Medical Benefits
Upcoming OCTOBER 1ST TPA Transition
As you know, effective October 1, 2025, Healthgram will replace Meritain as the health plan administrator, and pharmacy benefits will be managed by SmithRx. While the medical plans will remain the same, the companies processing claims for services as of October 1, 2025 is changing.
Please view the Healthgram Benefits Presentation and review the Argus Companies Healthgram Benefits Guide in the Downloads section below for further information.
Chat at members.healthgram.com or email at askconnect@healthgram.com.
In-Network |
|
|---|---|
Deductible (Individual/Family) |
$3,500/$7,000 |
Employee Coinsurance |
0% |
Out-of-Pocket Max (Individual/Family) |
$4,500/$9,000 |
Primary Care |
Deductible |
Specialist |
Deductible |
Urgent Care |
Deductible |
Emergency Room |
Deductible |
Retail Prescriptions |
|
|---|---|
Generic |
Deductible, then $10 Copay |
Brand Name |
Deductible, then $45 Copay |
Non-Preferred |
Deductible, then $70 Copay |
Specialty |
Deductible, then 20% to a max of $150 |
Employee Per Pay Period Cost |
Standard Rate |
Wellness Rate |
|---|---|---|
Employee Only |
$34.62 |
$0.00 |
Employee + Spouse |
$270.00 |
$235.38 |
Employee + Spouse* |
$339.23 |
$304.62 |
Employee + Children |
$205.38 |
$170.77 |
Employee + Family |
$362.31 |
$327.69 |
Employee + Family* |
$431.54 |
$396.92 |
*Surcharge applies only if the employee’s spouse is eligible for coverage through their employer’s group |
If you choose to elect the HSA option, Argus Consulting will contribute $75 per month to your Health Savings Account. |
Upcoming OCTOBER 1ST TPA Transition
As you know, effective October 1, 2025, Healthgram will replace Meritain as the health plan administrator, and pharmacy benefits will be managed by SmithRx. While the medical plans will remain the same, the companies processing claims for services as of October 1, 2025 is changing.
Please view the Healthgram Benefits Presentation and review the Argus Companies Healthgram Benefits Guide in the Downloads section below for further information.
Chat at members.healthgram.com or email at askconnect@healthgram.com.
In-Network |
|
|---|---|
Deductible (Individual/Family) |
$1,000/$2,000 |
Employee Coinsurance |
20% |
Out-of-Pocket Max (Individual/Family) |
$3,500/$7,000 |
Primary Care |
$25 Copay |
Specialist |
$50 Copay |
Urgent Care |
$75 Copay |
Emergency Room |
$200 Copay, then Deductible, then Coinsurance |
Retail Prescriptions |
|
|---|---|
Generic |
$10 Copay |
Brand Name |
$45 Copay |
Non-Preferred |
$70 Copay |
Specialty |
20% to max of $150 |
Employee Per Pay Period Cost |
Standard Rate |
Wellness Rate |
|---|---|---|
Employee Only |
$34.62 |
$0.00 |
Employee + Spouse |
$380.77 |
$346.15 |
Employee + Spouse |
$450.00 |
$415.38 |
Employee + Children |
$272.31 |
$237.69 |
Employee + Family |
$454.62 |
$420.00 |
Employee + Family |
$523.85 |
$489.23 |
*Surcharge applies only if the employee’s spouse is eligible for coverage through their employer’s group |