SMALL GROUP PLAN DESIGN AND BENEFITS OPEN CHOICE OUT-OF-STATE PPO PLAN - $1,000

Size: px
Start display at page:

Download "SMALL GROUP PLAN DESIGN AND BENEFITS OPEN CHOICE OUT-OF-STATE PPO PLAN - $1,000"

Transcription

1 PLAN FEATURES PREFERRED CARE NON-PREFERRED CARE Deductible (per calendar year; applies to all covered services) $1,000 Individual $3,000 Family $2,000 Individual $6,000 Family Plan Coinsurance ** 80% 60% Coinsurance Limits (per calendar year, excludes ) $2,500 Individual $7,500 Family $5,000 Individual $15,000 Family Certain member cost sharing elements may not apply toward the Coinsurance Limits, including amounts over Usual and Customary, copays, failure to pre-certify penalty, payments for chiropractic, mental health, substance abuse and DME continue to be payable after the maximum coinsurance limit is reached. Lifetime maximum Unlimited unless noted otherwise Unlimited unless noted otherwise Payment for Non-Preferred Care Not Applicable Usual and Customary* Primary Care Physician Selection Not Required Not Applicable Referral Requirement None None Precertification Requirements Precertification for certain types of non-preferred care must be obtained to avoid a reduction in benefits paid for that care. Precertification for Hospital Admissions, Treatment Facility Admissions, Skilled Nursing Facility Admissions, Home Health Care and Hospice Care and Private Duty Nursing is required. Benefits will be reduced by $400 per occurrence if Precertification is not obtained. PREVENTIVE CARE PREFERRED CARE NON-PREFERRED CARE Routine Adult Physical Exams / Immunizations 1 exam every 24 months up to age 65 and 1 exam every 12 months for adults age 65 and older. $25 copay; no 60%; after Well Child Exams / Immunizations 6 exams in first 12 months of life, 2 exams in the 13th 24th months of life, 1 exam every 12 months of life thereafter up to age 18, 1 exam every 24 months for children age 18 and older. Routine Gynecological Care Exams Includes Pap smears and related lab fees. One Routine exam per calendar year. Routine Mammograms Includes coverage for routine mammograms with no age or frequency limitation. Routine Digital Rectal Exams/ Prostate Specific Antigen Test For covered males age 40 and over. One digital rectal exam and prostate specific antigen test per calendar year. Colorectal Cancer Screening For all members age 50 and over. Includes coverage for an annual fecal occult blood test (3 specimens), 1 flexible sigmoidoscopy every 5 years, 1 colonoscopy every 10 years and 1 double contrast barium enema every 5 years. Routine Eye Exams $25 copay; no 60%; after $40 copay; no 60%; after $0 copay; no 60%; after the type of service and where it is performed the place where is rendered Not covered (except as part of routine physical) 60%; after 60%; after Not covered (except as part of routine physical) PHYSICIAN SERVICES PREFERRED CARE NON-PREFERRED CARE Office Visits to Non-Specialist $25 copay; no 60%; after Includes services of an internist, general physician, family practitioner or pediatrician for routine care as well as diagnosis and treatment of an illness or injury. Specialist Office Visits $40 copay; no 60%; after OB Visit (for initial visit only) Allergy Testing $40 copay; no 60%; after Allergy Injections $40 copay; no, copay waived when office visit charge is not made. 60%; after Out-of-State Small Group PPO Plan - $1,000 Page 1 Edition: 7/05

2 Out-of-State Small Group PPO Plan - $1,000 Page 2 Edition: 7/05

3 PHARMACY PRESCRIPTION DRUG BENEFITS Retail Up to a 30 day supply Mail Order Delivery (MOD) 31 to 60 day supply PARTICIPATING PHARMACY $10 copay for generic drugs, $20 copay for formulary brandname drugs, and $35 copay for non-formulary brand-name drugs. $20 copay for generic drugs, $40 copay for formulary brand-name drugs, and $70 copay for nonformulary brand-name drugs. No Mandatory Generic (No MG) Member is responsible to pay the applicable copay and/or coinsurance. Plan includes: Contraceptive drugs and devices obtainable from a pharmacy and diabetic supplies. Prescription Drug Deductible (per calendar year) (Must be satisfied before any prescription drug benefits are paid. Combined for all preferred and non-preferred retail and mail order brand-name drugs.) NON-PARTICIPATING PHARMACY $10 copay plus 80% for generic drugs, $20 copay plus 80% for formulary brand-name drugs, and $35 copay plus 80% for nonformulary brand-name drugs. Not Covered $100 Individual $300 Family DIAGNOSTIC PROCEDURES PREFERRED CARE NON-PREFERRED CARE Outpatient Diagnostic Laboratory and X-ray (If performed as a part of a physician's office visit and billed by the physician, expenses are covered subject to the member coinsurance office visit copay.) Outpatient Diagnostic X-ray for Complex Imaging Services (Including, but not limited to, MRI, MRA, PET and CAT Scans) EMERGENCY MEDICAL CARE PREFERRED CARE NON-PREFERRED CARE Urgent Care Provider 80%; after Same as Preferred Care (Benefit availability may vary by location.) Non-Urgent Use of Urgent Care Provider 50%; after 50%; after Emergency Room Copay waived if admitted. 80% after $75 Emergency Room Copay; no Same as Preferred Care Non-Emergency Care in an Emergency Room 50%; after 50%; after Ambulance HOSPITAL CARE PREFERRED CARE NON-PREFERRED CARE Inpatient Coverage (Including maternity - prenatal, delivery and postpartum) Applied per admission. 3x limit per calendar year; waived if readmitted to a hospital within 10 days of discharge; nonpreferred cannot be lower than preferred. 80% after $250 per confinement and calendar year 60% after $500 per confinement and calendar year Outpatient Surgery MENTAL HEALTH SERVICES PREFERRED CARE NON-PREFERRED CARE Inpatient Mental Disorders Limited to 30 days per calendar year. 80% after 250 per confinement and calendar year 60% after $500 per confinement and calendar year Outpatient Hospital 80%; after 50%; after Outpatient Mental Disorders $40 copay; no 50%; after Out-of-State Small Group PPO Plan - $1,000 Page 3 Edition: 7/05

4 ALCOHOL/DRUG ABUSE SERVICES PREFERRED CARE NON-PREFERRED CARE Inpatient Hospital/Treatment Facility Limited to 30 days per calendar year. Outpatient Hospital/Treatment Facility/Physician Limited to 20 visits per calendar year. 80% after $250 per confinement and calendar year 60% after $500 per confinement and calendar year 80%; after 50%; after OTHER SERVICES AND PLAN DETAILS PREFERRED CARE NON-PREFERRED CARE Skilled Nursing Facility Limited to 120 days per member per calendar year, 3 day prior hospital confinement required. Home Health Care Limited to 120 visits per member per calendar year. Hospice Care Inpatient Limited to 30 days. Hospice Care Outpatient Up to a Maximum benefit of $5,000. Private Duty Nursing (Outpatient) Limited to 70 eight-hours shifts per calendar year. Benefits will not be paid during a calendar year for private duty nursing for any shifts in excess of the Private Duty Nursing Care maximum shifts. Each period of up to 8-hours will be deemed to be one private duty nursing shift. Outpatient Speech Therapy Outpatient Physical and Occupational Therapy Chiropractic Services Spinal Disorder $1,000 maximum per member per calendar year. This calendar year limit will not apply if the insured is confined in a hospital; is receiving treatment of scoliosis or fracture care; or for surgery (including pre/post surgical care given or ordered by the operating physician). Durable Medical Equipment Diabetic Supplies not obtainable at a pharmacy Contraceptive drugs and devices not obtainable at a pharmacy Transplants FAMILY PLANNING PREFERRED CARE NON-PREFERRED CARE Infertility Treatment Coverage only for the diagnosis and treatment of the underlying medical condition Voluntary Sterilization Including tubal ligation and vasectomy. SPECIAL PROGRAMS/SERVICES Certain Special programs and Services may be included in your plan: Aetna Navigator, Fitness, Healthy Outlook, Moms-to-Babies Maternity Management, National Advantage, National Medical Excellence, Natural Alternatives, Natural Products, Vision One, and Vitamin Advantage. * Payment for Non-Preferred care is determined based upon the lowest of: the provider s usual charge for furnishing it; or the charge Aetna determines to be appropriate, based on factors such as the cost of providing the same or a similar service or supply and the manner in which charges for the service or supply are made. These charges are referred to in your plan documents as "reasonable" or recognized charges. ** The dollar amount copayments indicate what the member is required to pay and the percentage copayments indicate what Aetna is required to pay. Out-of-State Small Group PPO Plan - $1,000 Page 4 Edition: 7/05

5 Items not covered under the office visit copay. X-rays/lab bills are not covered under office visit copay when the x-rays/lab charges are billed and submitted separately from the Preferred Provider office visit charge. Employees should ask their Preferred Provider how he/she bills for x-rays/lab facilities. It may be that the facility submits its charges directly to Aetna and not through the office visit charge; if this is the case, these benefits will be subject to the and paid under the provisions of the plan indicated under "Other Charges. Surgery performed in a Preferred Provider's office is not considered routine office visit. Benefits are subject to the and paid at the Preferred coinsurance level (e.g., 20% after ). Maternity: A PPO provider will normally bill an initial office visit, which is subject to your co-pay. Subsequent pre-natal office visits are billed as part of the global fee at the time of delivery. The global fee and any laboratory or testing expenses are subject to your and then payable at the Preferred coinsurance level. Allergy shots during an office visit are not considered a routine office visit when the Preferred Provider is not seen during the visit. Benefits are subject to the and paid at the Preferred Provider coinsurance level (e.g., $8.00 allergy shot is paid at 20% after ). If a Preferred Provider is seen, shots and office visits are covered under single office visit co-pay (e.g., $20 copay). This plan does not cover all health care expenses and includes exclusions and limitations. Members should refer to their plan documents to determine which health care services are covered and to what extent. The following is a partial list of services and supplies that are generally not covered. However, your plan documents may contain exceptions to this list based on state mandates. All medical or hospital services not specifically covered in, or which are limited or excluded in the plan documents; Charges related to any eye surgery mainly to correct refractive errors; Cosmetic surgery, including breast reduction; Custodial care; Dental care and X-rays; Donor egg retrieval; Experimental and investigational procedures; Hearing aids; Immunizations for travel or work; Infertility services, including, but not limited to, artificial insemination and advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI and other related services, unless specifically listed as covered in your plan documents; Treatment of those for or related to treatment of obesity or for diet or weight control; Non-medically necessary services or supplies; Orthotics except as specified in the plan; Over-the-counter medications and supplies; Reversal of sterilization; Services for the treatment of sexual dysfunction or inadequacies, including therapy, supplies, or counseling; and Special duty nursing. Pre-Existing Conditions Exclusion Provision This plan imposes a pre-existing conditions exclusion, which may be waived in some circumstances (that is, creditable coverage) and may not be applicable to you. A pre-existing condition exclusion means that if you have a medical condition before coming to our plan, you might have to wait a certain period of time before the plan will provide coverage for that condition. This exclusion applies only to conditions for which medical advice, diagnosis or treatment was recommended or received or for which the individual took prescribed drugs within 180 days. Generally, this period ends the day before your coverage becomes effective. However, if you were in a waiting period for coverage, the 180 day period ends on the day before the waiting period begins. The exclusion period, if applicable, may last up to 365 days from your first day of coverage, or, if you were in a waiting period, from the first day of your waiting period. If you had prior credible coverage within 90 days immediately before the date you enrolled under this plan, then the pre-existing conditions exclusion in your plan, if any, will be waived. If you had no prior creditable coverage within the 90 days prior to your enrollment date (either because you had no prior coverage or because there was more than a 90 day gap from the date your prior coverage terminated to your enrollment date), we will apply your plan's pre-existing conditions exclusion. In order to reduce or possibly eliminate your exclusion period based on your creditable coverage, you should provide us a copy of any Certificates of Creditable Coverage you have. Please contact your Aetna Member Services representative at AETNA if you need assistance in obtaining a Certificate of Creditable Coverage from your prior carrier or if you have any questions on the information noted above. The pre-existing condition exclusion does not apply to pregnancy nor to a child who is enrolled in the plan within 31 days after birth, adoption, or placement for adoption. Note: For late enrollees, coverage will be delayed until the plan's next open enrollment; the preexisting exclusion will be applied from the individual's effective date of coverage. This material is for informational purposes only and is neither an offer of coverage nor medical advice. It contains only a partial, general description of plan benefits or programs and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Consult the plan documents (i.e. Booklet, Booklet-Certificate and/or Group Policy) to determine governing contractual provisions, including procedures, exclusions and limitations relating to the plan. The availability of a plan or program may vary by geographic service area. With the exception of Aetna Rx Home Delivery, LLC, participating providers and vendors are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Aetna Rx Home Out-of-State Small Group PPO Plan - $1,000 Page 5 Edition: 7/05

6 Delivery, LLC is a subsidiary of Aetna Inc. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change without notice. Some benefits are subject to limitations or visit maximums. Certain services require pre-certification or prior approval of coverage. Failure to pre-certify for these services may lead to substantially reduced benefits or denial of coverage. Some of the benefits requiring precertification may include, but are not limited to, inpatient hospital, inpatient mental health, inpatient skilled nursing, and outpatient surgery, substance abuse (detoxification, inpatient and outpatient rehabilitation). When the Member s preferred provider is coordinating care, the preferred provider will obtain the pre-certification. When the member utilizes a non-preferred provider, Member must obtain the precertification. Pre-certification requirements may vary. Depending on the plan selected, new prescription drugs not yet reviewed by our medication review committee are either available at the highest copayment under plans with an open formulary, or excluded from coverage unless a medical exception is obtained under plans that use a closed formulary. They may also be subject to pre-certification or step-therapy. Non-prescription drugs and drugs in the Limitations and Exclusions section of the plan documents (received after enrollment) are not covered, and medical exceptions are not available for them. Aetna Rx Home Delivery, LLC, is a licensed pharmacy providing mail-order pharmacy services. Aetna's negotiated reimbursement rates with Aetna Rx Home Delivery may be higher than Aetna Rx Home Delivery's cost of purchasing drugs and providing mail-order pharmacy services. In prescription plans with copayment or coinsurance tiers, use of formulary drugs generally will result in lower costs to members. However, where the prescription plan utilizes copayments or coinsurance calculated on a percentage basis, there could be some circumstances in which a formulary drug would cost the member more than a non-formulary drug because (i) the negotiated pharmacy payment rate for the formulary drug may be more than the negotiated pharmacy payment rate for the non-formulary drug, and (ii) rebates received by Aetna from drug manufacturers are not reflected in the cost of a prescription drug obtained by a member. Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies. The Aetna Company that underwrites or administers benefits coverage includes Aetna Life Insurance Company. Plans are offered by Aetna Life Insurance Company. While this material is believed to be accurate as of the print date, it is subject to change. Out-of-State Small Group PPO Plan - $1,000 Page 6 Edition: 7/05

PLAN DESIGN AND BENEFITS - Tx OAMC 2500 08 PREFERRED CARE

PLAN DESIGN AND BENEFITS - Tx OAMC 2500 08 PREFERRED CARE PLAN FEATURES Deductible (per calendar year) $2,500 Individual $5,000 Individual $7,500 3 Individuals per $15,000 3 Individuals per Unless otherwise indicated, the Deductible must be met prior to benefits

More information

California Small Group MC Aetna Life Insurance Company

California Small Group MC Aetna Life Insurance Company PLAN FEATURES Deductible (per calendar year) $3,000 Individual $6,000 Family Unless otherwise indicated, the Deductible must be met prior to benefits being payable. All covered expenses accumulate separately

More information

PLAN DESIGN AND BENEFITS Basic HMO Copay Plan 1-10

PLAN DESIGN AND BENEFITS Basic HMO Copay Plan 1-10 PLAN FEATURES Deductible (per calendar year) Member Coinsurance Not Applicable Not Applicable Out-of-Pocket Maximum $5,000 Individual (per calendar year) $10,000 Family Once the Family Out-of-Pocket Maximum

More information

PLAN DESIGN AND BENEFITS POS Open Access Plan 1944

PLAN DESIGN AND BENEFITS POS Open Access Plan 1944 PLAN FEATURES PARTICIPATING Deductible (per calendar year) $3,000 Individual $9,000 Family $4,000 Individual $12,000 Family Unless otherwise indicated, the Deductible must be met prior to benefits being

More information

Medical Plan - Healthfund

Medical Plan - Healthfund 18 Medical Plan - Healthfund Oklahoma City Community College Effective Date: 07-01-2010 Aetna HealthFund Open Choice (PPO) - Oklahoma PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY -

More information

PLAN DESIGN AND BENEFITS HMO Open Access Plan 912

PLAN DESIGN AND BENEFITS HMO Open Access Plan 912 PLAN FEATURES Deductible (per calendar year) $1,000 Individual $2,000 Family Unless otherwise indicated, the Deductible must be met prior to benefits being payable. Member cost sharing for certain services

More information

California Small Group MC Aetna Life Insurance Company

California Small Group MC Aetna Life Insurance Company PLAN FEATURES Deductible (per calendar year) $1,000 per member $1,000 per member Unless otherwise indicated, the Deductible must be met prior to benefits being payable. All covered expenses accumulate

More information

PLAN DESIGN AND BENEFITS - Tx OAMC Basic 2500-10 PREFERRED CARE

PLAN DESIGN AND BENEFITS - Tx OAMC Basic 2500-10 PREFERRED CARE PLAN FEATURES Deductible (per calendar year) $2,500 Individual $4,000 Individual $7,500 Family $12,000 Family 3 Individuals per Family 3 Individuals per Family Unless otherwise indicated, the Deductible

More information

PLAN DESIGN AND BENEFITS AETNA LIFE INSURANCE COMPANY - Insured

PLAN DESIGN AND BENEFITS AETNA LIFE INSURANCE COMPANY - Insured PLAN FEATURES Deductible (per calendar year) Individual $750 Individual $1,500 Family $2,250 Family $4,500 All covered expenses accumulate simultaneously toward both the preferred and non-preferred Deductible.

More information

New York Small Group Indemnity Aetna Life Insurance Company Plan Effective Date: 10/01/2010. PLAN DESIGN AND BENEFITS - NY Indemnity 1-10/10*

New York Small Group Indemnity Aetna Life Insurance Company Plan Effective Date: 10/01/2010. PLAN DESIGN AND BENEFITS - NY Indemnity 1-10/10* PLAN FEATURES Deductible (per calendar year) $2,500 Individual $7,500 Family Unless otherwise indicated, the Deductible must be met prior to benefits being payable. Member cost sharing for certain services,

More information

Employee + 2 Dependents

Employee + 2 Dependents FUND FEATURES HealthFund Amount $500 Individual $1,000 Employee + 1 Dependent $1,000 Employee + 2 Dependents $1,000 Family Amount contributed to the Fund by the employer Fund Coinsurance Percentage at

More information

PDS Tech, Inc Proposed Effective Date: 01-01-2012 Aetna HealthFund Aetna Choice POS ll - ASC

PDS Tech, Inc Proposed Effective Date: 01-01-2012 Aetna HealthFund Aetna Choice POS ll - ASC FUND FEATURES HealthFund Amount $500 Individual $1,000 Employee + 1 Dependent $1,000 Employee + 2 Dependents $1,000 Family Amount contributed to the Fund by the employer Fund Coinsurance 100% Percentage

More information

Optional PREFERRED CARE. Covered 100%; deductible waived

Optional PREFERRED CARE. Covered 100%; deductible waived PLAN FEATURES Deductible (per plan year) $2,000 Employee $2,000 Employee $3,000 Employee + Spouse $3,000 Employee + Spouse $3,000 Employee + Child(ren) $3,000 Employee + Child(ren) $4,000 Family $4,000

More information

Bates College Effective date: 01-01-2010 HMO - Maine PLAN DESIGN AND BENEFITS PROVIDED BY AETNA HEALTH INC. - FULL RISK PLAN FEATURES

Bates College Effective date: 01-01-2010 HMO - Maine PLAN DESIGN AND BENEFITS PROVIDED BY AETNA HEALTH INC. - FULL RISK PLAN FEATURES PLAN FEATURES Deductible (per calendar year) $500 Individual $1,000 Family Unless otherwise indicated, the Deductible must be met prior to benefits being payable. Once Family Deductible is met, all family

More information

100% Fund Administration

100% Fund Administration FUND FEATURES HealthFund Amount $500 Employee $750 Employee + Spouse $750 Employee + Child(ren) $1,000 Family Amount contributed to the Fund by the employer Fund Coinsurance Percentage at which the Fund

More information

PLAN DESIGN AND BENEFITS - New York Open Access EPO 1-10/10

PLAN DESIGN AND BENEFITS - New York Open Access EPO 1-10/10 PLAN FEATURES Deductible (per calendar year) $1,000 Individual $3,000 Family Unless otherwise indicated, the Deductible must be met prior to benefits being payable. Member cost sharing for certain services,

More information

PLAN DESIGN AND BENEFITS - Tx OAMC 1500-10 PREFERRED CARE

PLAN DESIGN AND BENEFITS - Tx OAMC 1500-10 PREFERRED CARE PLAN FEATURES Deductible (per calendar year) $1,500 Individual $3,000 Individual $4,500 Family $9,000 Family 3 Individuals per Family 3 Individuals per Family Unless otherwise indicated, the Deductible

More information

California PCP Selected* Not Applicable

California PCP Selected* Not Applicable PLAN FEATURES Deductible (per calendar ) Member Coinsurance * Not Applicable ** Not Applicable Copay Maximum (per calendar ) $3,000 per Individual $6,000 per Family All member copays accumulate toward

More information

100% Percentage at which the Fund will reimburse Fund Administration

100% Percentage at which the Fund will reimburse Fund Administration FUND FEATURES HealthFund Amount $500 Employee $1,000 Employee + 1 Dependent $1,000 Employee + 2 Dependents $1,000 Family Amount contributed to the Fund by the employer Fund amount reflected is on a per

More information

IL Small Group PPO Aetna Life Insurance Company Plan Effective Date: 04/01/2009 PLAN DESIGN AND BENEFITS- PPO HSA HDHP $2,500 100/80 (04/09)

IL Small Group PPO Aetna Life Insurance Company Plan Effective Date: 04/01/2009 PLAN DESIGN AND BENEFITS- PPO HSA HDHP $2,500 100/80 (04/09) PLAN FEATURES OUT-OF- Deductible (per calendar ) $2,500 Individual $5,000 Individual $5,000 Family $10,000 Family Unless otherwise indicated, the Deductible must be met prior to benefits being payable.

More information

PLAN DESIGN AND BENEFITS Georgia 2-100 HNOption 13-1000-80

PLAN DESIGN AND BENEFITS Georgia 2-100 HNOption 13-1000-80 Georgia Health Network Option (POS Open Access) PLAN DESIGN AND BENEFITS Georgia 2-100 HNOption 13-1000-80 PLAN FEATURES PARTICIPATING PROVIDERS NON-PARTICIPATING PROVIDERS Deductible (per calendar year)

More information

PREFERRED CARE. All covered expenses, including prescription drugs, accumulate toward both the preferred and non-preferred Payment Limit.

PREFERRED CARE. All covered expenses, including prescription drugs, accumulate toward both the preferred and non-preferred Payment Limit. PLAN FEATURES Deductible (per plan year) $300 Individual $300 Individual None Family None Family All covered expenses, excluding prescription drugs, accumulate toward both the preferred and non-preferred

More information

CA Group Business 2-50 Employees

CA Group Business 2-50 Employees PLAN FEATURES Network Primary Care Physician Selection Deductible (per calendar year) Member Coinsurance Copay Maximum (per calendar year) Lifetime Maximum Referral Requirement PHYSICIAN SERVICES Primary

More information

Unlimited except where otherwise indicated.

Unlimited except where otherwise indicated. PLAN FEATURES Deductible (per calendar year) $1,250 Individual $5,000 Individual $2,500 Family $10,000 Family All covered expenses including prescription drugs accumulate separately toward both the preferred

More information

PARTICIPATING PROVIDERS / REFERRED Deductible (per calendar year)

PARTICIPATING PROVIDERS / REFERRED Deductible (per calendar year) Your HMO Plan Primary Care Physician - You choose a Primary Care Physician. The Aetna HMO Deductible provider network gives you access to a wide selection of Primary Care Physicians ( PCP's) and Specialists

More information

PLAN DESIGN AND BENEFITS - PA Health Network Option AHF HRA 1.3. Fund Pays Member Responsibility

PLAN DESIGN AND BENEFITS - PA Health Network Option AHF HRA 1.3. Fund Pays Member Responsibility HEALTHFUND PLAN FEATURES HealthFund Amount (Per plan year. Fund changes between tiers requires a life status change qualifying event.) Fund Coinsurance (Percentage at which the Fund will reimburse) Fund

More information

Individual. Employee + 1 Family

Individual. Employee + 1 Family FUND FEATURES HealthFund Amount Individual Employee + 1 Family $750 $1,125 $1,500 Amount contributed to the Fund by the employer is reflected above. Fund Amount reflected is on a per calendar year basis.

More information

$6,350 Individual $12,700 Individual

$6,350 Individual $12,700 Individual PLAN FEATURES IN-NETWORK OUT-OF-NETWORK Deductible $5,000 Individual $10,000 Individual $10,000 Family $20,000 Family All covered expenses accumulate separately toward the preferred or non-preferred Deductible.

More information

IL Small Group MC Open Access Aetna Life Insurance Company Plan Effective Date: 10/01/2010 PLAN DESIGN AND BENEFITS- MC CDHP $2,500 90/70 (10/10)

IL Small Group MC Open Access Aetna Life Insurance Company Plan Effective Date: 10/01/2010 PLAN DESIGN AND BENEFITS- MC CDHP $2,500 90/70 (10/10) PLAN FEATURES Deductible (per calendar ) $2,500 Individual $5,000 Individual $7,500 Family $15,000 Family Unless otherwise indicated, the Deductible must be met prior to benefits being payable. All covered

More information

PLAN DESIGN & BENEFITS - CONCENTRIC MODEL

PLAN DESIGN & BENEFITS - CONCENTRIC MODEL PLAN FEATURES Deductible (per calendar year) Rice University None Family Member Coinsurance Applies to all expenses unless otherwise stated. Payment Limit (per calendar year) $1,500 Individual $3,000 Family

More information

Aetna HealthFund Health Reimbursement Account Plan (Aetna HealthFund Open Access Managed Choice POS II )

Aetna HealthFund Health Reimbursement Account Plan (Aetna HealthFund Open Access Managed Choice POS II ) Health Fund The Health Fund amount reflected is on a per calendar year basis. If you do not use the entire fund by 12/31/2015, it will be moved into a Limited-Purpose Flexible Spending Account. Health

More information

SPIN Effective Date: 01-01-2013 Aetna HealthFund Aetna Choice POS ll - ASC PLAN DESIGN & BENEFITS ADMINISTERED BY AETNA LIFE INSURANCE COMPANY

SPIN Effective Date: 01-01-2013 Aetna HealthFund Aetna Choice POS ll - ASC PLAN DESIGN & BENEFITS ADMINISTERED BY AETNA LIFE INSURANCE COMPANY HealthFund Amount $1,500 Employee $1,500 Employee + 1 Dependent $1,500 Employee + 2 Dependents $1,500 Family Amount contributed to Fund by employer Fund Coinsurance 100% Percentage at which Fund will reimburse

More information

MITRE High Deductible Health Plan (HDHP) with a Health Savings Account (HSA)

MITRE High Deductible Health Plan (HDHP) with a Health Savings Account (HSA) PLAN FEATURES Deductible (per calendar year) $1,500 Employee $3,000 Employee $3,000 Employee + one dependent $6,000 Employee + one dependent $3,000 Family $6,000 Family All covered expenses including prescription

More information

1 exam every 12 months for members age 22 to age 65; 1 exam every 12 months for adults age 65 and older. Routine Well Child

1 exam every 12 months for members age 22 to age 65; 1 exam every 12 months for adults age 65 and older. Routine Well Child PLAN FEATURES IN-NETWORK OUT-OF-NETWORK Deductible (per calendar year) $1,000 Individual $1,000 Individual $2,000 Family $2,000 Family All covered expenses accumulate separately toward the preferred or

More information

PLAN DESIGN AND BENEFITS STANDARD HEALTH BENEFITS PLAN NJ HMO $30 PLAN (Also Marketed As: NJ SGB HMO $30/$300/D (5/10K) Plan)

PLAN DESIGN AND BENEFITS STANDARD HEALTH BENEFITS PLAN NJ HMO $30 PLAN (Also Marketed As: NJ SGB HMO $30/$300/D (5/10K) Plan) PLAN FEATURES Deductible (per calendar year) Plan Coinsurance Maximum Out-of-Pocket (per calendar year) $5,000 Individual $10,000 Family All covered expenses apply toward the Maximum Out-of-Pocket. Once

More information

THE MITRE CORPORATION PPO High Deductible Plan with a Health Saving Account (HSA)

THE MITRE CORPORATION PPO High Deductible Plan with a Health Saving Account (HSA) THE MITRE CORPORATION PPO High Deductible Plan with a Health Saving Account (HSA) Effective Date: 01-01-2016 PLAN FEATURES Annual Deductible $1,500 Employee $3,000 Employee $3,000 Employee + 1 Dependent

More information

Rice University Effective Date: 07-01-2014 Aetna Choice POS ll - ASC PLAN DESIGN & BENEFITS ADMINISTERED BY AETNA LIFE INSURANCE COMPANY PLAN FEATURES

Rice University Effective Date: 07-01-2014 Aetna Choice POS ll - ASC PLAN DESIGN & BENEFITS ADMINISTERED BY AETNA LIFE INSURANCE COMPANY PLAN FEATURES PLAN DESIGN & BENEFITS PLAN FEATURES NON- Deductible (per calendar year) None Individual $1,000 Individual None Family $3,000 Family All covered expenses, excluding prescription drugs, accumulate toward

More information

THE MITRE CORPORATION PPO High Deductible Plan with a Health Saving Account (HSA)

THE MITRE CORPORATION PPO High Deductible Plan with a Health Saving Account (HSA) THE MITRE CORPORATION PPO High Deductible Plan with a Health Saving Account (HSA) Effective Date: 01-01-2015 PLAN FEATURES Deductible (per calendar year) $1,500 Employee $3,000 Employee $3,000 Employee

More information

Small Business Solutions Medical Plan Options

Small Business Solutions Medical Plan Options Small Business Solutions Medical Plan Options Indiana Choice. Simplicity. Affordability. 14.02.927.1-IN (10/04) AETNA SMALL GROUP MEDICAL PLANS AETNA CHOICE PPO PLAN OPTIONS Plan Option 1 Plan Option 2

More information

THE MITRE CORPORATION High Deductible Health Plan (HDHP) with a Health Saving Account (HSA)

THE MITRE CORPORATION High Deductible Health Plan (HDHP) with a Health Saving Account (HSA) THE MITRE CORPORATION High Deductible Health Plan (HDHP) with a Health Saving Account (HSA) PLAN FEATURES Deductible (per calendar year) $1,500 Employee $3,000 Employee $3,000 Employee + 1 Dependent$6,000

More information

$100 Individual. Deductible

$100 Individual. Deductible PLAN FEATURES Deductible $100 Individual (per calendar year) $200 Family Unless otherwise indicated, the deductible must be met prior to benefits being payable. Member cost sharing for certain services,

More information

Prepared: 04/06/2012 04:19 PM

Prepared: 04/06/2012 04:19 PM PLAN FEATURES NON- Deductible (per calendar year) $2,000 Individual $4,000 Individual $6,000 Family $12,000 Family All covered expenses accumulate simultaneously toward both the preferred and non-preferred

More information

20% 40% Individual Family

20% 40% Individual Family PLAN FEATURES NON-* Deductible (per calendar year) $2,500 Individual $3,000 Individual $5,000 Family $6,000 Family Unless otherwise indicated, the Deductible must be met prior to benefits being payable.

More information

PLAN DESIGN & BENEFITS MEDICAL PLAN PROVIDED BY AETNA LIFE INSURANCE COMPANY

PLAN DESIGN & BENEFITS MEDICAL PLAN PROVIDED BY AETNA LIFE INSURANCE COMPANY Gettysburg College, Inc. PLAN FEATURES Deductible (per calendar year) $500 Individual $1,500 Individual $1,000 Family $3,000 Family All covered expenses accumulate separately toward the preferred or non-preferred

More information

$20 office visit copay; deductible 20%; after deductible. $30 office visit copay; deductible Not Covered. $30 office visit copay; deductible waived

$20 office visit copay; deductible 20%; after deductible. $30 office visit copay; deductible Not Covered. $30 office visit copay; deductible waived PLAN FEATURES IN-NETWORK OUT-OF-NETWORK Deductible (per calendar year) $300 Individual $600 Individual $600 Family $1,200 Family All covered expenses, accumulate separately toward the preferred or non-preferred

More information

$25 copay. One routine GYN visit and pap smear per 365 days. Direct access to participating providers.

$25 copay. One routine GYN visit and pap smear per 365 days. Direct access to participating providers. HMO-1 Primary Care Physician Visits Office Hours After-Hours/Home Specialty Care Office Visits Diagnostic OP Lab/X Ray Testing (at facility) with PCP referral. Diagnostic OP Lab/X Ray Testing (at specialist)

More information

THE CITY OF HOPE Proposed Effective Date: 01-01-2012 HMO - California PLAN DESIGN & BENEFITS PROVIDED BY AETNA HEALTH OF CALIFORNIA INC.

THE CITY OF HOPE Proposed Effective Date: 01-01-2012 HMO - California PLAN DESIGN & BENEFITS PROVIDED BY AETNA HEALTH OF CALIFORNIA INC. PLAN FEATURES Deductible (per calendar year) Out-of-Pocket Maximum (per calendar year) None Individual None Family $1,500 Individual $3,000 Family Member cost sharing for certain services may not apply

More information

LOCKHEED MARTIN AERONAUTICS COMPANY PALMDALE 2011 IAM NEGOTIATIONS UNDER AGE 65 LM HEALTHWORKS SUMMARY

LOCKHEED MARTIN AERONAUTICS COMPANY PALMDALE 2011 IAM NEGOTIATIONS UNDER AGE 65 LM HEALTHWORKS SUMMARY Annual Deductibles, Out-of-Pocket Maximums, Lifetime Maximum Benefits Calendar Year Deductible Calendar Year Out-of- Pocket Maximum Lifetime Maximum Per Individual Physician Office Visits Primary Care

More information

Orthodox HealthPlan Effective: 05-01-2015 Aetna HealthFund Open Choice (PPO)

Orthodox HealthPlan Effective: 05-01-2015 Aetna HealthFund Open Choice (PPO) FUND FEATURES HealthFund Amount Orthodox HealthPlan $750 Employee $1,500 Family Amount contributed to the Fund by the employer Fund amount reflected is on a per calendar year basis. The fund received may

More information

Additional Information Provided by Aetna Life Insurance Company

Additional Information Provided by Aetna Life Insurance Company Additional Information Provided by Aetna Life Insurance Company Inquiry Procedure The plan of benefits described in the Booklet-Certificate is underwritten by: Aetna Life Insurance Company (Aetna) 151

More information

FEATURES NETWORK OUT-OF-NETWORK

FEATURES NETWORK OUT-OF-NETWORK Schedule of Benefits Employer: The Vanguard Group, Inc. ASA: 697478-A Issue Date: January 1, 2014 Effective Date: January 1, 2014 Schedule: 3B Booklet Base: 3 For: Choice POS II - 950 Option - Retirees

More information

Medical plan options. Small Business Solutions. New York FOR BUSINESSES WITH 2 50 ELIGIBLE EMPLOYEES

Medical plan options. Small Business Solutions. New York FOR BUSINESSES WITH 2 50 ELIGIBLE EMPLOYEES Medical plan options Small Business Solutions New York FOR BUSINESSES WITH 2 50 ELIGIBLE EMPLOYEES Health insurance plans are offered, underwritten or administered by Aetna Life Insurance Company. 14.02.929.1-NY

More information

100% Percentage at which the Fund will reimburse Fund Administration

100% Percentage at which the Fund will reimburse Fund Administration FUND FEATURES HealthFund Amount $750 Employee $1,500 Family Amount contributed to the Fund by the employer Fund amount reflected is on a per calendar year basis, The fund received may be prorated based

More information

OVERVIEW OF YOUR BENEFITS

OVERVIEW OF YOUR BENEFITS OVERVIEW OF YOUR BENEFITS IMPORTANT PHONE NUMBERS Benefit Fund s Member Services Department (646) 473-9200 For answers to questions about your eligibility or prescription drug benefit. You can also visit

More information

PLAN DESIGN & BENEFITS PROVIDED BY AETNA HEALTH INC. - FULL RISK

PLAN DESIGN & BENEFITS PROVIDED BY AETNA HEALTH INC. - FULL RISK PLAN FEATURES Deductible (per calendar year) PLAN DESIGN & BENEFITS None Individual None Family The family Deductible is a cumulative Deductible for all family members. The family Deductible can be met

More information

Sherwin-Williams Medical, Prescription Drug and Dental Plans Plan Comparison Charts

Sherwin-Williams Medical, Prescription Drug and Dental Plans Plan Comparison Charts Sherwin-Williams Medical, Prescription Drug and Dental Plans Plan Comparison Charts You and Sherwin-Williams share the cost of certain benefits including medical and dental coverage and you have the opportunity

More information

FCPS BENEFITS COMPARISON Active Employees and Retirees Under 65

FCPS BENEFITS COMPARISON Active Employees and Retirees Under 65 FCPS S COMPARISON Medical Lifetime Maximum Unlimited Unlimited Unlimited Unlimited Unlimited Individual Annual Deductible None $250 None $250 None Family Annual Deductible Limit None $500 None $500 None

More information

None Individual. Deductible (per calendar year)

None Individual. Deductible (per calendar year) PLAN FEATURES Deductible (per calendar year) UNIVERSITY OF PENNSYLVANIA POSTDOCTORAL INSURANCE PLAN None Individual None Family The family Deductible is a cumulative Deductible for all family members.

More information

PLAN DESIGN & BENEFITS PROVIDED BY AETNA HEALTH INC. AND AETNA HEALTH INSURANCE COMPANY - FULL RISK

PLAN DESIGN & BENEFITS PROVIDED BY AETNA HEALTH INC. AND AETNA HEALTH INSURANCE COMPANY - FULL RISK PLAN FEATURES IN-NETWORK OUT-OF-NETWORK Deductible None Individual $750 Individual (per calendar year) None Family $2,250 Family Unless otherwise indicated, the deductible must be met prior to benefits

More information

None Individual. Deductible (per calendar year)

None Individual. Deductible (per calendar year) PLAN FEATURES Deductible (per calendar year) None Individual None Family The family Deductible is a cumulative Deductible for all family members. The family Deductible can be met by a combination of family

More information

HEALTH SAVINGS PPO PLAN (WITH HSA) - COLUMBUS PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE JANUARY 1, 2016 AETNA INC.

HEALTH SAVINGS PPO PLAN (WITH HSA) - COLUMBUS PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE JANUARY 1, 2016 AETNA INC. HEALTH SAVINGS PPO PLAN (WITH HSA) - COLUMBUS PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE JANUARY 1, 2016 AETNA INC. CPOS II DEDUCTIBLE, COPAYS/COINSURANCE AND DOLLAR MAXIMUMS and Aligned Deductible

More information

BENEFIT PLAN. What Your Plan Covers and How Benefits are Paid. Appendix A. Prepared Exclusively for The Dow Chemical Company

BENEFIT PLAN. What Your Plan Covers and How Benefits are Paid. Appendix A. Prepared Exclusively for The Dow Chemical Company Appendix A BENEFIT PLAN Prepared Exclusively for The Dow Chemical Company What Your Plan Covers and How Benefits are Paid Choice POS II (MAP Plus Option 2 - High Deductible Health Plan (HDHP) with Prescription

More information

Group Insurance Plan of Benefits for New York University (Control # 620610) administered by Aetna International Effective Date: January 1, 2016

Group Insurance Plan of Benefits for New York University (Control # 620610) administered by Aetna International Effective Date: January 1, 2016 Eligibility Provision Employee Regular full-time employees of New York University participating in this plan working a minimum of 25 hours per week. Dependent Wife or husband; same or opposite sex domestic

More information

Member s responsibility (deductibles, copays, coinsurance and dollar maximums)

Member s responsibility (deductibles, copays, coinsurance and dollar maximums) MICHIGAN CATHOLIC CONFERENCE January 2015 Benefit Summary This is intended as an easy-to-read summary and provides only a general overview of your benefits. It is not a contract. Additional limitations

More information

PPO Schedule of Payments (Maryland Large Group) Qualified High Deductible Health Plan National QA2000-20

PPO Schedule of Payments (Maryland Large Group) Qualified High Deductible Health Plan National QA2000-20 PPO Schedule of Payments (Maryland Large Group) Qualified High Health Plan National QA2000-20 Benefit Year Individual Family (Amounts for Participating and s services are separated in calculating when

More information

PLAN FEATURES ACO TIER LEVEL 1 AETNA NETWORK TIER 2 OUT-OF-NETWORK Deductible

PLAN FEATURES ACO TIER LEVEL 1 AETNA NETWORK TIER 2 OUT-OF-NETWORK Deductible PLAN FEATURES ACO TIER LEVEL 1 AETNA NETWORK TIER 2 OUT-OF-NETWORK Deductible $250 Individual $2,000 Individual $3,000 Individual (per calendar year) $500 Family $4,000 Family $6,000 Family Unless otherwise

More information

S c h o o l s I n s u r a n c e G r o u p Health Net Plan Comparison Fiscal Year 7/1/15-6/30/16

S c h o o l s I n s u r a n c e G r o u p Health Net Plan Comparison Fiscal Year 7/1/15-6/30/16 S c h o o l s I n s u r a n c e G r o u p Health Net Plan Comparison Fiscal Year 7/1/15-6/30/16 This information sheet is for reference only. Please refer to Evidence of Coverage requirements, limitations

More information

S c h o o l s I n s u r a n c e G r o u p Health Net Plan Comparison Fiscal Year 7/1/14-6/30/15

S c h o o l s I n s u r a n c e G r o u p Health Net Plan Comparison Fiscal Year 7/1/14-6/30/15 S c h o o l s I n s u r a n c e G r o u p Health Net Plan Comparison Fiscal Year 7/1/14-6/30/15 This information sheet is for reference only. Please refer to Evidence of Coverage requirements, limitations

More information

2015 Medical Plan Options Comparison of Benefit Coverages

2015 Medical Plan Options Comparison of Benefit Coverages Member services 1-866-641-1689 1-866-641-1689 1-866-641-1689 1-866-641-1689 1-866-641-1689 1-800-464-4000 Web site www.anthem.com/ca/llns/ www.anthem.com/ca/llns/ www.anthem.com/ca/llns/ www.anthem.com/ca/llns/

More information

OAKLAND COMMUNITY COLLEGE

OAKLAND COMMUNITY COLLEGE OAKLAND COMMUNITY COLLEGE Flexible Compensation Plan Flex Comp Exempt Administration and Management Staff Plan Year January 1, - December 31, The benefits described in this booklet do not constitute a

More information

Lesser of $200 or 20% (surgery) $10 per visit. $35 $100/trip $50/trip $75/trip $50/trip

Lesser of $200 or 20% (surgery) $10 per visit. $35 $100/trip $50/trip $75/trip $50/trip HOSPITAL SERVICES Hospital Inpatient : Paid in full, Non-network: Hospital charges subject to 10% of billed charges up to coinsurance maximum. Non-participating provider charges subject to Basic Medical

More information

1 exam every 12 months for members age 22 to age 65; 1 exam every 12 months for adults age 65 and older. Routine Well Child

1 exam every 12 months for members age 22 to age 65; 1 exam every 12 months for adults age 65 and older. Routine Well Child Open Choice (O) Maine Aetna Consumer Choice (HSA) lan LAN DESIGN & BENEFITS ROVIDED BY AETNA LIFE INSURANCE COMANY LAN FEATURES IN-NETWORK OUT-OF-NETWORK Deductible (per calendar year) $1,800 Individual

More information

Greater Tompkins County Municipal Health Insurance Consortium

Greater Tompkins County Municipal Health Insurance Consortium WHO IS COVERED Requires both Medicare A & B enrollment. Type of Coverage Offered Single only Single only MEDICAL NECESSITY Pre-Certification Requirement None None Medical Benefit Management Program Not

More information

CENTRAL MICHIGAN UNIVERSITY - Premier Plan (PPO1) 007000285-0002 0004 Effective Date: July 1, 2015 Benefits-at-a-Glance

CENTRAL MICHIGAN UNIVERSITY - Premier Plan (PPO1) 007000285-0002 0004 Effective Date: July 1, 2015 Benefits-at-a-Glance CENTRAL MICHIGAN UNIVERSITY - Premier Plan (PPO1) 007000285-0002 0004 Effective Date: July 1, 2015 Benefits-at-a-Glance This is intended as an easy-to-read summary and provides only a general overview

More information

Blue Cross Premier Bronze Extra

Blue Cross Premier Bronze Extra An individual PPO health plan from Blue Cross Blue Shield of Michigan. You will have a broad choice of doctors and hospitals within Blue Cross Blue Shield of Michigan s unsurpassed statewide PPO network

More information

Plans. Who is eligible to enroll in the Plan? Blue Care Network (BCN) Health Alliance Plan (HAP) Health Plus. McLaren Health Plan

Plans. Who is eligible to enroll in the Plan? Blue Care Network (BCN) Health Alliance Plan (HAP) Health Plus. McLaren Health Plan Who is eligible to enroll in the Plan? All State of Michigan Employees who reside in the coverage area determined by zip code. All State of Michigan Employees who reside in the coverage area determined

More information

2016 HealthFlex Plan Comparison: PPO B1000 with HRA and HDHP H1500 with HSA

2016 HealthFlex Plan Comparison: PPO B1000 with HRA and HDHP H1500 with HSA Caring For Those Who Serve 1901 Chestnut Avenue Glenview, Illinois 60025-1604 1-800-851-2201 www.gbophb.org 2016 HealthFlex Plan Comparison: PPO B1000 with HRA and HDHP H1500 with HSA Please note: This

More information

Delta College 007000338-0001, 0002, 0003, 0004, 0005, 0006, 0007 Community Blue SM PPO Medical Coverage Benefits-at-a-Glance

Delta College 007000338-0001, 0002, 0003, 0004, 0005, 0006, 0007 Community Blue SM PPO Medical Coverage Benefits-at-a-Glance Delta College 007000338-0001, 0002, 0003, 0004, 0005, 0006, 0007 Community Blue SM PPO Medical Coverage Benefits-at-a-Glance This is intended as an easy-to-read summary and provides only a general overview

More information

2015 Medical Plan Summary

2015 Medical Plan Summary 2015 Medical Plan Summary AVMED POS PLAN This Schedule of Benefits reflects the higher provider and prescription copayments for 2015. This is not a contract, it s a summary of the plan highlights and is

More information

SUMMARY OF BENEFITS. Cigna Health and Life Insurance Co. Laramie County School District 2 Open Access Plus Base - Effective 7/1/2015

SUMMARY OF BENEFITS. Cigna Health and Life Insurance Co. Laramie County School District 2 Open Access Plus Base - Effective 7/1/2015 SUMMARY OF BENEFITS Cigna Health and Life Insurance Co. Laramie County School District 2 Open Access Plus Base - Effective General Services In-Network Out-of-Network Physician office visit Urgent care

More information

AVMED POS PLAN. Allergy Injections No charge 30% co-insurance after deductible Allergy Skin Testing $30 per visit 30% co-insurance after deductible

AVMED POS PLAN. Allergy Injections No charge 30% co-insurance after deductible Allergy Skin Testing $30 per visit 30% co-insurance after deductible AVMED POS PLAN This Schedule of Benefits reflects the higher provider and prescription copays for 2015. This is not a contract, it s a summary of the plan highlights and is subject to change. For specific

More information

SUMMARY OF BENEFITS. Cigna Health and Life Insurance Co. Grand County Open Access Plus Effective 1/1/2015

SUMMARY OF BENEFITS. Cigna Health and Life Insurance Co. Grand County Open Access Plus Effective 1/1/2015 SUMMARY OF BENEFITS Cigna Health and Life Insurance Co. Grand County Open Access Plus Effective General Services In-Network Out-of-Network Primary care physician You pay $25 copay per visit Physician office

More information

National PPO 1000. PPO Schedule of Payments (Maryland Small Group)

National PPO 1000. PPO Schedule of Payments (Maryland Small Group) PPO Schedule of Payments (Maryland Small Group) National PPO 1000 The benefits outlined in this Schedule are in addition to the benefits offered under Coventry Health & Life Insurance Company Small Employer

More information

BRYN MAWR COLLEGE MEDICAL INSURANCE BENEFITS COMPARISON EFFECTIVE NOVEMBER 1, 2009

BRYN MAWR COLLEGE MEDICAL INSURANCE BENEFITS COMPARISON EFFECTIVE NOVEMBER 1, 2009 BENEFITS Description of Plan Annual Deductible (January - December) - Individual - Family PERSONAL CHOICE PPO BRYN MAWR COLLEGE KEYSTONE HEALTH PLAN EAST KEYSTONE POS Provides comprehensive health Provides

More information

FUND FEATURES HealthFund Amount

FUND FEATURES HealthFund Amount FUND FEATURES HealthFund Amount Miami Dade College $750 Employee $1,500 Family Amount contributed to the Fund by the employer Fund amount reflected is on a per calendar year basis. The fund received may

More information

Greater Tompkins County Municipal Health Insurance Consortium

Greater Tompkins County Municipal Health Insurance Consortium WHO IS COVERED Requires Covered Member to be Enrolled in Both Medicare Parts A & B Type of Coverage Offered Single only Single only MEDICAL NECESSITY Pre-Certification Requirement Not Applicable Not Applicable

More information

California Ironworkers Field Welfare Plan 1/1/2014 Open Enrollment Benefit Plan Comparison Non-Medicare Retired Participants Residing in Nevada

California Ironworkers Field Welfare Plan 1/1/2014 Open Enrollment Benefit Plan Comparison Non-Medicare Retired Participants Residing in Nevada Non- Choice of Providers Calendar Year Deductible *The Fund s Calendar Year Deductible is never waived. However, some services are not subject to the Deductible. If you live in Nevada, your network of

More information

Group Insurance Plan of Benefits for The MITRE Corporation (418895) administered by Aetna International Effective Date: January 1, 2016

Group Insurance Plan of Benefits for The MITRE Corporation (418895) administered by Aetna International Effective Date: January 1, 2016 Employee Dependent PLAN FEATURES Group Insurance Plan of Benefits for Eligibility Provision Regular full time employees of The MITRE Corporation participating in this plan who reside outside the United

More information

Garden City Public Schools Community Blue PPO SM Plan 1 LG Medical Coverage Benefits-at-a-Glance

Garden City Public Schools Community Blue PPO SM Plan 1 LG Medical Coverage Benefits-at-a-Glance Garden City Public Schools Community Blue PPO SM Plan 1 LG Medical Coverage Benefits-at-a-Glance Effective for groups on their plan year beginning on or after January 1, 2015 This is intended as an easy-to-read

More information

Prescription Drugs and Vision Benefits

Prescription Drugs and Vision Benefits Medical Plans Prescription Drugs and Vision Benefits Salaried Employees. may enroll for coverage in either the Cigna Open Access Plus Plan or the Cigna Choice Fund (Health Savings Account [HSA] Eligible)

More information

Flexible Blue SM Plan 2 Medical Coverage with Flexible Blue SM RX Prescription Drugs Benefits-at-a-Glance for Western Michigan Health Insurance Pool

Flexible Blue SM Plan 2 Medical Coverage with Flexible Blue SM RX Prescription Drugs Benefits-at-a-Glance for Western Michigan Health Insurance Pool Flexible Blue SM Plan 2 Medical Coverage with Flexible Blue SM RX Prescription Drugs Benefits-at-a-Glance for Western Michigan Health Insurance Pool The information in this document is based on BCBSM s

More information

ROCHESTER INSTITUTE OF TECHNOLOGY 2014 Medical Benefits Comparison Chart Medicare-Eligible Retirees in the Rochester Area

ROCHESTER INSTITUTE OF TECHNOLOGY 2014 Medical Benefits Comparison Chart Medicare-Eligible Retirees in the Rochester Area Contacting the Carrier Voice: (877) 883-9577 TTY: (585) 454-2845 Website: Voice: (800) 665-7924 TTY: (800) 252-2452 Website: www.excellusbcbs.com www.mvphealthcare.com Deductible Carry Over None None Deductible,

More information

Benefit Summary - A, G, C, E, Y, J and M

Benefit Summary - A, G, C, E, Y, J and M Benefit Summary - A, G, C, E, Y, J and M Benefit Year: Calendar Year Payment for Services Deductible Individual $600 $1,200 Family (Embedded*) $1,200 $2,400 Coinsurance (the percentage amount the Covered

More information

GUIDE TO MEDICAL AND DENTAL PLANS

GUIDE TO MEDICAL AND DENTAL PLANS GUIDE TO MEDICAL AND DENTAL PLANS B e n e f i t s e f f e c t i v e J u l y 1, 2016 t h r o u g h J u n e 3 0, 2 0 1 7 Choosing your benefits is an important decision. This guide provides you with the

More information

DRAKE UNIVERSITY HEALTH PLAN

DRAKE UNIVERSITY HEALTH PLAN DRAKE UNIVERSITY HEALTH PLAN Effective Date: 1/1/2015 This is a general description of coverage. It is not a statement of contract. Actual coverage is subject to terms and the conditions specified in the

More information

Utah Renewal Instructions

Utah Renewal Instructions Utah Renewal Instructions For 2 50 Eligible Employees Effective August 1, 2009 Easy steps to renew your coverage 14.02.138.1-UT A (5/09) Aetna is the brand name used for products and services provided

More information

Schedule of Benefits (Who Pays What) HMO Colorado Name of Carrier BlueAdvantage HMO Plan $1,500 Deductible 30/$200D Name of Plan $200D-15/40/60/30%

Schedule of Benefits (Who Pays What) HMO Colorado Name of Carrier BlueAdvantage HMO Plan $1,500 Deductible 30/$200D Name of Plan $200D-15/40/60/30% Schedule of Benefits (Who Pays What) HMO Colorado Name of Carrier BlueAdvantage HMO Plan $1,500 Deductible 30/$200D Name of Plan $200D-15/40/60/30% PART A: TYPE OF COVERAGE 1. TYPE OF PLAN Health maintenance

More information

Boehringer Ingelheim Benefit Information Sheet Plan Year 2016

Boehringer Ingelheim Benefit Information Sheet Plan Year 2016 Boehringer Ingelheim Benefit Information Sheet Plan Year 2016 AETNA CHOICE POS II AETNA HEALTHFUND HRA AETNA HEALTHFUND HSA Contact and Further Information Internet Web Sites Overview Service Area If you

More information

Independence Blue Cross Plan Summary PPO Core Medical Plan

Independence Blue Cross Plan Summary PPO Core Medical Plan TO: FROM: SUBJECT: MLH Medical Plan Participants MLH Human Resources Benefits Team Independence Blue Cross Plan Summary PPO Core Medical Plan Attached you will find the Independence Blue Cross (IBC) Plan

More information

Covered 100% No deductible Not Applicable (exam, related tests and x-rays, immunizations, pap smears, mammography and screening tests)

Covered 100% No deductible Not Applicable (exam, related tests and x-rays, immunizations, pap smears, mammography and screening tests) A AmeriHealth EPO Individual Summary of Benefits Value Network IHC EPO $30/50% Benefit Network Non network Benefit Period+ Calendar year Individual deductible $2,500 Family deductible $5,000 50% Individual

More information