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  • 2025
    MEDICAL PLAN COMPARISON    		 Charter Select Earn $35,00 orless Charter
    Basic    		 Nexus
    Basic    		 Choice
    HDHP    		 Charter
    Plus         		 Nexus
    Plus    		 Choice
    RATES
    Based on 24 pay periods Employee Only $2.75 $21.18 $23.30 $36.95 $42.67 $46.94 $74.39
    Employee + Spouse $106.92 $119.03 $130.93 $207.52 $160.68 $176.75 $267.69
    Employee + Child(ren) $97.24 $110.24 $121.28 $192.25 $148.83 $163.71 $248.79
    Employee + Family $176.55 $203.93 $224.33 $355.60 $275.30 $302.84 $430.11
    PLAN LIMITS
    Annual Deductible Individual $500 $2,500 $2,500 $3,300 $1,750 $1,750 $1,750
    Family $1000 $5,000 $5,000 $6,600 $3,500 $3,500 $3,500
    Annual out-of-pocket max (includes all medical and pharmacy deductibles, copays, and coinsurance) Individual $4,900 $7,900 $7,900 $7,900 $6,150 $6,150 $6,150
    Family $9,800 $15,800 $15,800 $15,800 $12,300 $12,300 $12,300
    Preventive CARE Exams  Free Free Free Free Free Free Free
    COST FOR COVERED SERVICES AFTER DEDUCTIBLE HAS BEEN MET
    Office Visits Primary Care (PCP) $30 copay1  $30 copay1  25%/45%4  20% $30 copay1 20%/40%4  20%
    Specialists $65 copay1  $65 copay1  25%/45%4 20% $65 copay1 20%/40%4  20%
    HISD Onsite Clinics & PRIME1  Free Free Free Not available Free Free Free
    Inpatient-Hospital3  30%  25% 25%/45%4 20% 20% 20%/40%4  20%
    Outpatient - Hospital3 30% 25% 25%/45%4 20% 20% 20%/40%4  20%
    Outpatient - Freestanding and Surgical Centers3 30% 25% 25%/45%4 20% 20% 20%/40%4  20%
    Emergency Room 30% +
    $750 copay    		 25% +
    $750
    copay    		 25% + $750
    copay    		 20%+ $750 copay 20% + $750
    copay    		 20% + $750
    copay    		 20% + $750
    copay
    Urgent Care Facility 100 copay1 100 copay1 100 copay1 20% 100 copay1 100 copay1 100 copay1
    Lab, X-Ray, Diagnostic and Mammograms 30% 25% 25% 20% 20% 20% 20%
    Diagnostic Scans (MRI, MRA, CAT, PET) 30% 25% 25% 20% 20% 20% 20%
    Maternity - Delivery (Hospital) 30% 25% 25%/45%4 20% 20% 20%/40%4 20%
    Mental Health and Substance Abuse - Inpatient 30% 25% 25% 20% 20% 20% 20%
    Mental Health and Substance Abuse - Outpatient $65 copay1  $65 copay1 25% $20  $65 copay1  20% 20%
    PRESCRIPTION DRUG COMPARISON          
    Annual pharmacy deductible $50 per person $100
    per person    		 $100
    per person    		 Integrated with medical $100
    per person    		 $100
    per person    		 $100
    per person
     

    Prescription drugs (30-day retail)5

    		 Tier 1 Generally Genetic $20 $20 $20 20% $20 $20 $20
    Tier 2 Generally preferferd brand $60 $75 $75 20% $75 $75 $75
    Tier 3 Generally Non-preferferd brand generic $100 25%
    (min. $100 copay/max. $250 copay)    		 25%
    (min. $100 copay/max. $250 copay)    		 20% 25%
    (min. $100 copay/max. $250 copay)    		 25%
    (min. $100 copay/max. $250 copay)    		 25%
    (min. $100 copay/max. $250 copay)
    Specialty Drugs $150 25%
    (min. $100 copay/max. $250 copay)    		 25%
    (min. $100 copay/max. $250 copay)    		 20% 25%
    (min. $100 copay/max. $250 copay)    		 25%
    (min. $100 copay/max. $250 copay)    		 25%
    (min. $100 copay/max. $250 copay
    Prescription drugs (90-day or retail)5 Tier 1 Generally Genetic $50 $50 $50 20% $50 $50 $50
    Tier 2 Generally Genetic  $150
    $187.50    		 $187.50 20% $187.50 $187.50 $187.50
    Tier 3 Generally Non-preferred brand generic $250 25%
    (min. $250 copay/max. $500 copay)    		 25%
    (min. $250 copay/max. $500 copay)    		 20% 25%
    (min. $250 copay/max. $500 copay)    		 25%
    (min. $100 copay/max. $500 copay)    		 25%
    (min. $250 copay/max. $500 copay)
    1 - Charter PCP and specialist copays do not count towards the annual deductible; but, do apply towards the annual out-of-pocket maximum.
    2 - Free if you are enrolled in an HISD medical plan (not available to Choice HDHP members).
    3 - Pre-certification may be required.
    4 - Services are tiered under Nexus Basic and Nexus Plus.
    5 - Separate pharmacy copay applies after separate pharmacy deductible has been met (except Choice HDHP).