Your health plan for every day's moments

For over 35 years, we’ve partnered with the GIC to offer their members comprehensive coverage that provides exceptional care, convenience, and value. Read on to find out if the Complete HMO for GIC members is the right plan for you.

Covered benefits and services

Schedule of Benefits (PDF)

Summary of Benefits and Coverage (PDF)

Member Handbook (PDF)

 

2024 virtual health fair kit

Read all about the Complete HMO for GIC members

 

 

Need help with the transition of your care?

If you’re receiving care for a certain condition, have plans to see a specialist later this summer, or need prescriptions that require authorization (including for infusions or durable medical equipment), we can help ensure you continue to receive care as you join us.

Let us know as soon as possible if you or a family member have care that needs to continue with your new plan by completing and sending this form (also available en español) to us by email, mail or fax. You can also call us at 866-567-9175 (TTY users call 711).

Complete HMO for GIC members plan overview (effective July 1, 2024)













Benefit Cost sharing
Medical deductible $500 / $1,000
Out-of-pocket maximum (includes medical, pharmacy, and behavioral health) $5,000 / $10,000
Primary care provider office visit copay $10 / $20 / $40
Specialist office visit copay $30 / $60 / $75
Behavioral health office visit $10 copay
Emergency room (emergency care covered at any hospital emergency room) $100 copay then deductible (copay waived if admitted)
Inpatient acute medical care $275 copay then deductible / $500 copay then deductible / $1,500 copay then deductible
Outpatient surgery at a freestanding ambulatory surgical center (for non-preventive colonoscopies, endoscopies, and eye surgeries) $150 copay then deductible
Outpatient surgery (plus hospital based non-preventive colonoscopies, endoscopies, and eye surgeries) $250 copay then deductible
High-tech imaging $100 copay then deductible
Telemedicine through On Demand urgent care, PCP, or Specialist $10 copay
Telemedicine for mental health care or substance use care $10 copay (waived for first 3 visits)

Benefit information good through June 30, 2025

Benefits must be received by a participating provider unless otherwise indicated.

GIC Coordinators

Our 2024 GIC coordinator fact sheet is now available. 
Click here to download.