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Thank you for your interest in the PreferredOne Insurance Company (PIC) Individual plans. Listed below and enclosed in this packet is information outlining the PIC Individual plan options and application process.

Plan options:
  • PIC 5180 - $1,500/$3,000 deductible
  • PIC 5200 - $2,000/$4,000 deductible
  • PIC 5250 - $2,850/$5,650 deductible
  • PIC 5510 - $5,500/$11,000 deductible
You may select a Chemical Dependency Rider Option at an additional cost (includes benefits for the diagnosis and treatment of chemical dependency related disorders, including inpatient and outpatient services). This option is listed at the bottom of each benefit plan summary.

All options are intended to qualify as a high deductible health plan that may be paired with a Health Savings Account (HSA). Health Savings Accounts have two parts:
  1. the first part is a health insurance policy (PIC Individual benefit plan) that covers eligible medical expenses;
  2. the second part is an HSA account, typically set up with a bank/trustee, from which you can withdraw money tax-free to pay for eligible medical expenses.
Please check with your tax advisor for guidance on your particular situation.

If you are applying for coverage with the assistance of an insurance broker/agency, you should complete the HIPAA Authorization Individual Underwriting Form included in this packet. This form allows PreferredOne to disclose protected health information with your broker/agency for underwriting purposes only.

The network for the PIC Individual plans is the PreferredOne Open Access Network 200, with over 6900 primary care physicians, 7100 specialists and 260 hospitals participating. For more information on participating providers, go to www.preferredone.com, click Find A Provider and Open Access Network 200, or call Customer Service at 763-847-4477 or 1-800-997-1750.

Area 1 and 2 rates. Please check the county listing at the bottom of the rate pages to determine the rate table you should be using. Individual rates are determined by the age and health history of the individuals seeking medical coverage. There is a range of rates by age category for each plan and final rates may be up to 66.7% higher than the listed preferred rates.

To apply for coverage, first complete the Eligibility Review Form. If you answer yes to any of the questions, you may not be eligible for coverage. To continue the application process, complete the PreferredOne Insurance Company (PIC) Individual Insurance Application Form and return it, along with the Eligibility Review Form and the HIPAA Authorization Individual Underwriting Form (if applicable). You must be a resident of Minnesota to apply for coverage. Processing time for your application is approximately 3 – 4 weeks depending on the completeness of your application. The first month's premium is required in order to process your application.

You may also submit your application electronically at this site. Once you are accepted as a member, you will have Web access to medical cost tools that will help you to make wise spending decisions.

Thank you for your interest in the PIC Individual plans. If you have questions, please call PIC Customer Service at 763-847-4477 or 1-800-997-1750.


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