products with fully-insured Saint Mary’s Health Plans products, a group-specific product is created which can save money and manage utilization. HRA contributions are tax-free to members and tax-deductible to employers.
For a complete list of medical plan summaries, click here and select your group size.
Health Suite Select Portfolio for Small Groups
The Health Suite Select portfolio of health care plans is designed for small businesses 2 to 50. The concept is to offer maximum choice and flexibility all within a simple approach and at an affordable cost.
Tailor specific plan options to meet the personal needs of any small groups. Customized benefits packages can be selected from any of our plan types and plan designs at various price points.
Employers with 5 or more enrolled employees can offer up to five of the available plans without restrictions, many of which would be typically associated with larger employer groups. They can build their own plan suite – select five different plans or perhaps only two. How many plans and plan types they want to offer is completely up to them. Employers with less than 5 enrolled employees can select their favorite plan to offer.
Employees can then select what plan works best for them and their lifestyle – whether they are a young family, empty nester or single and on-the-go, it’s all about choice. Being empowered to make a decision about their health care offers employees a sense of value, a feeling that they are an active participant in what is right for them.
For a complete brochure about northern Nevada Health Suite Select plans for small businesses 2-50, click here.
For a complete brochure about southern Nevada Health Suite Select plans for small businesses 2-50, click here.
For a complete list of medical plan summaries, click here and select your group size.
