CA License #0C10932
NP Benefit Services
Licensed CA / AZ / UT
1791 Third Street, Norco, CA 92860
888-954-8999 · 909-227-6465
npillow@npbenefitservices.com
Group benefits illustration
Employer group
Prepared October 23, 2026 · Requested start December 1, 2026 · Situs CA · PHCS · Contract 15/21 · Administered by Marpai
The same contribution applies to each plan selected.
Employer / month
$0.00
Employees / month
$0.00
Total premium
$0.00
Employer / year
$0.00
0 enrolled on medical · $0.00 employer PEPM · figures below are for 8300 HSA
Plan in this quote
| 8300 HSA | |
|---|---|
| Deductible | $8,300 / $16,600 |
| Out-of-pocket | $8,300 / $16,600 |
| Coinsurance | 0% in / 50% out |
| Office / ER | Deductible, then 0% · Deductible, then 0% · Deductible, then 0% |
| Employer / mo | $0.00 |
| Employees / mo | $0.00 |
Census
| Tier | Count |
|---|---|
| Employee | 0 |
| Employee + spouse | 0 |
| Employee + child(ren) | 0 |
| Family | 0 |
| Enrolled employees | 0 |
Monthly premium by line
| Line | Lives | Premium | Employer | Employee |
|---|---|---|---|---|
| 8300 HSA · PHCS | 0 | $0.00 | $0.00 | $0.00 |
| Total | $0.00 | $0.00 | $0.00 |
Medical rates for this census
8300 HSA. Employer and employee amounts use the medical contribution above.
| Tier | # | Rate | Employer | Employee | Line total |
|---|---|---|---|---|---|
| Employee | 0 | $529.00 | $264.50 | $264.50 | $0.00 |
| Employee + spouse | 0 | $919.00 | $264.50 | $654.50 | $0.00 |
| Employee + child(ren) | 0 | $1,039.00 | $264.50 | $774.50 | $0.00 |
| Family | 0 | $1,299.00 | $264.50 | $1,034.50 | $0.00 |
Benefits · 8300 HSA
| 8300 HSA |
|---|
| Preventive care$0 copay |
| TelemedicineUnlimited $0 copay |
| Primary careDeductible + 0% |
| SpecialistDeductible + 0% |
| Inpatient hospitalDeductible + 0% |
| Outpatient surgeryDeductible + 0% |
| Emergency roomDeductible + 0% |
| Urgent careDeductible + 0% |
| Labs & X-rays (Quest / LabCorp)Deductible + 0% |
| Advanced imagingDeductible + 0% |
| Preventive Rx (generic formulary)$0 copay |
| Other prescriptionsDeductible + 0% |
Dental, vision, and life
- Dental: Not included.
- Vision: Not included.
- Life: Not included.
Other medical options on this network
Same census and contribution. Employer / month includes ancillary already selected.
| Plan | Deductible | OOP | EE rate | Employer / mo |
|---|---|---|---|---|
| 8300 HSA (quoted) | $8,300 | $8,300 | $529 | $0.00 |
| 3500 HSA | $3,500 | $7,000 | $649 | $0.00 |
| $4500 Copay | $4,500 | $9,000 | $687 | $0.00 |
| $3500 Copay | $3,500 | $7,000 | $794 | $0.00 |
| HSA VL 1750 | $1,750 | $8,500 | $359 | $0.00 |
| VL 1000 Deductible | $1,000 | $8,500 | $399 | $0.00 |
Broker-facing illustration only. Not a binder, certificate, or SPD. Rates from the XGB Marpai proposal, V1.81226. One network for groups under 100 enrolled employees. Final rates confirm at enrollment. Pharmacy: Phoenix. Telemedicine: Recuro. CA License #0C10932. NP Benefit Services. Mon–Thu 9 a.m.–5 p.m. · Fri 10 a.m.–4 p.m. PT. npillow@npbenefitservices.com.