OPERATING ENGINEERS HEALTH & WELFARE FUND BENEFIT PLANS SUMMARY COMPARISON FOR ACTIVE and RETIRED PARTICIPANTS
|
|
- Melvin Cobb
- 8 years ago
- Views:
Transcription
1 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.) Pre-Existing Condition Limitations If you choose your own doctor who is not contracted with Anthem Blue Cross the Plan will pay the following benefits according to Plan rules Individual $500 per ; maximum $1,500 per family (Applicable to Most Services) Out of Network $6,000 per individual; $12,000 per family The Plan will pay a maximum of $400,000 per individual per. Once met, you may enroll in an HMO for the remainder of that. January 1 st of the next year you may re-enroll in the F-F-S Plan If you use Anthem Blue Cross PPO providers, the Plan will pay the following benefits according to Plan rules Treatment must be rendered by a PPO contract provider and be a covered service Individual $250 per calendar year; maximum $750 per family (Applicable to Most Services) In-Network $3,000 per individual; $6,000 per family The Plan will pay a maximum of $400,000 per individual per. Once met, you may enroll in an HMO for the remainder of that. January 1 st of the next year you may re-enroll in the F-F-S Plan If you enroll in this plan you must use Kaiser facilities for all of your medical care If you enroll in this plan you must choose a participating medical group where you must go for all your medical care None None None $1,500 per Individual $3,000 for Two or More Family Members $1,500 per Individual $3,000 for Two Family members $4,500 for Three or More Family Members None None None None None None None None If you enroll in this plan, you must choose a participating medical group where you must go for all your medical care $6,500 per Individual
2 Operating Engineers Kaiser Permanente Plan PROFESSIONAL SERVICES: Office Visits Hospital Visits Plan pays $15 per visit. of 50 visits per Plan pays 100% of the contracted after a $20 co-pay per visit of 50 visits per $25 co-pay per visit $25 co-pay per visit $5 co-pay per visit $250 co-pay per admission $250 co-pay per admission Inpatient $100 co-pay per admission Outpatient $50 co-pay per admission Lab and X-Ray Therapy - Acupuncture, Biofeedback, Chiropractic & Physical Therapy (Note: The combined 26 visit limit on the FFS and PPO plans is a combined limit. You do not receive a separate benefit of 26 visits under each plan.) Speech Therapy Routine Physicals Surgeon Assistant Surgeon Anesthetist Urgent Care Services reasonable Plan pays $15 per visit with a combined limit of 26 visits per Plan pays $15 per visit of 52 visits per to a maximum of $150 for one annual routine physical Plan pays 20% of payable to primary surgeon for one or more assistant surgeons. Plan pays 10% of payable to primary surgeon for physician assistant services performed as an assistant surgeon (Only if surgery warrants an Assistant Surgeon) Chiro/PT - Plan pays 50% of the contracted Acupuncture/Biofeedback Plan pays 90% of the contracted after a $20 co-pay per visit All services have a combined limit of 26 visits per calendar year of 52 visits per to a maximum of $175 for one annual routine physical. (Only if surgery warrants an Assistant Surgeon) $10 co-pay per service $25 co-pay per visit (see Kaiser s Summary of Benefits for ) (see Health Net s Summary of Benefits of complete details) $5 co-pay per service $25 co-pay per visit No Charge $10 co-pay per visit $25 co-pay per visit $25 co-pay per visit $10 co-pay per visit $35 per occurrence $10 co-pay per visit. (see s Summary of Benefits for ) N/A $35.00 per occurrence $20 per occurrence within service area $40 per occurrence outside of service area
3 HOSPITAL SERVICES: Inpatient Care Semi-Private Room and Misc. Charges Outpatient Care Emergency Room Care Non Emergency covered Plan pays $15 for Emergency Room Visit, 70% of reasonable for Lab and X-ray services the negotiated contract the hospital s charge $ per admission $ per admission $ per admission $50 co-pay per visit Emergency Room Care Emergency related the hospital s charge $50 co-pay per visit Surgical Facility Inpatient Mental Health Care covered the contract negotiated contract. You are responsible for 10% of the negotiated contract. $250 co-pay per procedure of 45 days per $250 co-pay per occurrence of 30 days per $50 co-pay per occurrence $100 per admission of 30 days per Inpatient Alcohol and Substance Abuse Care covered negotiated contract. You are responsible for 10% of the negotiated contract. $250 per inpatient admission for detoxification. $100 co-pay per admission for transitional residential recovery services Detoxification only of $9,000 per Skilled Nursing Facility Plan pays 80% of reasonable. Limited to a 60 day maximum per Co-pay is 10% of the negotiated contract. 60 day maximum per of 60 days per, not to exceed 120 days in any 5 year period 100 days per benefit period 100 days per 100 days per
4 OTHER SERVICES: Ambulance reasonable Plan pays 80% of the contract $50 per trip $50 per trip $50 per trip Hearing Aids Plan pays 100% to a maximum of $1,000 per aid (x2), once every 3 years See Fee-for-Service Plan option Not covered Not covered Not covered Durable Medical Equipment reasonable not to exceed purchase price Plan pays 90% of the contract not to exceed purchase price In accordance with formulary Covered on a case by case basis Prosthetic Appliances reasonable Plan pays 90% Plan pays $200 per device with a lifetime maximum of $10,000, including repairs
5 PRESCRIPTION DRUGS: Contract Prescription Card Walk-in (30 Day Supply) At contracting pharmacies your copay is $10 for a generic drug. For a preferred brand name drug with NO generic equivalent your co-pay is $25. For a non-preferred brand name drug with NO generic equivalent your co-pay is $40. For a brand name drug WITH a generic equivalent you pay the applicable copay $25 or $40 plus 50% of the difference in price between the brand drug and the generic drug At contracting pharmacies your co-pay is $10 for a generic drug. For a preferred brand name drug with NO generic equivalent your co-pay is $25. For a non-preferred brand name drug with NO generic equivalent your co-pay is $40. For a brand name drug WITH a generic equivalent you pay the applicable copay $25 or $40 plus 50% of the difference in price between the brand drug and the generic drug For generic drugs at plan pharmacies you pay $10 for up to a 30 day supply, $20 for a 31 to 60 day supply, or $30 for a 61 to 100 day supply For brand drugs at plan pharmacies you pay $20 for up to a 30 day supply, $40 for a 31 to 60 day supply or $60 for a 61 to 100 day supply At Plan pharmacies you pay $10 for a generic drug on the Health Net recommended drug list (RDL). For a RDL brand name drug you pay $30. For a drug not listed on the RDL you pay 50% of the drug cost At Plan pharmacies you pay $7 for a preferred generic drug. For a preferred brand name drug with NO generic equivalent you pay $30 Non preferred generic or nonpreferred brand $50 per prescription Contract Prescription Card Mail Order (90 Day Supply) Fee-For-Service Prescription Drug Plan (Drug store of your choice) At contracting pharmacies your copay is $25 for a generic drug. For a preferred brand name drug with NO generic equivalent your co-pay is $ For a non-preferred brand name drug with NO generic equivalent your co-pay is $100. For a brand name drug WITH a generic equivalent you pay the applicable copay $62.50 or $100 plus 50% of the difference in price between the brand drug and the generic drug Plan pays 80% of reasonable after satisfaction of deductible. You may obtain a max of 60 days of any one drug, after that you must use the contracting pharmacies for additional refills. Continued purchases at NON contract pharmacies will be denied At contracting pharmacies your co-pay is $25 for a generic drug. For a preferred brand name drug with NO generic equivalent your co-pay is $ For a non-preferred brand name drug with NO generic equivalent your co-pay is $100. For a brand name drug WITH a generic equivalent you pay the applicable copay $62.50 or $100 plus 50% of the difference in price between the brand drug and the generic drug Plan pays 80% of reasonable after satisfaction of deductible. You may obtain a max of 60 days of any one drug, after that you must use the contracting pharmacies for additional refills. Continued purchases at NON contract pharmacies will be denied For generic drugs through mail order you pay $10 for up to a 30 day supply or $20 for a 31 to 100 day supply You pay twice the applicable co-pay as outlined above Not applicable Not applicable Not applicable You pay twice the applicable co-pay as outlined above
6 United Concordia Advantage Plan - DPPO United Concordia Concordia Plus - DHMO Delta Dental PMI DHMO DENTAL/ORTHODONTIA CARE: Deductible Dental Coverage $25 per person, per, $75 per family per (Combined dental/orthodontia deductible) Plan pays 100% of the non contract fee schedule. (approx. 60% of cost) Any balance remaining is patient co-pay Benefit maximum of $6,000 in any two (2) year period, per person $25 per person, per, $75 per family per (Combined dental/orthodontia deductible) Plan pays 100% Benefit maximum of $6,000 in any two (2) year period, per person Dental Services: $25 per person, per, $75 per family per Orthodontic Services: $100 per person, per, $300 per family per Plan pays 100% In- Network Plan pays 50% Out-of- Network Calendar Year Benefit : $3,000 In-Network/Per Person $1,000 Out-of- Network/Per Person No deductible Plan pays 100% on most covered services coverage and copay s No deductible coverage and copay s Orthodontia Coverage Plan pays 50% of up to a lifetime maximum benefit of $2,000 Dependent Children only Plan pays 50% up to $995. Co-pay is also 50% up to $995 Lifetime maximum benefit of $2,000 Dependent Children only Plan pays 50% In and Out-of-Network Lifetime maximum benefit of $2,000 in and Out-of-Network Dependent Children only coverage and copay s Dependent Children and Adults coverage and copay s Dependent Children and Adults
7 VISION CARE: Eye Examination $15 deductible See Fee-For-Service Plan benefits $25 co-pay per visit $25 co-pay per visit Not Covered See Fee for Service Plan benefits Exam covered once every 12 months Eye Lenses / Frames Lenses covered once every Lenses covered once every Lenses covered once every Lenses covered once every Lenses covered once every Frames covered once every Frames covered once every Frames covered once every Frames covered once every Frames covered once every lenses every for a $65 co-pay lenses every for a $65 co-pay lenses every for a $65 co-pay lenses every for a $65 co-pay lenses every for a $65 co-pay SPECIAL NOTES: Limitations and Exclusions. Please refer to your Plan Booklet for
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 informationRETIRED LABORERS HEALTH AND WELFARE PLAN - COMPARISON OF BENEFITS - EFFECTIVE SEPTEMBER 1, 2015 LABORERS
When You Can Change Plans Type of Plan Geographical Area Covered Choice of Physicians Specialized Care: In-Network Outside Network Out-of-Area Care Claim Forms Annual Deductible RETIRED HEALTH AND WELFARE
More informationCalifornia 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 informationKAISER 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 informationCarpenters 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 informationFee-for-Service. Medicare Supplemental Retiree Health Plans
Sheet Metal Workers Health Plan of Southern California, Arizona & Nevada April 2011 Summary Comparison Of Benefits Available under the Fee-for-Service and Medicare Supplemental Retiree Health Plans Important:
More informationWhen 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 informationBenefits 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 informationYour 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 informationOperating 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 informationHealth 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 informationYour 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 informationMedical Plan Comparison - Retirees Age 65 or Over
* Plan Type Medicare Cost Plan with Prescription Coordinates with Medicare and includes Medicare prescription drug program Medicare Cost Plan with Prescription Medicare Advantage Plan with Prescription
More informationHealth 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 informationBenefit 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 informationBenefit 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 informationService AvMed Cigna Leon Cares Humana HMO Humana PPO UnitedHealthcare. Out-of- Network
2016 Medicare Advantage Plans Comparison Chart This comparison chart is a side-by-side representation of services offered through the AvMed, Cigna, UHC, and Humana Medicare Advantage Plans for both in-network
More information2015 IBM Health Benefit Comparison Charts for IBM Active Employees
2015 IBM Health Benefit Comparison Charts for IBM Active Employees These Health Benefit Comparison Charts provide a summary overview of the coverage available for medical, mental health/substance care
More information2013 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 informationSTATE 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 information2015 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 informationYour 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 informationYour Plan: Value HMO 25/40/20% (RX $10/$30/$45/30%) Your Network: Select Plus HMO
Your Plan: Value HMO 25/40/20% (RX $10/$30/$45/30%) Your Network: Select Plus HMO This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This summary
More informationCarpenters 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 informationImportant 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 informationRETIREE OPEN ENROLLMENT 2014
RETIREE OPEN ENROLLMENT 2014 The month of August 2014 is open enrollment for eligible retirees to switch from one retiree health plan to another. Open enrollment is also the time when you are allowed to
More information2015 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 informationAVMED 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 informationSherwin-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 informationLesser 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 informationAnthem 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 informationS 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 informationCALIFORNIA. Kaiser Permanente Student Health Plan. Comparison charts
CALIFORNIA Kaiser Permanente Student Health Plan Comparison charts 1 Protect your students with award-winning integrated care Offer your students and their dependents a health plan with broad coverage
More informationWhat is the overall deductible? Are there other deductibles for specific services?
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.anthem.com/cuhealthplan or by calling 1-800-735-6072.
More informationLos Rios Community College District KAISER PERMANENTE
Los Rios Community College District KAISER PERMANENTE GROUP # 602838: Early Retiree DHMO Plan (under age 65 or over 65 w/o Medicare A & B) Senior Advantage (age 65+ with Medicare A & B) In order to continue
More informationMAYFLOWER MUNICIPAL HEALTH GROUP ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ PPO REVIEW OF BENEFITS
Fiscal Year 2015 2016 MAYFLOWER MUNICIPAL HEALTH GROUP ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ PPO REVIEW OF S ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
More informationS 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 informationSUMMARY OF BENEFITS. Out-of-Network Care: $10,000 per policy year
OUTPATIENT BENEFITS Most Primary Care office visits at SHC are provided at no charge. This is not an insured benefit but is provided by NYU to all matriculated students including students who waive the
More informationSOUTHERN CALIFORNIA DRUG BENEFIT FUND
PLATINUM PLUS PLAN SUMMARY As of January 1, 2012 This group health plan believes this plan is a "grandfathered health plan" under the Patient Protection and Affordable Care Act (the Affordable Care Act).
More informationSUMMARY!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 informationImportant Questions Answers Why this Matters:
HealthKeepers Anthem HealthKeepers 20 POS / $10/$20/$35/20% Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 01/01/2015-12/31/2015 Coverage For: Individual/Family
More informationPace 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 informationNATIONAL 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 information2016 Summary of Benefits
2016 Summary of Benefits Health Net Violet Option 3 (PPO) Douglas and Josephine counties, OR Benefits effective January 1, 2016 H5520 Health Net Life Insurance Company H5520_2016_0202 CMS Accepted 09162015
More informationSUMMARY 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 informationHEALTH PLAN COMPARISON
City of San José HEALTH PLAN COMPARISON For Employees Represented by AEA, AMSP, CAMP, CEO, IAFF, IBEW, MEF and OE#3 SERVICE Kaiser Permanente Blue Shield HMO QUESTIONS ABOUT PLAN DESIGN AND PROVIDER NETWORKS
More informationFIRSTCAROLINACARE INSURANCE COMPANY 2015 Summary of Benefits. FirstMedicare Direct PPO Plus (PPO)
FIRSTCAROLINACARE INSURANCE COMPANY 2015 Summary of Benefits FirstMedicare Direct PPO Plus (PPO) Chatham, Hoke, Lee, Montgomery, Moore, Richmond, Scotland Counties 1 P age SECTION I - INTRODUCTION TO SUMMARY
More informationAnthem 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 informationThe 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 informationYou can see the specialist you choose without permission from this 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 www.cvtrust.org or by calling 1-800-288-9870. Important Questions
More informationBRYN 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 informationKraft Foods Group, Inc. Retiree Medical and Prescription Plan Summary High Deductible Health Plan
General Provisions Deductible (eligible medical and prescription drug expenses apply to the deductible) Kraft Foods Group, Inc. Retiree Medical and Prescription Plan Summary Care can be obtained in-network
More informationSummary 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 informationMedical Benefits Analysis
Medical Benefits Analysis (Active and Retired Under Age 65) Insurance Plan Health Net 5KF Kaiser Maximum Lifetime Benefit Deductible Maximum Out-of-Pocket Hospitalization Outpatient Surgery Emergency Room
More informationSummary of Benefits Community Advantage (HMO)
Summary of Benefits Community Advantage (HMO) January 1, 2015 - December 31, 2015 This booklet gives you a summary of what we cover and what you pay. It doesn't list every service that we cover or list
More informationSenate Bill 91 (2011) Standard Plan - EHB and Cost Share Matrix - Updated for 2016 ***NOT INTENDED AS A STATEMENT OF COVERAGE***
Deductible Medical: $1,250; Medical: $2,500; Integrated Medical/Rx: Rx: $0 Rx: $0 $5,000 Maximum OOP Combined Medical Combined Medical Combined Medical and and Drug: $6,350 and Drug: $6,350 Drug: $6,350
More informationAetna Medicare Advantage HMO SHBP 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.state.nj.us/treasury/pensions/health-benefits.shtml or
More informationImportant Questions Answers Why this Matters:
Anthem BlueCross BlueShield Blue Access PPO Option D58 / Rx Option 8 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 12/01/2013-11/30/2014 Coverage For: Individual/Family
More informationLOCKHEED 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 informationIn-network: $5,000 per insured/ $10,000 per family per calendar year. Out-of-network: $10,000 per insured / $20,000
Regence BlueShield of Idaho: Coverage Period: Beginning on or after 01/01/2014 Regence Individual Direct Bronze HSA Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for:
More informationIt Pays to Think Ahead. 2014 Benefit Summary
It Pays to Think Ahead. 2014 Benefit Summary Benefits Overview Aurora Public Schools is proud to offer a comprehensive benefits package to eligible employees. The complete benefit package is briefly summarized
More informationFind the plan that s right for you
Take a glance at what our plans have to offer Plans at a glance for s and families Effective January 1, 2014 Find the plan that s right for you Our easy-to-understand plans offer comprehensive benefits
More information[2015] SUMMARY OF BENEFITS H1189_2015SB
[2015] SUMMARY OF BENEFITS H1189_2015SB Section I You have choices in your health care One choice is to get your Medicare benefits through Original Medicare (fee-for-service Medicare). Original Medicare
More informationYour Plan: Anthem Gold PPO 500/20%/4500 Your Network: Prudent Buyer PPO
Your Plan: Anthem Gold PPO 500/20%/4500 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 not reflect
More informationMassachusetts Laborers' Health Fund: Plan A Summary of Benefits and Coverage: What this Plan Covers & What it Costs
Massachusetts Laborers' Health Fund: Plan A Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 01/01/2015-12/31/2015 Coverage for: Individual + Family Plan Type: PPO
More informationHealth Plan Comparison Chart
Page 1 of 6 Health Plan Comparison Chart Background Information Outpatient Services Inpatient Services Prescription Drug Coverage Other Services The data provided in the chart below is for the 2015 plan
More informationGateway Health Medicare Assured RubySM (HMO SNP) $6,700 out-of-pocket limit for Medicare-covered services. No No No No. Days 1-6: $0 or $225 copay per
Assured RubySM (HMO Premium $0 monthly plan $0 - $33.90 monthly plan Assured GoldSM (HMO $12.40 - $46.30 monthly plan $43.90 - $77.80 monthly plan In Network Maximum Out-of-Pocket $3,400 out-of-pocket
More informationLEGACY 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 informationWestern Health Advantage: City of Sacramento HSA ABHP Coverage Period: 1/1/2016-12/31/2016
Coverage For: Self Plan Type: HMO 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.westernhealth.com or
More informationWhat is the overall deductible? $250 per person/$500 per family. Are there other deductibles for specific services? No.
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.etf.wi.gov or by calling 1-877-533-5020. Important Questions
More information2015 Summary of Benefits
2015 Summary of Benefits Effective January 1, 2015, through December 31, 2015 H3909 Y0041_H3909_PC_15_18889 Accepted 09/01/2014 Section I: Introduction to Summary of Benefits You have choices about how
More informationIndependent Health s Medicare Passport Advantage (PPO)
Independent Health s Medicare Passport Advantage (PPO) (a Medicare Advantage Preferred Provider Organization Option (PPO) offered by INDEPENDENT HEALTH BENEFITS CORPORATION with a Medicare contract) Summary
More informationLGC HealthTrust: MT Blue 5-RX10/20/45 Coverage Period: 07/01/2013 06/30/2014 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.anthem.com or by calling 1-800-870-3057. Important Questions
More informationAnnual Notice of Changes for 2014
Blue Medicare HMO SM Standard offered by Blue Cross and Blue Shield of North Carolina (BCBSNC) Annual Notice of Changes for 2014 You are currently enrolled as a member of Blue Medicare HMO Standard. Next
More informationSummary of PNM Resources Health Care Benefits Active Employees 2011
of PNM Resources Health Care Benefits Active Employees 2011 The following charts show deductibles, limits, benefit levels and amounts for the PNM Resources medical, dental and vision programs. For more
More informationHealthy Benefits HMO 6850.0
Coverage Period: Beginning on or after 1/1/2016 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 https://www.capbluecross.com/sbcsia
More information2016 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 informationAdditional 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 informationImportant Questions Answers Why this Matters:
Anthem Blue Cross Life and Health Insurance Company Unify: PPO Coverage Period: 01/01/2015 12/31/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual/Family
More informationSchedule of Medical Benefits: State Participants 2015
I. Schedule of Medical Benefits Schedule of Medical Benefits: State Participants 2015 All benefits are paid according to the terms of the Master Contract between the Health Plan and Pharmacy Benefit Manager
More information2015 Summary of Benefits
2015 Summary of Benefits Effective January 1, 2015, through December 31, 2015 H3952 Y0041_H3952_KS_15_18734 Accepted 09/01/2014 Section I: Introduction to Summary of Benefits You have choices about how
More informationYour Plan: Premier HMO 20/200A/100 OP Your Network: California Care HMO
Your Plan: Premier HMO 20/200A/100 OP 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 reflect
More informationSummary of Benefits January 1, 2016 December 31, 2016. FirstMedicare Direct PPO Plus (PPO)
Summary of Benefits January 1, 2016 December 31, 2016 FIRSTCAROLINACARE INSURANCE COMPANY FirstMedicare Direct PPO Plus (PPO) Chatham, Hoke, Lee, Montgomery, Moore, Richmond, Scotland Counties This booklet
More informationImportant Questions Answers Why this Matters:
Anthem BlueCross Premier HMO 20 / $10/$25/$45/20% Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 01/01/2014-12/31/2014 Coverage For: Individual/Family Plan Type:
More informationAnthem Blue Cross Life and Health Insurance Company University of California San Francisco Custom Premier PPO 200/20 (200/20/80/60)
Anthem Blue Cross Life and Health Insurance Company University of California San Francisco Custom Premier PPO 200/20 (200/20/80/60) Summary of Benefits and Coverage: What this Plan Covers & What it Costs
More informationBlueSelect Silver ValueTwo for Individuals
BlueSelect Silver ValueTwo for Individuals Coverage Period: 1/1/2015-12/31/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Single Plan Type: PPO This is only
More informationBlue Cross Blue Shield: Select 6350 Package VH, a Multi-State Plan Coverage Period: 01/01/2014-12/31/2014
Blue Cross Blue Shield: Select 6350 Package VH, a Multi-State Plan Coverage Period: 01/01/2014-12/31/2014 Summary of Coverage: What this Plan Covers & What it Costs Coverage for: Individual or Family Plan
More informationPPO 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 informationPLAN DESIGN AND BENEFITS POS Open Access Plan 1944
PLAN FEATURES PARTICIPATING Deductible (per calendar year) $3,000 Individual $9,000 Family $4,000 Individual $12,000 Family Unless otherwise indicated, the Deductible must be met prior to benefits being
More information!"#$%$&!"'()*+,-".-,/ &01*+("12"31+4156"$,+0"!*7("819".5(<(/4*<("&,5( :(()";(,-40"&,5( !"#$%$&!",/)"'()*+,5(
submitted anytime during the year to your institution HR/Benefits Office, and the tobacco premium will be waived beginning the first of the month following submission of the form. Important: A member is
More informationImportant Questions Answers Why this Matters: What is the overall deductible? Are there other deductibles for specific services?
: VIVA HEALTH Access Plan Coverage Period: 01/01/2015 12/31/2015 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
More informationCigna 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 informationWhat 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 informationThis 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
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.kaiserpermanente.org or by calling 1-800-464-4000. Important
More information$0 See the chart starting on page 2 for your costs for services this plan covers. Are there other. deductibles for specific No.
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at capbluecross.com or by calling 1-800-730-7219. Important
More informationSCHEDULE OF BENEFITS. Group Access Care Comprehensive Health Insurance Policy
SCHEDULE OF BENEFITS Classes of Employees Insured: [Class 1 All Active Full-Time Indian Employees] [Monthly Premium Rates: Individual - [$ 398.34] Two-Person [$796.68] Family Coverage [$1,210.66]] Benefit
More informationUniversity 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 information2016 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 informationKaiser Permanente: Platinum 90 HMO
Kaiser Permanente: Platinum 90 HMO Coverage Period: Beginning on or after 01/01/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual/Family Plan Type: HMO
More information