A clear briefing of the XGB medical menu for small-group employers.
Start with the lean PHCS visit-limit and Cigna EPO 1750 / 1000 designs, or quote the full PPO menu. Benefit grids, HSA rules, and ancillary schedules are in the proposal section below.
PHCS visit-limit plans cap physician visits and hospital services. Cigna EPO is in-network only except emergencies. Groups under 100 enrolled employees may elect one network.
Group quote
Build a group quote
Census, contribution, and plan mix against the XGB Marpai rate card. Effective November 1, 2026. Effective date is the 1st of next month if quoted by the 15th, or the 1st of the month after that.
XGB Group Benefits · Group quote
Employer group · CA License #0C10932
Effective November 1, 2026 · Contract 15/22 · CA · PHCS · Marpai
Employer pays 0% of the employee-only premium. Dependent premiums are not employer-paid.
Employee monthly
$0.00
Total premium
$0.00
Employer annual
$0.00
PEPM
$0.00
Premium by line
Line
Lives
Premium
ER
EE
8300 HSA · PHCS
0
$0.00
$0.00
$0.00
Total premium
$0.00
$0.00
$0.00
Total premium = employer premium + employees pay. Employer monthly is premium only.
Census
No employees enrolled yet.
This census
Tier
#
Rate
Premium
ER
EE pays
Contribution schedule
Tier
Premium
Employer
Employee
Employee
$529.00
$0.00
$529.00
Employee + spouse
$919.00
$0.00
$919.00
Employee + child(ren)
$1,039.00
$0.00
$1,039.00
Family
$1,299.00
$0.00
$1,299.00
Selected coverage
Highest deductible, then the plan pays 100% in-network. Comes with $25/month on the HSA card. Best when employees are well, use generics, and want a tax-advantaged savings account.
Preventive care$0 copay
TelemedicineUnlimited $0 copay
Primary careDeductible + 0%
SpecialistDeductible + 0%
Inpatient hospitalDeductible + 0%
Outpatient surgeryDeductible + 0%
Emergency roomDeductible + 0%
Urgent careDeductible + 0%
Compare medical plans
Tap a plan to quote it. Totals keep this census, contribution, and ancillary.
Plan
Ded
OOP
EE rate
ER / mo
$8,300
$8,300
$529
$0.00
$3,500
$7,000
$649
$0.00
$4,500
$9,000
$687
$0.00
$3,500
$7,000
$794
$0.00
$1,750
$8,500
$359
$0.00
$1,000
$8,500
$399
$0.00
Selected: 8300 HSA. Employer / mo is premium (medical + ancillary). Plan-funded HSA is an employee perk, not an added premium charge.
Broker-facing illustration only. Rates from the XGB 10/1 2026 Marpai proposal, V2.5.81226. One network allowed for groups under 100 enrolled employees. Not a binder. Final rates confirm at enrollment. Rates are good for plans beginning by October 1, 2026. Pharmacy: Phoenix · Telemedicine: Recuro. CA License #0C10932. NP Benefit Services. Send this quote to npillow@npbenefitservices.com.
Proposal packet · V2.5.81226
How the XGB Marpai menu is built for a small-group employer.
Broker-facing illustration, customized per employer. The plan pays 100% of the network allowable minus the member’s deductible, copay, coinsurance, and out-of-pocket maximum. Rates are good for plans beginning by October 1, 2026. Administered by Marpai.
Pharmacy
Phoenix via marpaihealth.com
Telemedicine
Recuro 24/7 · $0 copay, unlimited
Networks
PHCS Extended PPO or Cigna PPO / EPO
Under 100 lives
One network per group
Four families, one election
8300 / 3500 HSA (PPO). For healthy groups. Preventive and Recuro are $0. Most other care waits for the deductible. 8300 then pays 100% in-network; 3500 shares 30% to a $7,000 individual OOP. IRS 2026 HSA room is $4,400 self-only / $8,750 family. The 8300 includes a plan-funded $25/mo HSA card ($300/yr) that is not added to premium.
$4500 / $3500 Copay (PPO). For groups that want a $40 PCP / $75 specialist / $90 urgent-care copay and pharmacy copays ($20 / $65 / $95–$200). Hospital, surgery, and ER still run through the deductible, then 30% or 20% coinsurance.
Cigna EPO 1000 / HSA EPO 1750. Stay in Cigna except true emergencies. Copays apply after the deductible. Brand drugs may go through a patient assistance program rather than a listed copay. EPO 1750 is HSA-qualified with the $25 card.
PHCS visit-limit 1000 / HSA VL 1750. Lowest premiums. Combined 10 physician visits a year, plus annual caps on hospital, surgery, ER, labs, and imaging. Do not elect these if the group uses care.
HSA pharmacy rule
HSA plans are HDHPs. Except certain IRS-approved preventive drugs (flu shots, birth control, and listed formulary preventives), prescriptions are subject to the deductible — no benefit until it is met. After the deductible, cost-sharing follows the plan.
Example: Greg takes blood pressure and cholesterol medication. His blood-pressure drug is not on the formulary and costs $300, so it hits the deductible. His cholesterol drug is $58 and is on the formulary, so it is a $0 copay.
2026 IRS HSA maximum: $4,400 self-only / $8,750 family, plus $1,000 catch-up at age 55+. Payroll contributions are pre-tax and skip FICA. Qualified medical withdrawals are tax-free.
PPO HSA — 8300 vs 3500
Both on PHCS Extended PPO or Cigna PPO. Insurance pays 100% of network allowable minus member cost-share.
Benefit
8300 HSA
3500 HSA
Annual deductible (ind. in / out)
$8,300 / $16,600
$3,500 / $7,000
Family deductible (in / out)
$16,600 / $33,200
$7,000 / $14,000
OOP max (ind. in / out)
$8,300 / $16,600
$7,000 / $14,000
Family OOP max (in / out)
$16,600 / $33,200
$14,000 / $28,000
Member coinsurance (in / out)
0% / 50%
30% / 50%
Preventive
$0 copay
$0 copay
Telemedicine
Unlimited $0
Unlimited $0
PCP / specialist
Deductible + 0%
Deductible + 30%
Inpatient / outpatient surgery / ER
Deductible + 0%
Deductible + 30%
Urgent care
Deductible + 0%
Deductible + 30%
Labs & X-rays (Quest / LabCorp)
Deductible + 0%
Deductible + 30%
Advanced imaging
Deductible + 0%
Deductible + 30%
Preventive Rx (generic formulary)
$0 copay
$0 copay
All other Rx
Deductible + 0%
Deductible + 30%
HSA card
$25 / mo plan-funded
HSA-eligible, no card
PPO copay — $4500 vs $3500
Copays at the doctor and pharmacy. Hospital, surgery, and ER still use the deductible.
Benefit
$4500 Copay
$3500 Copay
Annual deductible (ind. in / out)
$4,500 / $9,000
$3,500 / $7,000
Family deductible (in / out)
$9,000 / $18,000
$7,000 / $14,000
OOP max (ind. in / out)
$9,000 / $18,000
$7,000 / $14,000
Family OOP max (in / out)
$18,000 / $36,000
$14,000 / $28,000
Member coinsurance (in / out)
30% / 50%
20% / 50%
Telemedicine
Unlimited $0
Unlimited $0
PCP
$40 copay
$40 copay
Specialist
$75 copay
$75 copay
Urgent care
$90 copay
$90 copay
Inpatient / outpatient surgery / ER
Deductible + 30%
Deductible + 20%
Labs & X-rays
$25 after deductible
$25 after deductible
Advanced imaging
$200 after deductible
$200 after deductible
Rx generic / preferred / non-pref.
$20 / $65 / $95–$200
$20 / $65 / $95–$200
Cigna EPO — 1000 vs HSA 1750
Cigna in-network only except emergencies. Deductible must be met before listed copays.
Benefit
EPO 1000
HSA EPO 1750
Network
Cigna in-network only (emergencies excepted)
Cigna in-network only (emergencies excepted)
Annual deductible (ind. / family)
$1,000 / $2,000
$1,750 / $3,500
OOP max (ind. / family)
$8,500 / $17,000
$8,500 / $17,000
Preventive
$0 copay, $0 deductible
$0 copay, $0 deductible
Telemedicine
$0 unlimited
$0 unlimited
PCP / specialist / urgent care
$50 after deductible
$50 after deductible
Inpatient / outpatient surgery
$2,500 after deductible
$2,500 after deductible
Emergency room
$1,000 after deductible
$1,000 after deductible
Labs / X-rays / advanced imaging
$25 / $50 / $200 after deductible
$25 / $50 / $200 after deductible
Retail Rx
Generic $0; brand via PAP
Generic $0; brand via PAP
HSA card
No
$25 / mo plan-funded
PHCS visit-limit — 1000 vs HSA VL 1750
Visit and service caps apply every year. Telemedicine does not count against the 10-visit physician cap.
Benefit
VL 1000
HSA VL 1750
Network
PHCS only
PHCS only
Annual deductible (ind. / family)
$1,000 / $2,000
$1,750 / $3,500
OOP max (ind. / family)
$8,500 / $17,000
$8,500 / $17,000
Physician services
10 visits/yr combined — $50 after deductible
10 visits/yr combined — $50 after deductible
Inpatient
2 ICU + 2 non-ICU/yr — $1,000/admit after deductible
2 ICU + 2 non-ICU/yr — $1,000/admit after deductible
Outpatient surgery
3 surgeries/yr — $250 after deductible
3 surgeries/yr — $250 after deductible
ER
2 accident + 2 sickness/yr — $250 after deductible
2 accident + 2 sickness/yr — $250 after deductible
Cigna: cigna.com. Find a Doctor → zip → Guest → PPO or Choice Fund PPO. EPO quotes use Cigna in-network only.
Search the zip codes you actually hire in — not just headquarters.
Groups under 100 enrolled employees may elect one network, not both.
What this proposal is — and is not
Illustration from the XGB 10/1 2026 Marpai proposal, V2.5.81226. Not a binder or SPD.
Effective date is the 1st of next month if quoted by the 15th, or the 1st of the month after that (Pacific).
Final rates confirm at enrollment. Underwriting, participation, and provider access can change the number.
Visit-limit and EPO designs trade premium for access. Read the caps before you price them as the “cheap” option.
Misrepresenting or distributing this packet outside a client presentation is prohibited.
On every medical election
Care access that sits beside the deductible.
These four pieces ship with the medical menu. They are why a high-deductible HSA can still handle a sinus infection or a refill without an in-office wait.
Virtual urgent care — Recuro
24/7 access to board-certified doctors for common acute issues. Multi-channel visits, integrated prescriptions, and a handoff back to primary care. $0 copay and unlimited on every medical design — including the high-deductible HSAs, where an office visit otherwise waits for the deductible.
24/7 acute care
Integrated Rx
PCP coordination
customerservice@recurohealth.com
Behavioral health
Virtual psychiatry, therapy, and PGx testing. Counseling through medication management, delivered remotely so employees do not need a separate local panel for first-line mental health.
Psychiatry
Therapy
PGx testing
Phoenix pharmacy
Pharmacy is Phoenix via Marpai (marpaihealth.com). HSA plans: preventive generic formulary can be $0; everything else hits the deductible. Copay PPOs: $20 generic / $65 preferred / $95 non-preferred retail / $200 specialty. VL and EPO brand drugs may route through a patient assistance program instead of a listed copay.
Phoenix
Formulary + PAP
HSA Rx after deductible
Two national networks
PHCS Extended PPO (out-of-network benefit) or Cigna PPO / Choice Fund PPO. Cigna EPO is in-network only except emergencies. Visit-limit plans are PHCS only. Groups under 100 enrolled employees pick one network for the whole group.
PHCS Extended PPO
Cigna PPO / EPO
One network <100
Under 100 enrolled employees: one network per group. Confirm PHCS Extended PPO or Cigna PPO access for the zip codes you actually hire in before you pick a rate column.
Start here
Three questions, two plans to look at first.
This is a briefing aid, not underwriting. Visit-limit plans only surface for light-use groups.
1. How do employees typically use care?
2. What should the plan optimize for?
3. Which network are you willing to lock?
Answer all three to unlock a shortlist.
Medical menu
Four PPO designs, then leaner visit-limit and EPO options.
Rates are monthly. PHCS is listed first, Cigna second. Open a card for the full schedule.
8300 HSA
HSA
Highest deductible, then the plan pays 100% in-network. Comes with $25/month on the HSA card. Best when employees are well, use generics, and want a tax-advantaged savings account.
Coverage
Monthly
Employee
$529
Employee + spouse
$919
Employee + child(ren)
$1,039
Family
$1,299
Deductible in / out
Ind $8,300 / $16,600Fam $16,600 / $33,200
Out-of-pocket max
Ind $8,300 / $16,600Fam $16,600 / $33,200
Member coinsurance
0% in-network50% out-of-network
Schedule of benefits
Preventive care
$0 copay
Telemedicine
Unlimited $0 copay
Primary care
Deductible + 0%
Specialist
Deductible + 0%
Inpatient hospital
Deductible + 0%
Outpatient surgery
Deductible + 0%
Emergency room
Deductible + 0%
Urgent care
Deductible + 0%
Labs & X-rays (Quest / LabCorp)
Deductible + 0%
Advanced imaging
Deductible + 0%
Preventive Rx (generic formulary)
$0 copay
Other prescriptions
Deductible + 0%
Includes $25 per month loaded on the HSA card.
HSA-qualified HDHP. Except IRS-approved preventive drugs, pharmacy is subject to the deductible.
Includes $25/month employer contribution loaded on the HSA card.
Open MultiPlan search, then choose PHCS Extended PPO.
Rate sheet
Every medical option, one table.
Tap a row to open the schedule. Use Compare on up to three plans for a side-by-side.
Plan
EE PHCS
EE Cigna
Ind. ded.
Ind. OOP
Office
$529
$589
$8,300
$8,300
Deductible, then 0%
$649
$709
$3,500
$7,000
Deductible, then 30%
$687
$759
$4,500
$9,000
$40 copay
$794
$864
$3,500
$7,000
$40 copay
$359
—
$1,750
$8,500
$50 after deductible (10 visits/yr combined)
$399
—
$1,000
$8,500
$50 after deductible (10 visits/yr combined)
—
$439
$1,750
$8,500
$50 after deductible
—
$489
$1,000
$8,500
$50 after deductible
Add two or three plans to open a benefit-by-benefit compare.
Stack on top
Dental, vision, and life from the same proposal.
Optional lines. Each can use the medical census and contribution, or its own, in the calculator. Dental health is often a sign of other conditions — preventive coverage is the point of the stack.
Dental
Humana PPO in most states (100/80/50 in-network, 80/50/50 out, U&C+). Traditional Preferred in AK, GA, LA, SD, TX, and WV. Open-access Smart Premium treats any dentist who bills the TPA as in-network — often the cheapest way to add a benefit employees actually use.
Same PPO coinsurance with unlimited annual max and $1,500 ortho.
All states except AK, GA, LA, SD, TX, WV
Unlimited annual max
Ortho $1,500
Employee
$56.97
Employee + spouse
$121.10
Employee + child(ren)
$121.10
Family
$194.88
Humana Traditional Preferred · $1,500
100/80/50 usual & customary. Used where the PPO is not filed.
Only AK, GA, LA, SD, TX, WV
$1,500 annual maximum
Traditional preferred
Employee
$61.01
Employee + spouse
$125.50
Employee + child(ren)
$125.50
Family
$193.64
Humana Traditional Preferred · Unlimited
Unlimited max with $1,500 ortho in traditional preferred states.
Only AK, GA, LA, SD, TX, WV
Unlimited annual max
Ortho $1,500
Employee
$70.12
Employee + spouse
$148.15
Employee + child(ren)
$148.15
Family
$236.65
Smart Premium · Open Access
Any dentist who bills the TPA directly is treated as in-network.
$1,000 annual max
$50 / $150 deductible
100/80/50
Employee
$34.77
Employee + spouse
$69.54
Employee + child(ren)
$78.58
Family
$113.34
Smart Premium Plus · Open Access
Higher max, same open-access PPO, with orthodontia included.
$2,000 annual max
Ortho included
100/80/50
Employee
$60.22
Employee + spouse
$120.45
Employee + child(ren)
$131.73
Family
$191.95
Vision
Humana vision ($10/10 copay, $150 frame, $1,150 contacts) or VSP Choice (31,000 preferred providers / 57,000 access points). At a VSP ophthalmologist or optometrist the member number is the employee’s Social Security number.
Major (crowns, root canals, perio, dentures, bridges, implants, oral surgery)
50%
50%
Orthodontia
Not included
Included
VSP Choice in vs out of network
Find doctors at vsp.com/eye-doctor. Extra: 20% off additional pairs, ~15% LASIK, hearing-aid discounts, Diabetic Eyecare Plus.
Benefit
In-network you pay
OON reimbursement
Eye exam
$10 copay
$10 copay
Single / bi / trifocal / lenticular lenses
$25 copay
Up to $30 / $50 / $65 / $100
Frames
$150 allowance
Up to $70
Necessary contacts
$25 copay
Up to $210
Elective contacts (in lieu of glasses)
$150 allowance
Up to $105
Contact fitting & evaluation
15% off (copay not over $60)
—
Plain-language glossary
Deductible
What an employee pays for covered care before the plan shares cost (except $0 preventive and any listed copays). Family amounts are typically 2× individual.
Out-of-pocket maximum
The most they can pay in a year for covered in-network care. After this, the plan pays 100% of the network allowable.
Coinsurance
The employee’s share after the deductible — 0%, 20%, or 30% in-network on these designs; 50% out-of-network on the PPOs.
HSA / HDHP
A tax-advantaged account that can only sit on a qualifying high-deductible plan. 2026 IRS max is $4,400 self-only / $8,750 family (+$1,000 catch-up at 55). Several options include a $25/month plan-funded HSA card that is not billed as premium.
Preventive Rx (HSA)
IRS-approved preventive drugs (flu shots, listed birth control, certain formulary preventives) can be $0 before the deductible. All other Rx waits for the deductible on HSA plans.
PPO vs EPO
PPO (PHCS or Cigna) has an out-of-network benefit. EPO is Cigna in-network only, aside from emergencies — and is priced lower.
Visit-limit (VL)
Lowest-premium PHCS plans. Combined 10 physician visits/year, 2 ICU + 2 non-ICU admits, 3 surgeries, 2 accident + 2 sickness ER, 3 labs / X-rays / imaging. Telemedicine is $0 and does not count against the 10.
PAP
Patient assistance program. On VL and EPO designs, many brand and specialty drugs are not a listed copay — they may be routed through manufacturer assistance.
U&C+
Usual and customary plus — how out-of-network dental is allowed on the Humana PPO designs.
Open-access dental
Smart Premium: any dentist who bills the TPA directly is treated as in-network. $50 / $150 deductible, waived on preventive.
One-network rule
Groups under 100 enrolled employees may offer PHCS or Cigna, not both. Check providers in the hire zips before you pick the rate column.
Contract 15 / effective date
Quoted by the 15th (Pacific): 1st of next month. After the 15th: 1st of the month after that. Header shows cutoff day / today’s Pacific day.
Contribution split
Employer percent or fixed dollars toward the employee-only rate, plus an optional share of the extra cost to cover a spouse, children, or family. Dental, vision, and life can use a different split.
PEPM
Per employee per month — the employer’s illustrated monthly premium divided by enrolled medical subscribers. Plan-funded HSA is not in PEPM.