Medical and Pharmacy
The ECU Health Medical Plan is administered by Allegiance.
ECU HealthNow
You can use ECU HealthNow to connect with a provider 24/7 by phone or online.
Visit ECU HealthNow or download the ECU HealthNow app from your app store.
Comparing the 2026 Options
| Tier 1 ECU Health Alliance/In-Network |
Tier 2 Allegiance/In-Network |
Tier 3 Out-of-Network |
|
|---|---|---|---|
| Preventive | Covered at 100% | Covered at 100% | Ded., then 50% coins. |
| Plan Coinsurance | Ded., then 15% coins. | Ded., then 25% coins. | Plan pays 50%, you pay 50% |
| Primary Care Physician Visit | Ded., then 5% coins. | Ded., then 5% coins. | Ded., then 50% coins. |
| Specialty Visit | Ded., then 10% coins. | Ded., then 25% coins. | Ded., then 50% coins. |
| Behavioral Health Office Visit | Ded., then 5% coins. | Ded., then 5% coins. | Ded., then 50% coins. |
| ECU HealthNow | Covered at 100% | Covered at 100% | Covered at 100% |
| Med Deductible (Single/Family) | $2,000/$4,000 | $2,500/$5,000 | $6,000/$12,000 |
| Med Max OOP (Single/Family) | $6,000/$12,000 | $6,750/$13,500 | $12,500/$25,000 |
| Prescription Max OOP (Single/Family) | Included in medical OOP max | Included in OOP max | Included in OOP max |
| Combined OOP Max (Med + Rx) | $6,000/$12,000 | $6,750/$13,500 | $12,500/$25,000 |
| Emergency Room | Ded., then 15% coins. | Tier 1 ded., then 15% coins.* | Tier 1 ded., then 15% coins.* |
| Urgent Care | Ded., then 15% coins. | Ded., then 25% coins. | Ded., then 50% coins. |
| Inpatient/Outpatient Hospital | Ded., then 15% coins. | Ded., then 25% coins. | Ded., then 50% coins. |
* For these services, you first pay the Tier 1 deductible. Once the Tier 1 deductible is met, you will then pay only the coinsurance.
| Tier 1 ECU Health Alliance/In-Network |
Tier 2 Allegiance/In-Network |
Tier 3 Out-of-Network |
|
|---|---|---|---|
| Preventive | Covered at 100% | Covered at 100% | Ded., then 50% coins. |
| Plan Coinsurance | Plan pays 85%, you pay 15% | Plan pays 75%, you pay 25% | Plan pays 50%, you pay 50% |
| PCP Visit | $10 copay | $10 copay | Ded., then 50% coins. |
| Specialty Visit | $25 copay | $60 copay | Ded., then 50% coins. |
| Behavioral Health Office Visit | $10 copay | $10 copay | Ded., then 50% coins. |
| ECU HealthNow | Covered at 100% | Covered at 100% | Covered at 100% |
| Deductible (Single/Family) | $1,200/$2,400 | $1,500/$3,000 | $4,500/$9,000 |
| Med Max OOP (Single/Family) | $4,000/$8,000 | $5,000/$10,000 | $10,000/$20,000 |
| Rx Max OOP (Single/Family) | $2,500/$5,000 | $2,500/$5,000 | $2,500/$5,000 |
| OOP Max (Med + Rx) | $6,500/$13,000 | $7,500/$15,000 | $12,500/$25,000 |
| Emergency Room | $250 copay + ded./15% coins. | $250 copay + Tier 1 ded./15% coins. * | $250 copay + Tier 1 ded./15% coins. * |
| Urgent Care | $50 copay | $60 copay | Ded., then 50% coins. |
| In/Outpatient Hospital | Ded., then 15% coins. | Ded., then 25% coins. | Ded., then 50% coins. |
* For these services, you first pay the Tier 1 deductible, and then coinsurance.
| Tier 1 ECU Health Alliance/In-Network |
Tier 2 Allegiance/In-Network |
Tier 3 Out-of-Network |
|
|---|---|---|---|
| Preventive | Covered at 100% | Covered at 100% | Ded., then 50% coins. |
| Plan Coinsurance | Plan pays 85%, you pay 15% | Plan pays 75%, you pay 25% | Plan pays 50%, you pay 50% |
| PCP Visit | $10 copay | $10 copay | Ded., then 50% coins. |
| Specialty Visit | $15 copay | $50 copay | Ded., then 50% coins. |
| Behavioral Health Office Visit | $10 copay | $10 copay | Ded., then 50% coins. |
| ECU HealthNow | Covered at 100% | Covered at 100% | Covered at 100% |
| Deductible (Single/Family) | $850/$1,700 | $1,250/$2,500 | $3,500/$7,000 |
| Med Max OOP (Single/Family) | $3,300/$6,600 | $4,500/$9,000 | $8,000/$16,000 |
| Rx Max OOP (Single/Family) | $2,500/$5,000 | $2,500/$5,000 | $2,500/$5,000 |
| OOP Max (Med + Rx) | $5,800/$11,600 | $7,000/$14,000 | $10,500/$21,000 |
| Emergency Room | $200 copay + ded./15% coins. | $200 copay + Tier 1 ded./15% coins. * | $200 copay + Tier 1 ded./15% coins. * |
| Urgent Care | $40 copay | $50 copay | Ded., then 50% coins. |
| In/Outpatient Hospital | Ded., then 15% coins. | Ded., then 25% coins. | Ded., then 50% coins. |
* For these services, you first pay the Tier 1 deductible, and then coinsurance.
| Resident Plan (PPO) | |||
|---|---|---|---|
| Tier 1 ECU Health In-Network |
Tier 2 Allegiance In-Network |
Tier 3 Out-of-Network |
|
| Preventative | Covered at 100% | Covered at 100% | Ded., then 50% coins. |
| Plan Coinsurance | Ded., then 15% coins. | Ded., then 25% coins. | Plan pays 50%, you pay 50% |
| Primary Care Physician Visit | $10 copay | $10 copay | Ded., then 50% coins. |
| Specialty Visit | $15 copay | $50 copay | Ded., then 50% coins. |
| Behavioral Health Office Visit | $10 copay | $10 copay | Ded., then 50% coins. |
| ECU HealthNow | Covered at 100% | Covered at 100% | Covered at 100% |
| Med Deductible (Single/Family) | $500/$1,700 | $1,250/$2,500 | $3,500/$7,000 |
| Med Max OOP (Single/Family) | $2,000/$6,000 | $4,500/$9,000 | $8,000/$16,000 |
| Prescription Max OOP (Single/Family) | Included in medical OOP max | Included in OOP max | Included in OOP max |
| Combined OOP Max (Med + Rx) | $4,500/$11,600 | $7,000/$14,000 | $10,500/$21,000 |
| Emergency Room | $200 copay + ded./15% coins. | $200 copay + Tier 1 ded./15% coins.* | $200 copay + Tier 1 ded./15% coins.* |
| Urgent Care | $40 | $50 | Ded/50% coins. |
| Inpatient/Outpatient Hospital | Ded., then 15% coins. | Ded., then 25% coins. | Ded., then 50% coins. |
Pharmacy
Prescription drug coverage for you and your covered dependents is included with each of the ECU Health medical plans. Capital Rx administers the prescription drug benefit for all ECU Health medical plan participants. If you enroll in one of the medical plans, your prescription drug coverage is provided.
When you or a covered family member need a prescription filled, you may use your medical ID card at the ECU Health Employee Pharmacy or a retail pharmacy that participates in the pharmacy network. You pay a share of the cost of your prescription in the form of a copay or coinsurance. The amount you pay depends on whether you receive a generic, preferred brand or non-preferred brand name drug and which pharmacy you choose. Review this packet to learn more about your Capital Rx Pharmacy Benefits. Questions about ECU Health prescription drug benefits? Contact Capital Rx at 833-554-4733 or visit cap-rx.com.
Maintenance Medications
If you take chronic/maintenance medications, you can get a 90-day prescription at the Employee Pharmacy for the equivalent cost of 2.5 rather than 3 full copays.
ECU Health provides a fertility benefit for medications, with a maximum lifetime limit of $10,000.
ECU Health Pharmacy Plan
| Pharmacy | Medical Savings Plan | Basic, Choice and Resident Plan | ||
|---|---|---|---|---|
| ECU Health Pharmacy | Retail Pharmacy | ECU Health Pharmacy | Retail Pharmacy | |
| Rx Deductible | Included w/medical | Included w/medical | None | None |
| Rx Max OOP (Single/Family) | Included w/medical | Included w/medical | $2,500/$5,000 | $2,500/$5,000 |
| Generic (30 days) | Ded., then 10% coins. | Ded., then 20% coins. | $10 copay | $25 copay |
| Preferred Brand (30 days) | Ded., then 20% coins. | Ded., then 30% coins. | $25 copay | $50 copay |
| Non-Preferred Brand (30 days) | Ded., then 30% coins. | Ded., then 40% coins. | $50 copay | $100 copay |
| Generic (90 days) | Ded., then 10% coins. | Ded., then 20% coins. | $25 copay | $75 copay |
| Preferred Brand (90 days) | Ded., then 20% coins. | Ded., then 30% coins. | $62.50 copay | $150 copay |
| Non-Preferred Brand (90 days) | Ded., then 30% coins. | Ded., then 40% coins. | $125 copay | $300 copay |
| Preferred Brand Specialty Rx | Ded., then 20% coins. | No coverage | $100 copay | No coverage |
| Non-Preferred Specialty Rx | Ded., then 30% coins. | No coverage | $300 copay | No coverage |
| If cost exceeds $300 for all tiers and number of day supply | N/A | N/A | 15% coins. | 25% coins. |
Once a covered family member meets the individual out-of-pocket maximum, the plan will pay the full cost of covered charges for that family member. Charges for all covered family members will continue to count toward the family out-of-pocket maximum. The annual out-of-pocket maximum includes amounts paid toward your deductible.
2026 Premiums
Full-time team members — 24 biweekly deductions
| Coverage | Medical Savings Plan | Basic Medical | Choice Medical | Basic Dental | Choice Dental |
|---|---|---|---|---|---|
| Single | $40.22 | $45.97 | $60.91 | $10.15 | $19.73 |
| + Children* | $149.40 | $174.68 | $202.26 | $18.60 | $34.38 |
| + Spouse* | $234.44 | $273.51 | $306.84 | $21.42 | $40.01 |
| + Family* | $257.42 | $299.94 | $335.57 | $30.43 | $56.92 |
* Includes domestic partner/domestic partner’s children.
Part-time team members — 24 biweekly deductions
| Coverage | Medical Savings Plan | Basic Medical | Choice Medical | Basic Dental | Choice Dental |
|---|---|---|---|---|---|
| Single | $112.62 | $129.86 | $143.65 | $10.15 | $19.73 |
| + Children* | $255.12 | $297.65 | $324.08 | $18.60 | $34.38 |
| + Spouse* | $322.93 | $378.09 | $412.57 | $21.42 | $40.01 |
| + Family* | $381.54 | $444.74 | $479.22 | $30.43 | $56.92 |
* Includes domestic partner/domestic partner’s children.