Effective Date: 06/21/2026
Broker: Jack Gordman
Prepared by: Morgan White Group
| Alternate MM | PS Option 1 | PS Option 2 | PS Option 3 | |
|---|---|---|---|---|
| Carrier | Altcare | AmFirst | AmFirst | AmFirst |
| Deductible | $2500 | $500 | $1000/$2000 | $1500/$3000 |
| Coinsurance | 100/0% to $0 | 100/0% to $0 | 100/0% to $0 | 100/0% to $0 |
| Premium Saver Benefit | $2000 | $1000/$2000 | $1000/$2000 | |
| Premium Saver Deductible | Embedded | Non-Embedded | Non-Embedded | |
| Deductible Cap X2 | Yes | No | No | |
| Coinsurance Cap X2 | No | No | No | |
| 4th Quarter Rollover | No | No | No | |
| PS Professional Fee Copay | $30 for 6 visits | $40 for 3 visits | $40 for 3 visits | |
| PS Rx Rider | $15/50 | |||
| PS Rx Maximum | $2,500 |
| Alternate MM | PS Option 1 | PS Option 2 | PS Option 3 | |
|---|---|---|---|---|
| Employee | $300.00 | $100.00 | $75.00 | $50.00 |
| E + Spouse | $700.00 | $150.00 | $125.00 | $100.00 |
| E + Child | $0.00 | $121.14 | $121.14 | $121.14 |
| E + Child(ren) | $500.00 | $141.94 | $141.94 | $141.94 |
| Family | $1000.00 | $225.85 | $225.85 | $225.85 |
| Monthly Totals | $30,000.00 | $5,000.00 | $6,000.00 | $7,000.00 |
| Total MM + PS Option | $35,000.00 | $36,000.00 | $37,000.00 | |
| Total Monthly Savings | $3,000.00 | $2,000.00 | $1,000.00 | |
| Total Annual Savings | $36,000.00 | $24,000.00 | $12,000.00 | |
| 1st Month PS Premium | $XX,XXX.XX | $XX,XXX.XX | $XX,XXX.XX |
Alternate major medical rates could be an estimate. Actual rates are based on the major medical carrier's actual quote.
Deductible: $1,000 / Coinsurance: 80%/20% to $2,000
| Current MM Rates | # on Plan | Total Monthly Premium | |
|---|---|---|---|
| Employee | $421.40 | 54 | 22,755.60 |
| E + Spouse | $939.06 | 4 | $3,756.24 |
| E + Child | $0.00 | 0 | $0.00 |
| E + Child(ren) | $686.70 | 8 | $5,493.60 |
| Family | $1,271.24 | 9 | $11,441.16 |
| Total | $43,446.60 | ||
Deductible: $1,000 / Coinsurance: 80%/20% to $2,000
| Renewal MM Rates | # on Plan | Total Monthly Premium | |
|---|---|---|---|
| Employee | $379.26 | 54 | $20,480.04 |
| E + Spouse | $845.15 | 4 | $3,380.60 |
| E + Child | $0.00 | 0 | $0.00 |
| E + Child(ren) | $618.03 | 8 | $4,944.24 |
| Family | $1,144.12 | 9 | $10,297.08 |
| Total | $39,101.96 | ||
Deductible: $4,000 / Coinsurance: 80/20% to $2,850
Deductible: $500 per person / Coinsurance: 20% to $2,850 / Benefit: $3,500
* 2 Family members must meet the per person deductible and coinsurance to reach the family cap
| Alternate Plan MM Rates | Premium Saver Plan Rates | Total w/PS | # on Plan | Total New Monthly Premium | |
|---|---|---|---|---|---|
| Employee | $314.06 | $75.24 | $389.30 | 54 | $21,022.20 |
| E + Spouse | $699.86 | $160.59 | $860.45 | 4 | $3,441.80 |
| E + Child | $0.00 | $121.14 | $121.14 | 0 | $0.00 |
| E + Child(ren) | $511.79 | $141.94 | $653.73 | 8 | $5,229.84 |
| Family | $947.44 | $225.85 | $1,173.29 | 9 | $10,559.61 |
| Monthly Totals | $32,379.96 | $7,873.49 | 75 | $40,253.45 | |
Total Monthly Savings
Total Annual Savings
1st Month PS Premium
Alternate major medical rates could be an estimate. Actual rates are based on the major medical carrier's actual quote.
Each insured person has a $500 annual deductible. After the deductible is met the insured person pays 20% until they pay $2,850 coinsurance. Two family members must meet the per person deductible and coinsurance to reach the family cap. This plan serves as secondary coverage to your high deductible health plan, covering amounts applied to your major medical plan's deductible and coinsurance until our payments reach the maximum benefit amount.
This plan covers all eligible expenses covered by your major medical plan except the professional fee of a physician in a doctor's office or medical clinic and outpatient prescription drugs.
$3,500 is the maximum benefit amount payable for benefits described on this page during a benefit year for each Insured Person.
| Employee | $75.24 |
|---|---|
| E + Spouse | $160.59 |
| E + Child | $121.14 |
| E + Child(ren) | $141.94 |
| Family | $225.85 |
* Monthly rates include a non-commissionable $3.00 administration fee for billing.
Participation requirements: All persons covered by the group major medical or comprehensive health plan must be covered by the Premium Saver Plan except when the HSA is funded.
This is a brief description of coverage, see policy for complete details.
The Premium Saver Plan pays the benefits directly to the provider, upon assignment, which saves the insured time and it is the quickest way to get payment to the providers.
Please note: Always give your Premium Saver insurance card to the provider.
This is the most efficient method to submit a claim.
Claims can be filed electronically by the provider. This eliminates paperwork and helps expedite the payment of your claim to the provider. MWG Administrators has partnered with some of the largest claims clearinghouses in the nation.
Providers can email, mail or fax your claim information to us if they are not contracted with our clearinghouses. We will be glad to contact providers that want to contract with our clearinghouses.
If the insured files the claim, they need to submit the two forms described below:
The Explanation of Benefits is a form provided by your major medical carrier that describes the procedures covered, facility used, benefit paid and the amount applied to the insured's deductible or coinsurance.
These forms describe the procedures codes, provides us with the address and the provider's federal identification number so we can pay the claim for you.
Administered by:
Underwritten by: