2025 Benefits Summary
GOH Employee Benefits Guide
At GOH, we’re committed to providing our employees with top-quality benefits.
That’s why we’re excited and proud to present our 2025 Benefits Plans.
HSA Plan
| Individual Weekly Premium | HSA Plan |
|---|---|
| With No Discounts | $49.52 |
| With Nicotine-Free Discount | $33.14 |
| With Wellness Program Discount | $16.69 |
| With Nicotine-Free & Wellness Program Discounts | $0.00 |
| Family Weekly Premium | HSA Plan |
|---|---|
| With No Discounts | $58.25 |
| With Nicotine-Free Discount | $42.39 |
| With Wellness Program Discount | $26.73 |
| With Nicotine-Free & Wellness Program Discounts | $10.00 |
| In-Network Benefits | HSA Plan |
|---|---|
| Annual Deductible | $3,300 Individual / $6,600 Family* |
| GOH Contribution to HSA | Up to $1,650 Individual / Up to $3,300 Family |
| Co-Insurance Percentage | You pay 0% after deductible |
| Preventive Care | No Charge |
| Primary Office Visit | No Charge after deductible |
| Specialist Office Visit | No Charge after deductible |
| Teladoc Visit | No Charge after deductible** |
| Urgent Care Visit | No Charge after deductible |
| Emergency Room Visit | No Charge after deductible |
| Hospital In-Patient | No Charge after deductible |
| Hospital Out-Patient | No Charge after deductible |
| Out-of-Pocket Maximum | $3,500 Individual / $6,800 Family* |
POS Plan
| Individual Weekly Premium | POS Plan |
|---|---|
| With No Discounts | $97.23 |
| With Nicotine-Free Discount | $76.66 |
| With Wellness Program Discount | $56.08 |
| With Nicotine-Free & Wellness Program Discounts | $35.51 |
| Family Weekly Premium | POS Plan |
|---|---|
| With No Discounts | $133.18 |
| With Nicotine-Free Discount | $112.61 |
| With Wellness Program Discount | $92.04 |
| With Nicotine-Free & Wellness Program Discounts | $71.47 |
| In-Network Benefits | POS Plan |
|---|---|
| Annual Deductible | $1,250 Individual / $2,500 Family* |
| Co-Insurance Percentage | You pay 20% after deductible |
| Preventive Care | No Charge |
| Primary Office Visit | $25 copay |
| Specialist Office Visit | $40 copay after deductible |
| Teladoc Visit | $25 copay |
| Urgent Care Visit | $25 copay after deductible |
| Emergency Room Visit | $1,000 copay after deductible |
| Hospital In-Patient | You pay 20% after deductible |
| Hospital Out-Patient | You pay 20% after deductible |
| Out-of-Pocket Maximum | $3,500 Individual / $6,800 Family* |
Vision
| Weekly Premium | |
|---|---|
| Individual | $0.00 |
| Family | $1.97 |
| Vision Care Services | Member Cost In-Network |
|---|---|
| Exams | $0 copay |
| Lenses (single, bifocals, trifocal, and lenticular) | $0 copay |
| Frames | $130 allowance, plus 20% off balance over $130 |
| Contact Lenses | $100 allowance, plus 15% off balance over $100 |
Dental
| Weekly Premium | |
|---|---|
| Individual | $5.01 |
| Individual +1 | $10.02 |
| Family | $15.03 |
| In-Network Benefits and Covered Services | Coverage Level |
|---|---|
| Deductible – Waived for diagnostic/preventive and orthodontics | $50 Individual / $150 Family |
| Maximum – Includes all covered services except orthodontics | $2,000 per person |
| Diagnostic and Preventive Services (exams, cleanings, x-rays, sealants) | 100% |
| Basic Services (fillings, posterior composites) | 80% |
| Endodontics (root canals) | 80% |
| Periodontics (gum treatment) | 80% |
| Oral Surgery | 80% |
| Major Services (crowns, inlays, onlays and cast restorations) | 50% |
| Prosthodontics (bridges and dentures, implants) | 50% |
| Orthodontic Maximum$1,000 Lifetime | $1,000 Lifetime |
| Orthodontic Benefits (dependent children to age 19) | 50% |
Benefits Apps
