We offer two health insurance plans for 2025. A PPO Plan and a HDHP with HSA Plan. Both plans share the same networks with BlueCross Blue Shield but are structured differently. Click on the words below for additional information on each plan.
NOTE: Employees active on our health insurance plan that do not participate in the wellness program will be responsible for an additional 10% of their individual premium.
Bolin’s Full Summary Plan Document
PPO Plan (also known as Base Plan)
Base Plan Summary of Benefits
HDHP with HSA Plan (also known as HSA Plan)
Health Savings Account Summary of Benefits
| Employee Weekly Rates | Base Plan | HSA Plan |
| Employee | $52 | $52 |
| Employee + Spouse | $202 | $183 |
| Employee + Child(ren) | $167 | $152 |
| Family | $328 | $291 |
| Base Plan | Base Plan | HSA Plan | HSA Plan | |
| Network | In-Network | Out-of-Network | In-Network | Out-of-Network |
| Deductible: | ||||
| Individual | $3,000 | $9,000 | $5,000 | $10,000 |
| Family | $9,000 | $18,000 | $10,000 | $20,000 |
| Coinsurance | 80% | 60% | 100% | 60% |
| Out-of-Pocket Maximum: | ||||
| Individual | $6,000 | $18,000 | $5,000 | $10,000 |
| Family | $13,500 | $40,500 | $10,000 | $20,000 |
| Physican Services: | ||||
| Preventative Care | 100% | 60%* | 100% | 60%* |
| Physician Visit | $35 copay | 60%* | 100%* | 60%* |
| Specialists Visit | $45 copay | 60%* | 100%* | 60%* |
| Diagnostic Testing | 80%* | 60%* | 100%* | 60%* |
| Lab Testing | 80%* | 60%* | 100%* | 60%* |
| Inpatient Hospitalization | 80%* | 60%* | 100%* | 60%* |
| Emergency Room | $175 copay | $175 copay | 100% | 100% |
| Urgent Care | $35 copay | 60%* | 100%* | 60%* |
| Telehealth | $35 copay | N/A | 100%* | N/A |
*Coinsurance percentage that applies after the deductible is met
| Pharmacy (In-Network) | Base Plan | HSA Plan |
| Retail (30 days) | Copays: $15 / $25 / $50 / 70% | 100%* |
| Mail Order (90 days) No Specialty | Copays: $45 / $75 / $150 | 100%* |