Medical
American Exchange is proud to offer Bywater as the medical plan administrator for the American Exchange medical plan. Bywater offers excellent customer care and utilizes the Cigna PPO Network of providers. The structure of American Exchanges medical plans a single PPO plan option.
Need assistance finding an In Network Provider? Please see the Cigna Find a Doc flyer in the medical section of the resources page for instructions.
The PPO 6000 plan offers first dollar coverage for services like office visits, Urgent Care visits, and prescription drugs. For most other services, you are responsible for a deductible and coinsurance until you meet your out-of-pocket maximum. Please be aware that copays do not count towards your deductible, only your out-of-pocket maximum. Preventive care is always covered at 100% before the deductible.
| PPO 6000 Plan - In network coverage only | |
|---|---|
|
Deductible
|
|
|
You
|
$6,000 |
|
You + Family
|
$12,000 |
|
Medical Out-of-Pocket Max
|
|
|
You
|
$7,500 |
|
You + Family
|
$15,000 |
|
Coinsurance (Plan Pays)
|
Member pays 30% after deductible |
|
Medical
|
|
|
ER
|
$1,000 Copay, waived if admitted |
|
Urgent Care
|
$125 Copay |
|
PCP Visit
|
$65 Copay |
|
Specialist Visit
|
$125 Copay |
|
Preventive Care
|
100% |
|
Retail Pharmacy: 30-day Supply
|
|
|
Generic Drug
|
$5 Copay |
|
Brand Name Drug
|
$25 Copay |
|
Non-Preferred Drug
|
$150 Copay |
|
Preventative Drug
|
No Charge |
|
Mail Order Pharmacy: 90-day Supply
|
|
|
Generic Drug
|
$12.50 Copay |
|
Brand Name Drug
|
$62.50 Copay |
|
Non-Preferred Drug
|
$375 Copay |
Garner - Medical Concierge
Find the BEST doctors in your area
Garner is a free benefit that helps you find the highest quality doctors while saving you up to $6,000 individual / $12,000 per family in costs from that care.
How does Garner deliver on both lower costs and better healthcare?
Contrary to popular opinion, the best doctors are often the least expensive. Missed diagnoses, unnecessary surgeries, and bad health outcomes are expensive. By setting you up with the best doctors, you not only get better care, but the cost is also lower for both you and American Exchange. As a result, American Exchange covers your entire medical bill up to $6,000 individual / $12,000 per family when you visit a Garner-approved doctor or medical provider.
Visit getgarner.com/signup to get started.
- Email concierge@getgarner.com or
- Call (866) 761-9586 to locate the top doctors in your area
How does it work?
- A member must use Garner to get a recommendation before visiting the provider.
- Visit the provider recommended by Garner, and the member’s out-of-pocket medical bills will be paid automatically.
Your ID Card
Your Bywater ID card contains all the information you, your doctor’s office, and pharmacist will need to access your health insurance information.
Please be sure to show your card the FIRST TIME you visit your healthcare provider or pharmacy. Your provider will need to call Bywater at (800) 337-0792 to verify your eligibility and benefits.
Transparency in Coverage - Machine-Readable Files (MRFs)
The Departments of Health and Human Services, Labor and the Treasury implemented the Transparency in Coverage Final Rule which requires that group health plans, for plan years on or after January 1, 2022, disclose machine-readable files (MRFs) on a public website starting July 1, 2022.
The MRFs can be found on the Bywater website and include the following:
- In-network negotiated payment rates, and
- Historical out-of-network allowed amounts
Data in these files will be in the JSON file format and will be updated monthly. You will find the MRFs here:
