Motion Picture Industry (MPI) Active Health Plan Medical Plan Benefit Comparison At-A-Glance

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Motion Picture Industry (MPI) Active Health Plan Medical Plan Benefit Comparison At-A-Glance"

Transcription

1 Motion Picture Industry (MPI) Active Health Plan Medical Plan Benefit Comparison At-A-Glance Hospital Services Room and Board Intensive Care Ancillary Services Semi-Private Room Extended Care Room and board in a skilled nursing facility Other services and supplies Emergency Services Within or Outside Service Area ** Professional Physician Visits: Hospital/Office Surgeon Assistant Surgeon Anesthesia ** In-network: $100 inpatient admission + 10% for unlimited number of days Out-of-network: $ % of allowable amount for unlimited number of days. Personal items are not covered 90 days for Participants 60 days for dependents 10% if contracting, 50% if non-contracting. All covered services when medically necessary are available anywhere in the world from any licensed physician, surgeon or general hospital $100 co-pay In-network: 10% Out-of-network: 50% for unlimited number of days for 100 days each $35 co-pay (waived if admitted to a hospital) $15 co-pay for office visit only for unlimited number of days (up to 100 days per benefit period) Emergency Room - Kaiser Medical Centers, 24 hours a day, 7 days a week. $35 co-pay (waived if admitted to a hospital) Outpatient: $15 co-pay In Network: $0 co-pay In Network: $0 co-pay per continuous confinement $25 per visit (waived if admitted to a hospital) In Network: $15 co-pay

2 Page 2 of 5 In-home Nursing Care ** Ambulance Services (including air ambulance) ** Laboratory Tests and Diagnostic Imaging ** Injectable Drugs Eye Examinations In-network: 10% Out-of-network: 50% Covered through Medco only Eye examinations and corrective lenses are available for all eligible Participants and their eligible dependents through VSP for injections, allergy injection services or testing (Injections for infertility are paid at 50 %.) Allergy serum is covered in full $15 co-pay Also available through VSP (See Vision Service Plan section) As medically necessary (some limitations) within service area if authorized Prior approval from Kaiser is required in nonemergency situations $15 office visit No charge for lab tests or x-rays $15 office visit co-pay Most injectable drugs including allergy tests, provided at no charge if administered in the medical office $15 for each visit Also available through VSP (See Vision Service Plan section) Considered Home Healthcare In Network: $15 co-pay, 60 visits/year, 4 hours/visit Out-of-Network: 30% co-pay, 60 visits/year, 4 hours/visit In Network: $0 co-pay when medically necessary Out-of-Network: Covered services will be covered as in network (Non-emergency Air Transportation is not always covered.) In Network: $0 co-pay at participating laboratories Subject to office visit co-pay Most injectable drugs including allergy tests, provided at no charge if administered in the medical office Discounts available on eye wear and eye care through General Vision Services Also available through VSP

3 Page 3 of 5 Chiropractic Services ** Physical Therapy ** Physical Examination ** Home Health Services Physician Home Visits** Home Health Nurse ** Maternity ** Maximum of 20 visits per Maximum of 16 visits per $15 co-pay Available through ASH Networks only $15 co-pay Available through ASH Networks only $15 for each visit $15 co-pay for Annual periodic health evaluations $30 per visit $10 co-pay on and after the 31st calendar day $15 for each examination $15 office visit co-pay in hospital In Network: $15 per visit, visits are subject to medical necessity, visits are subject to medical necessity In Network: Outpatient (through Ortho-Net); 90 visits/condition/ lifetime $15 co-pay Inpatient: 60 days/condition/ lifetime; $0 co-pay. Outpatient: 90 days/condition/ lifetime Inpatient: 60 days/condition/ lifetime Comprehensive Physical Exam age 13 and older: In Network: $0 co-pay Out-of-Network: Not covered In Network: $15 co-pay, 60 visits/year, 4 hours/visit, 60 visits/year, 4 hours/visit In Network: $15 per initial visit only, 60 visits/year, 4 hours/visit In Network: $15 co-pay

4 Page 4 of 5 Interrupted Pregnancies ** Family Planning Services Vasectomy Not covered $50 Tubal Ligation Not covered $150 Elective Abortion ** Intrauterine Device (IUD) ** Mental Health Outpatient Covered under Optum Health Behavioral Solutions $150 for elective abortion (No charge for medically necessary abortions) Fitting and insertion only $30 per visit up to 20 outpatient mental health consultation per unlimited days for conditions considered severe mental health illnesses $15 for each visit co-pay in hospital Outpatient: $15 co-pay Outpatient: $15 co-pay Outpatient: $15 co-pay Provided at reasonable rates $5 co-pay Up to 20 visits per (Visit limit does not apply to certain mental health care) $2 co-pay/visit for group therapy Treatment in the office is subject to office visit co-pay Inpatient Treatment: Inpatient hospital coverage Covered as medically necessary (This is separate from Terminations of Pregnancies) In Network: No charge, reversal not covered In Network: No charge, reversal not covered, reversal not covered In Network: Maximum allowance of $350 per abortion. Maximum allowance of $350 per abortion, once/year Not covered 40 visits per In Network: $15 co-pay per visit Out-of-Network: deductible plus 30% co-insurance per visit

5 Page 5 of 5 Mental Health Inpatient Covered under Optum Health Behavioral Solutions Non-severe No charge/30 days per Severe No charge/unlimited days per Up to 30 days per (Day limit does not apply to certain type of mental health care) 30 days per In Network: $15 co-pay per visit Out-of-Network: deductible plus 30% co-insurance per visit

6 Page 1 of 1 Motion Picture Industry (MPI) Active Health Plan Dental Plans Benefit Comparison At-A-Glance Delta Dental PPO (Available Nationwide) DeltaCare USA (Available in ) Dentists Available The dentist of your choice, anywhere in the world. Using Delta PPO dentists may reduce your out-ofpocket expense. Must use selected DeltaCare affiliated dentist only; dentists located throughout California Cost to You For Most Services You pay 20% of the usual, customary and reasonable charges No cost to you Deductible $25 annually per person, up to a maximum of $50 per family No deductible Maximum $2,000 per person, per No annual maximum Orthodontics Eligible dependent children only Pays 50% of usual, customary and reasonable charges $1,000 lifetime maximum Eligible dependent: Children: $1,100 Adults: $1,500 Start-up fee: $ 250

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

SERVICES IN-NETWORK COVERAGE OUT-OF-NETWORK COVERAGE

SERVICES IN-NETWORK COVERAGE OUT-OF-NETWORK COVERAGE COVENTRY HEALTH AND LIFE INSURANCE COMPANY 3838 N. Causeway Blvd. Suite 3350 Metairie, LA 70002 1-800-341-6613 SCHEDULE OF BENEFITS BENEFITS AND PRIOR AUTHORIZATION REQUIREMENTS ARE SET FORTH IN ARTICLES

More information

When You Can Change Plans. Care is provided through physicians or medical staff at a Kaiser Permanente facility located in the member's service area.

When You Can Change Plans. Care is provided through physicians or medical staff at a Kaiser Permanente facility located in the member's service area. CEMENT MASONS HEALTH AND WELFARE TRUST FUND ACTIVE CEMENT MASONS AND THEIR ELIGIBLE DEPENDENTS EFFECTIVE FEBRUARY 1, 2013 PLAN FEATURES DIRECT PAYMENT PLAN KAISER PERMANENTE When You Can Change Plans Type

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

The 2016 Health Care Plan Comparison Chart provides you with high-level coverage details on medical, dental and vision plans.

The 2016 Health Care Plan Comparison Chart provides you with high-level coverage details on medical, dental and vision plans. 2016 HEALTH PLAN COMPARISON CHART The 2016 Health Care Plan Comparison Chart provides you with high-level coverage details on medical, dental and vision plans. Andre Jacobs Field Services North America,

More information

KAISER PERMANENTE PLAN (Non-Medicare Eligible)

KAISER PERMANENTE PLAN (Non-Medicare Eligible) CEMENT MASONS HEALTH AND WELFARE TRUST FUND FOR NORTHERN CALIFORNIA RETIRED CEMENT MASONS AND THEIR ELIGIBLE DEPENDENTS EFFECTIVE JANUARY 1, 2015 GENERAL When You Can Change Plans Type of Plan, Service

More information

OPERATING ENGINEERS HEALTH & WELFARE FUND BENEFIT PLANS SUMMARY COMPARISON FOR ACTIVES and EARLY RETIREES

OPERATING ENGINEERS HEALTH & WELFARE FUND BENEFIT PLANS SUMMARY COMPARISON FOR ACTIVES and EARLY RETIREES PPO Kaiser Permanente For Non-PPO Providers Employee Premium None None None None None Explanation of s and Options Available to You If you choose a doctor who is not contracted with Anthem Blue Cross the

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

Benefits At A Glance Plan C

Benefits At A Glance Plan C Benefits At A Glance Plan C HIGHLIGHTS OF WELFARE FUND BENEFITS WELFARE FUND BENEFITS IN BRIEF Medical and Hospital Benefits Empire BlueCross BlueShield Plan C-1 Empire BlueCross BlueShield Plan C-2 All

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

No Charge (Except as described under "Rehabilitation Benefits" and "Speech Therapy Benefits")

No Charge (Except as described under Rehabilitation Benefits and Speech Therapy Benefits) An Independent Licensee of the Blue Shield Association Custom Access+ HMO Plan Certificated & Management Benefit Summary (For groups of 300 and above) (Uniform Health Plan Benefits and Coverage Matrix)

More information

SISC Custom SaveNet Zero Admit 10 Benefit Summary (Uniform Health Plan Benefits and Coverage Matrix)

SISC Custom SaveNet Zero Admit 10 Benefit Summary (Uniform Health Plan Benefits and Coverage Matrix) SISC Custom SaveNet Zero Admit 10 Benefit Summary (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California Highlights: A description of the prescription drug coverage is provided separately

More information

Health Insurance Matrix 01/01/16-12/31/16

Health Insurance Matrix 01/01/16-12/31/16 Employee Contributions Family Monthly : $121.20 Bi-Weekly : $60.60 Monthly : $290.53 Bi-Weekly : $145.26 Monthly : $431.53 Bi-Weekly : $215.76 Monthly : $743.77 Bi-Weekly : $371.88 Employee Contributions

More information

LEGACY PLAN Medical In-Ntwk Out-of-Ntwk

LEGACY PLAN Medical In-Ntwk Out-of-Ntwk Preventive Services Age, gender and frequency criteria Adult physical/immunizations Well child visits/immunizations Screenings 0 Co-Insurance (after deductible) Out-of-Pocket Maximums Office Visit (copays)

More information

CIGNA HEALTH AND LIFE INSURANCE COMPANY, a Cigna company (hereinafter called Cigna)

CIGNA HEALTH AND LIFE INSURANCE COMPANY, a Cigna company (hereinafter called Cigna) Home Office: Bloomfield, Connecticut Mailing Address: Hartford, Connecticut 06152 CIGNA HEALTH AND LIFE INSURANCE COMPANY, a Cigna company (hereinafter called Cigna) CERTIFICATE RIDER No CR7SI006-1 Policyholder:

More information

Carpenters Health & Welfare Trust Fund for California Retiree Plan Comparison

Carpenters Health & Welfare Trust Fund for California Retiree Plan Comparison Carpenters Health & Welfare Trust Fund for California Retiree Plan Comparison Information Needed: Eligibility, Benefits, COBRA or Disability Claims: Indemnity Medical Plan Indemnity Hearing Aid Benefit

More information

Benefit Coverage Chart & Rates

Benefit Coverage Chart & Rates Benefit Coverage Chart & Rates Effective July 1, 2014- June 30, 2015 PPO Medical Coverage by Category The following coverages are included with the PPO plan: o Prescription o Vision Additional Benefits

More information

OPERATING ENGINEERS HEALTH & WELFARE FUND BENEFIT PLANS SUMMARY COMPARISON FOR ACTIVE and RETIRED PARTICIPANTS

OPERATING ENGINEERS HEALTH & WELFARE FUND BENEFIT PLANS SUMMARY COMPARISON FOR ACTIVE and RETIRED PARTICIPANTS Employee Premium None None None None None Explanation of Plans and Options Available to You Deductible Annual Out-of-Pocket Calendar Year (Applicable to members who reside in California & Nevada Only.)

More information

Ultimate Full PPO for Small Business 0 Benefit Summary (For groups 1 to 50) (Uniform Health Plan Benefits and Coverage Matrix)

Ultimate Full PPO for Small Business 0 Benefit Summary (For groups 1 to 50) (Uniform Health Plan Benefits and Coverage Matrix) Ultimate Full PPO for Small Business 0 Benefit Summary (For groups 1 to 50) (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California Effective January 1, 2014 THIS MATRIX IS INTENDED

More information

NATIONWIDE INSURANCE $20-40 / 250A NATIONAL MANAGED CARE SCHEDULE OF BENEFITS

NATIONWIDE INSURANCE $20-40 / 250A NATIONAL MANAGED CARE SCHEDULE OF BENEFITS WASHINGTON NATIONWIDE INSURANCE $20-40 / 250A NATIONAL MANAGED CARE SCHEDULE OF BENEFITS General Features Calendar Year Deductible Lifetime Benefit Maximum (Does not apply to Chemical Dependency) ($5,000.00

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

Schenectady City School District HEALTH BENEFIT COMPARISON ALL PLANS

Schenectady City School District HEALTH BENEFIT COMPARISON ALL PLANS FEATURES Members can choose to go to ANY PROVIDER or HOSPITAL they choose. Out of pocket expenses will always be lower when using in-network providers and facilities. To find a provider visit www.bsneny.com

More information

EMPLOYEE INSURANCE BENEFITS 520 N. LAKE PARKER AVE LAKELAND, FL 33801 863-834-6795

EMPLOYEE INSURANCE BENEFITS 520 N. LAKE PARKER AVE LAKELAND, FL 33801 863-834-6795 Effective January 1, 2015 EMPLOYEE INSURANCE BENEFITS 520 N. LAKE PARKER AVE LAKELAND, FL 33801 863-834-6795 WELCOME! The insurance benefits extended to a City of Lakeland regular full-time employee will

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

Coventry Health and Life Insurance Company PPO Schedule of Benefits

Coventry Health and Life Insurance Company PPO Schedule of Benefits State(s) of Issue: Oklahoma PPO Plan: OI08C30050 30 Coventry Health and Life Insurance Company PPO Schedule of Benefits Covered Services Contract Year Deductible For All Eligible Expenses (unless otherwise

More information

Summary of Benefits and Coverage What this Plan Covers & What it Costs

Summary of Benefits and Coverage What this Plan Covers & What it Costs This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the plan document at www.mpiphp.org or by calling 1-855-275-4674. Important Questions Answers

More information

Summary of Benefits and Coverage What this Plan Covers & What it Costs - 2015

Summary of Benefits and Coverage What this Plan Covers & What it Costs - 2015 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the plan document at www.mpiphp.org or by calling 1-855-275-4674. Important Questions Answers

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

Schedule of Benefits for the MoDOT/MSHP Medical Plan Medicare ASO PPO 20088 Effective 1/1/2016

Schedule of Benefits for the MoDOT/MSHP Medical Plan Medicare ASO PPO 20088 Effective 1/1/2016 Schedule of Benefits for the MoDOT/MSHP Medical Plan Medicare ASO PPO 20088 Effective 1/1/2016 This Schedule of Benefits summarizes your obligation towards the cost of certain covered services. Refer to

More information

Pace University CIGNA Medical Detailed Benefit Summaries July 1, 2015 - June 30, 2016

Pace University CIGNA Medical Detailed Benefit Summaries July 1, 2015 - June 30, 2016 Consumer Core HDHP In Net $50 (ONLY APPLICABLE TO THOSE Network Core $25 ALREADY ENROLLED) Network Choice Fund In Network In Network In Network Deductible $1,300/$2,600 (Cumulative) N/A N/A Coinsurance

More information

Your Plan: Anthem Silver HMO 1500/30%/6550 Your Network: California Care HMO

Your Plan: Anthem Silver HMO 1500/30%/6550 Your Network: California Care HMO Your Plan: Anthem Silver HMO 1500/30%/6550 Your Network: California Care HMO This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This summary does

More information

International Student Health Insurance Program (ISHIP) 2014-2015

International Student Health Insurance Program (ISHIP) 2014-2015 2014 2015 Medical Plan Summary for International Students Translation Services If you need an interpreter to help with oral translation services, you may contact the LifeWise Customer Service team at 1-800-971-1491

More information

Medical Benefits. An Overview of Your Medical Benefits. What s Covered? Coverage Out-of-Network

Medical Benefits. An Overview of Your Medical Benefits. What s Covered? Coverage Out-of-Network Medical s An Overview of Your Medical s The Painters & Allied Trades District Council No. 35 Health Plan covers most medically necessary expenses. For provider discounts, we contract with CareLink, a Preferred

More information

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

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

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

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

Carpenters Health & Welfare Trust Fund for California

Carpenters Health & Welfare Trust Fund for California Carpenters Health & Welfare Trust Fund for California Comparison for Plan B & Flat Rate Benefits Information Needed: Eligibility, Benefits, COBRA, Disability, or Life and Accidental Death and Dismemberment

More information

STATE OF IOWA HEALTH INSURANCE PLAN COMPARISON EFFECTIVE JANUARY 1, 2016

STATE OF IOWA HEALTH INSURANCE PLAN COMPARISON EFFECTIVE JANUARY 1, 2016 This comparison is only a summary of benefits. Benefits will be administered as described in each plan s Summary of Benefits & Coverage. For further details, refer to those documents or call Wellmark Blue

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

NATIONAL HEALTH & WELFARE FUND PLAN C

NATIONAL HEALTH & WELFARE FUND PLAN C H E A LT H A N N U I T Y I O N V A C AT P E N S I O N NATIONAL HEALTH & WELFARE FUND PLAN C BENEFITS AT A GLANCE Introduction The IATSE National Health & Welfare Fund was set up to provide health care

More information

Summary of Services and Cost Shares

Summary of Services and Cost Shares Summary of Services and Cost Shares This summary does not describe benefits. For the description of a benefit, including any limitations or exclusions, please refer to the identical heading in the Benefits

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

Insure your health; protect your education

Insure your health; protect your education Health Insurance for Stanford Students Information and Requirements Insure your health; protect your education Cardinal Care Stanford University s Student Health Insurance 2011 2012 Academic Year Stanford

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

CSAC/EIA Health Small Group Access+ HMO 15-0 Inpatient Benefit Summary

CSAC/EIA Health Small Group Access+ HMO 15-0 Inpatient Benefit Summary CSAC/EIA Health Small Group Access+ HMO 15-0 Inpatient Benefit Summary (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California THIS MATRIX IS INTENDED TO BE USED TO HELP YOU COMPARE

More information

UC Care Plan. Benefit Booklet. University of California. Group Number: W0051612 Plan ID: PPOX0001 Effective Date: January 1, 2016

UC Care Plan. Benefit Booklet. University of California. Group Number: W0051612 Plan ID: PPOX0001 Effective Date: January 1, 2016 UC Care Plan Benefit Booklet University of California Group Number: W0051612 Plan ID: PPOX0001 Effective Date: January 1, 2016 An independent member of the Blue Shield Association Claims Administered by

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

Your Plan: Anthem Bronze PPO 5500/30%/6450 w/hsa Your Network: Prudent Buyer PPO

Your Plan: Anthem Bronze PPO 5500/30%/6450 w/hsa Your Network: Prudent Buyer PPO Your Plan: Anthem Bronze PPO 5500/30%/6450 w/hsa Your Network: Prudent Buyer PPO This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This summary does

More information

Reliability and predictable costs for individuals and families

Reliability and predictable costs for individuals and families INDIVIDUAL & FAMILY PLANS HEALTH NET HMO PLANS Reliability and predictable costs for individuals and families If you re looking for a health plan that s simple to use and easy to understand, you ve found

More information

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters: This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.gpatpa.com or by calling 915-887-3420. Important Questions

More information

University of Southern California USC. USC Senior Care. A Supplemental Plan to Medicare

University of Southern California USC. USC Senior Care. A Supplemental Plan to Medicare Senior Care A Supplemental Plan to Medicare What is Senior Care and Who is Eligible? A sponsored supplemental plan to Medicare for former employees of the University of Southern California, their spouses,

More information

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters: This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the Summary Plan Description (SPD) or Plan Document at www.pebtf.org or by calling 1-800-522-7279.

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

Anthem Blue Cross Life and Health Insurance Company Your Plan: Solution PPO 1500/15/20 Your Network: Prudent Buyer PPO

Anthem Blue Cross Life and Health Insurance Company Your Plan: Solution PPO 1500/15/20 Your Network: Prudent Buyer PPO Anthem Blue Cross Life and Health Insurance Company Your Plan: Solution PPO 1500/15/20 Your Network: Prudent Buyer PPO This summary of benefits is a brief outline of coverage, designed to help you with

More information

Benefit Coverage Chart & Rates Effective July 1, 2014 June 30, 2015

Benefit Coverage Chart & Rates Effective July 1, 2014 June 30, 2015 Benefit Coverage Chart & Rates Effective PPO Medical Coverage by Category The following coverages are included with the PPO plan: o Prescription o Vision Additional Benefits o Dental o Dental & Orthodontia

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

The Deductible is applicable to all covered services except for flat dollar Copayment services.

The Deductible is applicable to all covered services except for flat dollar Copayment services. PRIORITY HEALTH www.priorityhealth.com/mpsers PRIORITYHMO SM PLUS PLAN MICHIGAN PUBLIC SCHOOL EMPLOYEES RETIREMENT SYSTEM (MPSERS) Effective January 1, 2016 through December 31, 2016 The HMO Plus plan

More information

2015 Benefits Open Enrollment

2015 Benefits Open Enrollment 2015 Benefits Open Enrollment November 4-21, 2014 For House Staff WE RE STEPPING UP OUR FOCUS ON HEALTH Review changes to your 2015 benefits! HealthySteps Inside This Guide What s New for 2015... 4 Overview

More information

2013 IBM Health Benefit Comparison Charts

2013 IBM Health Benefit Comparison Charts 203 IBM Health Benefit Comparison Charts for IBM Active Employees These Health Benefit Comparison Charts provide a summary overview of the coverage available for medical services, mental health/substance

More information

Insure your health; protect your education

Insure your health; protect your education Health Insurance for Stanford Students Information and Requirements Insure your health; protect your education Cardinal Care Stanford University s Student Health Insurance 2014 2015 Academic Year Stanford

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

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

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

Benefits at a Glance: Visa Inc. Policy Number: 00784A

Benefits at a Glance: Visa Inc. Policy Number: 00784A Benefits at a Glance: Visa Inc. Policy Number: 00784A Visa Inc. Benefits at a Glance Policy #00784A Effective Date: January 1, 2016 Visa Inc. offers Medical, Pharmacy, Vision, Dental and Medical Evacuation

More information

Health Insurance Matrix 07/01/012-06/30/13

Health Insurance Matrix 07/01/012-06/30/13 Employee Contributions Family Monthly : $212.14 Bi-Weekly : $106.07 Monthly : $388.36 Bi-Weekly : $194.18 Monthly : $429.88 Bi-Weekly : $214.94 Monthly : $677.30 Bi-Weekly : $338.65 Employee Contributions

More information

Operating Engineers Public Employees Health and Welfare Trust Fund Plan D vs PERS CHOICE and PERS SELECT PPO Plan

Operating Engineers Public Employees Health and Welfare Trust Fund Plan D vs PERS CHOICE and PERS SELECT PPO Plan Calendar Year Deductible $500 Individual / $1,000 Family per calendar year Does not apply to PPO physician office visits, PPO preventive care or hospital emergency room charges for an emergency medical

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

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

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

Outline of Medicare Supplement Coverage

Outline of Medicare Supplement Coverage Outline of Medicare Supplement Coverage for Vermont residents Medicare supplement benefit plans with Dental and Vision: A, F, High Deductible F, K, and N Humana Reader s Digest Healthy Living Medicare

More information

Large group benefit comparison

Large group benefit comparison Large group benefit comparison effective January 1, 2015 A guide to choosing the right plan for your business San Diegans choose Health Plan With a range of plans and provider networks, we have the right

More information

Key Advantage With Expanded Benefits Benefits Summary

Key Advantage With Expanded Benefits Benefits Summary Key Advantage With Expanded Benefits Benefits Summary Effective July 1, 2008 or October 1, 2008 Benefit Highlights How The Plan Works.......................................... 1 Summary Of Benefits..........................................

More information

2015 OPEN ENROLLMENT MEDICAL PLANS

2015 OPEN ENROLLMENT MEDICAL PLANS 2015 OPEN ENROLLMENT MEDICAL PLANS Table of Contents Section I. Enrollment Guidelines Page 3 Health Plan Comparison Chart Page 4 Health Plan Premiums and Employee Cost-Sharing Page 5 Section II. Blue Shield

More information

2016 Retiree Open Enrollment Benefits Briefing Non Medicare

2016 Retiree Open Enrollment Benefits Briefing Non Medicare 2016 Retiree Open Enrollment Benefits Briefing Non Medicare October 28: Bankhead Theater, Livermore October 29: The Grand Theater, Tracy LLNL-PRES-678554 This work was performed under the auspices of the

More information

Your Plan: Anthem Gold HMO 500/20%/5000 Your Network: California Care HMO

Your Plan: Anthem Gold HMO 500/20%/5000 Your Network: California Care HMO Your Plan: Anthem Gold HMO 500/20%/5000 Your Network: California Care HMO This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This summary does not

More information

Health Plans Comparison Chart

Health Plans Comparison Chart Health Plans Comparison Chart PPO Deductible Coinsurance (Plan pays) Annual Out-of-Pocket Maximum (Medical) (all medical s, deductibles and coinsurance for covered services will apply. Once limit is met,

More information

Coverage Comparison Chart

Coverage Comparison Chart Coverage Comparison Chart Premera Blue Cross $500 Deductible/$1000 Deductible/CDHP Deductible PPO Plans $500-Deductible PPO Alaska Plan $1,000-Deductible PPO Alaska Plan CDHP $1,500-Deductible HSA-qualifed

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

COMPARISON OF BENEFITS* FOR CITY OF EUGENE AFSCME-REPRESENTED EMPLOYEES

COMPARISON OF BENEFITS* FOR CITY OF EUGENE AFSCME-REPRESENTED EMPLOYEES COMPARISON OF BENEFITS* FOR CITY OF EUGENE AFSCME-REPRESENTED EMPLOYEES Effective July 1, 2016 Medical/Vision/Pharmacy coverage is administered by PacificSource Health Plans Dental coverage is administered

More information

Anthem BCBS PPO 80/60. Network Out-of-Network Network Out-of-Network Network Out-of-Network $1,750 per person. $2,500 per person $5,000 per family

Anthem BCBS PPO 80/60. Network Out-of-Network Network Out-of-Network Network Out-of-Network $1,750 per person. $2,500 per person $5,000 per family Plan PPO 90/70 PPO 80/60 PPO 75/50 Annual Medical Deductible Network Out-of-Network Network Out-of-Network Network Out-of-Network $250 per person $500 per person $500 per person $1,000 per person $900

More information

UMC Health Plan Operations Coverage Period: 01/01/2013-12/31/2013

UMC Health Plan Operations Coverage Period: 01/01/2013-12/31/2013 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.healthplanoperations@umchealthsystem.com or by calling

More information

Cigna Open Access Plans for Tennessee

Cigna Open Access Plans for Tennessee Individual & Family Plans Insured by Connecticut General Life Insurance Company Cigna Open Access Plans for Tennessee medical & PHARMACY INSURANCE with the ONE-AND-ONLY YOU IN MIND. 858436 a 12/12 Services

More information

BCN65 NONGROUP COVERAGE DISCLOSURES

BCN65 NONGROUP COVERAGE DISCLOSURES BCN65 NONGROUP COVERAGE DISCLOSURES BCN65 is not a supplemental product. It is not designed to fit with. It may not fit all of the gaps in and it may duplicate some benefits. If you are eligible for, review

More information

Insurance Benefits For Employees C H E S T E R F I E L D C O U N T Y P U B L I C S C H O O L S

Insurance Benefits For Employees C H E S T E R F I E L D C O U N T Y P U B L I C S C H O O L S CCPS Insurance Benefits For Employees 2015 C H E S T E R F I E L D C O U N T Y P U B L I C S C H O O L S CHESTERFIELD COUNTY PUBLIC SCHOOLS BENEFITS DEPARTMENT Enrollment or Changes in Coverage 748-1226,

More information

SUMMARY!OF!BENEFITS!

SUMMARY!OF!BENEFITS! SUMMARY!OF!BENEFITS!! BASIC!PLAN! COMPREHENSIVE! Policy Year Maximum Unlimited Unlimited Out-of-Pocket Limit OUTPATIENT!BENEFITS! Doctor s Visits Most Primary Care office visits at SHC are provided at

More information

Final. $2,500 per member $5,000 per family

Final. $2,500 per member $5,000 per family Final PPO PPO Medical, Rx, Dental Core, Dental Buy Up Benefits-at-a-Glance City of Pontiac Group Number: 71489 Deductible, Copays/Coinsurance and Dollar Maximums Deductible - per calendar year Copays/Coinsurance

More information

2Page 2 of 11. Baker Hughes Incorporated. Benefits At A Glance International Plan Policy#: 05679B

2Page 2 of 11. Baker Hughes Incorporated. Benefits At A Glance International Plan Policy#: 05679B 2Page 2 of 11 Baker Hughes Incorporated Policy#: 05679B Baker Hughes, Inc. is offering Medical, Dental, Medical Evacuation and Repatriation benefits through Cigna Global Health Benefits to our employees.

More information

Grand Rapids Community College Benefit Comparison

Grand Rapids Community College Benefit Comparison Deductible Applies - $100 for Single and $200 for Family (Deductible does not apply to any 100% coverage) (Not Available for Meet & Confer Group) Deductible Out of Network Only - $250 for Single and $500

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

Northeastern University 2015 Medical Benefits

Northeastern University 2015 Medical Benefits Northeastern University 2015 Medical Benefits Northeastern s 2015 Open Enrollment Effective Date: January 1, 2015 2015 Medical Plan Options Blue Choice New England Core POS Plan New Plan Blue Choice New

More information

Blue Choice Silver PPO 004 Coverage Period: 01/01/2015-12/31/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs

Blue Choice Silver PPO 004 Coverage Period: 01/01/2015-12/31/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.bcbsil.com/member/policy-forms/ or by calling 1-800-538-8833.

More information

What is the overall deductible? Are there other deductibles for specific services? Is there an out-ofpocket

What is the overall deductible? Are there other deductibles for specific services? Is there an out-ofpocket Regence BlueShield: Regence Direct Gold with Dental, Vision, Individual Assistance Program Coverage Period: Beginning on or after 01/01/2014 Summary of Benefits and Coverage: What this Plan Covers & What

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

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

$0 See the chart starting on page 2 for your costs for services this plan covers. Are there other deductibles for specific

$0 See the chart starting on page 2 for your costs for services this plan covers. Are there other deductibles for specific This is only a summary. If you want more detail about your medical coverage and costs, you can get the complete terms in the policy or plan document at www.teamsters-hma.com or by calling 1-866-331-5913.

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

Administered by Capital BlueCross 1

Administered by Capital BlueCross 1 Administered by Capital BlueCross 1 PPO HRA Plan/Rx Plan This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at

More information

Anthem Blue Cross Preferred Provider Organization (PPO)

Anthem Blue Cross Preferred Provider Organization (PPO) Anthem Blue Cross Preferred Provider Organization (PPO) 1-877-687-0549 Call Monday through Friday from 8:30 a.m. to 7:00 p.m. Plan Highlights Medical Services at Discounted Rates Anthem Blue Cross has

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

Services and supplies required by Health Care Reform Age and frequency guidelines apply to covered preventive care Not subject to deductible if PPO

Services and supplies required by Health Care Reform Age and frequency guidelines apply to covered preventive care Not subject to deductible if PPO Page 1 of 5 Individual Deductible Calendar year $400 COMBINED Individual / Family OOP Calendar year $4,800 Individual $12,700 per family UNLIMITED Annual Maximum July 1 st to June 30 th UNLIMITED UNLIMITED

More information