Kaiser Permanente Sample Fee List
|
|
|
- Janice Paul
- 7 years ago
- Views:
Transcription
1 Kaiser Permanente Sample Fee List SOUTHERN CALIFORNIA As your partner in health, we want to help you better manage your care. Staying on top of your finances, related to how much you spend on health care, helps give you peace of mind so you can concentrate on the things in life you enjoy. This Sample Fee List shows estimated member charges for some commonly used medical services such as office visits, lab tests, X-rays, and prescription medicines when provided at Kaiser Permanente medical centers, medical offices, pharmacies, and other facilities. When you receive care or services from a provider at a non Kaiser Permanente facility, even if the provider is under contract to provide services for Kaiser Permanente members, the charges may be different. The amount of charges you pay out of your own pocket will depend on your plan coverage and on things such as whether or not your provider is a Kaiser Permanente practitioner. And your benefit plan may cover services at different levels of copayment or coinsurance. Use this Sample Fee List for Southern California to help you: Estimate your out-of-pocket medical spending for the coming year based on the care and services you expect to use from our facilities. Manage your Health Savings Account (HSA) or Health Reimbursement Account (HRA) balance if you re enrolled in a Kaiser Permanente HSA Qualified Deductible HMO Plan or Kaiser Permanente Deductible HMO Plan with HRA. (These products are not available in all regions. Contact our Member Service Call Center for information about availability in your area.) Plan for unexpected health care costs. Review your benefit options during open enrollment. (You may want to choose another Kaiser Permanente benefit option that better fits your needs at this time.) Estimate the funds you may need for your flexible spending account, if applicable. For more information about our charges not related to prescription drugs or for questions about a service that s not listed, contact our Deductible Products Service Team at , Monday through Friday, from 7 a.m. to 5 p.m. For more information about prescription drug charges, call the Kaiser Permanente pharmacy near you. You ll find our pharmacies phone numbers listed on the member section of our Web site at kp.org, in Your Guidebook to Kaiser Permanente Services, or a particular phone number on the label of your prescription filled at one of our pharmacies. The estimated member charges in the Sample Fee List are valid as of January 2009 and are subject to change without notice. 1
2 Office visits (outpatient) Office visit that includes a problem-focused history, exam, and simple medical decision for a new patient Office visit that includes an expanded problem-focused history, exam, and simple medical decision for a new patient Office visit that includes a detailed history, exam, and low complex medical decision for a new patient Office visit that includes a comprehensive history, exam, and moderately complex medical decision for a new patient Office visit that includes a comprehensive history, exam, and highly complex medical decision for a new patient Office visit by a nonphysician provider for a minimal problem for an established patient Office visit that includes a problem-focused history, exam, and simple medical decision for an established patient Office visit that includes an expanded problem-focused history, exam, and low complex medical decision for an established patient Office visit that includes a detailed history, exam, and moderately complex medical decision for an established patient Office visit that includes a comprehensive history, exam, and highly complex medical decision for an established patient $40 $70 $105 $160 $200 $25 $45 $70 $105 $140 Office visits (wellness) Well-baby office visit, new patient (under 1 year)* $130 Well-child office visit, new patient (1 11 years)* $135-$140 Well-child office visit, new patient (12 17 years)* $145 Well-adult office visit, new patient (18-39 years)* $145 Well-adult office visit, new patient (40 64 years)* $170 Well-adult office visit, new patient (65 and older)* $185 Well-baby office visit, established patient (under 1 year)* $100 Well-child office visit, established patient (1 11 years)* $110-$115 Well-child office visit, established patient (12 17 years)* $120 *These services are typically covered at a copayment level and not subject to the deductible. For information about your coverage, please see your Evidence of Coverage. Emergency care by a physician (excluding other fees such as X-rays, lab tests, or additional procedures) Emergency care by a physician $110 Emergency care by a physician, routine $165 Emergency care by a physician, complex $240 Emergency care by a physician, extensive $360 2
3 Psychotherapy visits Group psychological therapy $37 Managing mental health drugs $62 Therapy $112 Eye examinations Eye exam, routine visit, new patient $95 Eye exam and treatment, new patient $170 Eye exam, routine visit, established patient $90 Eye exam and treatment, established patient $133 Vision screening test $21 Hearing services Comprehensive audiometry evaluation $73 Ear cleaning $69 Eardrum test $32 Hearing screening test (pure tone, air only) $20 Physical therapy services Electric stimulation therapy, treatment only $20 Physical therapy evaluation $95 Physical therapy exercises, treatment only $37 Physical therapy, hot and cold application, treatment only $11 Physical therapy, ultrasound, treatment only $16 Vaccines and other injections Allergy shot $20 Chickenpox vaccine* $90 Diphtheria, tetanus booster vaccine* $17 Diphtheria, tetanus, pertussis vaccine* $12 Flu shot, children (3 years and older)* $12 Flu shot, infants* $11 Hepatitis B vaccine* $100 Measles, mumps, and rubella vaccine* $54 Pneumococcal vaccine* $96 Polio vaccine* $30 (continues) 3
4 Vaccines and other injections (continued) Rubella vaccine* $23 Therapeutic injection (administration only, does not include medication)* $28 Therapeutic IV injection (administration only, does not include medication)* $26 *These services are typically covered at a copayment level and not subject to the deductible. For information about your coverage, please see your Evidence of Coverage. Tests and procedures Breathing capacity test $49 Breathing treatment $17 Colonoscopy and removal of abnormal tissue using cautery $629 Colonoscopy and removal of abnormal tissue using snare technique $719 Colonoscopy and removal of colon tissue for examination $639 Diagnostic colonoscopy $544 Diagnostic proctosigmoidoscopy $107 Diagnostic sigmoidoscopy $181 Draining fluid from around swollen joint $97 EKG $35 Fetal monitoring $60 Removal of abnormal areas of skin $12 Sigmoidoscopy and removal of tissue for examination $235 Skin biopsy $112 Stress test $153 Surgically destroying an abnormal area of skin $70 Ultrasound test of heart $280 X-rays, CT scans, and other imaging studies CT scan of chest, including dye $500 CT scan of pelvis, including dye $483 CT scan of pelvis, without dye $420 CT scan of sinus and nasal passages $528 CT scan of stomach area with dye $518 CT scan of stomach area, without dye $439 Mammogram $150 Mammogram (one side) $120 Mammogram (screening) $125 Pregnancy ultrasound $202 (continues) 4
5 X-rays, CT scans, and other imaging studies (continued) Review of CT scan of the head or brain $354 Ultrasound of breast $113 Ultrasound of pelvis $170 Ultrasound of stomach area $191 Vaginal ultrasound $180 X-ray for osteoporosis $195 X-ray of abdomen (complete) $80 X-ray of ankle $50-$55 X-ray of both knees $50 X-ray of chest $50-$65 X-ray of finger $40 X-ray of foot $50-$55 X-ray of hand $50-$55 X-ray of hip $66 X-ray of knee $55 X-ray of knee (complete) $72 X-ray of lower back bones $70 X-ray of neck $99 X-ray of neck bones $72 X-ray of shoulder $66 X-ray of stomach area (one view) $57 X-ray of wrist $50-$55 Laboratory tests Albumin test $10 Alkaline phosphatase test $10 Allergy test $10 ALT test $10 Amylase test $12 AST test $10 Bilirubin test (total) $10 Blood antibody test $8 Blood clotting test $10 Blood sugar test, diagnostic $10 Blood sugar test, monitoring $20 (continues) 5
6 Laboratory tests (continued) Calcium test (total) $10 Cholesterol level test $10 Complete blood count $15 Creatinine test $10 Hepatitis B surface antigen test $21 Hepatitis C test $26 Kidney function test $10 Laboratory chemistry test for creatine kinase $15 Lipid panel test $26 Magnesium test $15 Pap test, cervical cancer screening $21 Phosphorus test $10 Potassium test $10 Pregnancy test $16 Prostate test $37 Sodium test $10 Strep A swab test $40 Test for blood in stool $5 Test for genital warts $70 Thyroid stimulating hormone test $32 Urine bacteria colony count $16 Urine test (complete) $5 Urine test (dipstick only) $5 Urine test (microanalysis only) $5 6
7 CHARGE PER PRESCRIPTION FOR TOP 50 MEDICATIONS DRUG DESCRIPTION QUANTITY Acetaminophen/Codeine 300/30mg tablet (generic Tylenol with Codeine) 100 $20 Amoxicillin 400mg/5ml suspension 100ml bottle 1 $16 Amoxicillin 500mg capsule (generic Amoxil) 30 $10 Atenolol 25mg tablet (generic Tenormin) 100 $11 Atenolol 50mg tablet (generic Tenormin) 100 $11 Azithromycin 250mg tablet (generic Zithromax) 6 $67 Cephalexin 500mg capsule (generic Keflex) 40 $16 Ciprofloxacin hydrochloride 500mg tablet (generic Cipro) 20 $16 Cyclobenzaprine 10mg tablet (generic Flexeril) 30 $14 Doxycycline hyclate 100mg tablet (generic Vibratab) 20 $12 Estradiol 1mg tablet (generic Estrace) 100 $21 Famotidine 40mg tablet (generic Pepcid) 100 $25 Fluoxetine hydrochloride 10mg capsule (generic Prozac) 100 $25 Fluoxetine hydrochloride 20mg capsule (generic Prozac) 100 $19 Fluticasone propionate 50mcg nasal spray solution, 16 gram inhaler (generic Flonase) 2 $44 Glipizide 5mg tablet (generic Glucotrol) 100 $20 Glipizide 10mg tablet (generic Glucotrol) 100 $19 Guaifenesin with Codeine syrup 240ml bottle (generic Robitussin AC) 1 $13 Hydrochlorothiazide 25mg tablet (generic Esidrix) 100 $11 Hydrocodone/Acetaminophen 10/325mg tablet (generic Vicodin) 60 $31 Hydrocodone/Acetaminophen 5/500mg tablet (generic Vicodin) 100 $19 Ibuprofen 600mg tablet (generic Motrin) 100 $11 Ibuprofen 800mg tablet (generic Motrin) 100 $18 Lantus Solostar Injection, 3ml pen 10 $349 Levitra 20mg tablet 8 $111 Levora 0.15mg/30mcg 28 day pack tablet 84 $63 Levothroid 100mcg tablet (generic Synthroid) 100 $29 Lisinopril 5mg tablet (generic Prinivil or Zestril) 100 $20 Lisinopril 10mg tablet (generic Prinivil or Zestril) 100 $25 Lisinopril 20mg tablet (generic Prinivil or Zestril) 100 $21 Lisinopril 40mg tablet (generic Prinivil or Zestril) 100 $26 (continues) 7
8 DRUG DESCRIPTION (continued) QUANTITY Lorazepam 1mg tablet (generic Ativan) 30 $13 Lovastatin 40mg tablet (generic Mevacor) 100 $28 Metformin hydrochloride 500mg tablet (generic Glucophage) 100 $19 Metformin hydrochloride 1000mg tablet (generic Glucophage) 100 $47 Naproxen 500mg tablet (generic Naprosyn) 100 $29 Nasarel 0.025% nasal spray solution, 25gm inhaler 2 $51 Novolin N 100 u/ml (NPH insulin), 10ml vial 3 $72 Omeprazole 20mg capsule (generic Prilosec) 100 $61 Plavix 75mg tablet 100 $492 Prednisone 20mg tablet (generic Deltasone) 30 $10 Proair HFA aerosol, 8.5gm inhaler 1 $34 Simvastatin 20mg tablet (generic Zocor) 100 $28 Simvastatin 40mg tablet (generic Zocor) 100 $29 Simvastatin 80mg tablet (generic Zocor) 100 $38 SMZ-TMP double-strength 800/160mg tablet (generic Septra DS or Bactrim DS) 20 $16 Trazodone hydrochloride 50mg tablet (generic Desyrel) 100 $17 Triamterene/Hydrochlorothiazide 75/50mg tablet (generic Maxzide) 100 $11 Yasmin tablet 28 day cycle 3 $122 Zolpidem tartrate 10mg tablet (generic Ambien) 100 $44 Please recycle r98 8
Kaiser Permanente 2016 Sample Fee List *
Kaiser Permanente 2016 Sample Fee List * NORTHWEST What s a Sample Fee List? Knowing how much you can expect to pay for care and services can help give you peace of mind. As a deductible plan member, you
Kaiser Permanente 2016 Sample Fees List 1
Kaiser Permanente 2016 Sample Fees List 1 SOUTHERN CALIFORNIA Knowing how much you can expect to pay for care and services can give you peace of mind. This Sample Fees List shows you estimated fees for
Kaiser Permanente 2015 Sample Fee List 1 Members in any deductible plan can use this list to help estimate their charges.
Kaiser Permanente 2015 Sample Fee List 1 Members in any deductible plan can use this list to help estimate their charges. COLORADO As your partner in health, we want to help you manage your health care
Vantage Health Plan. Nationwide Coverage. Nationwide Care. Nationwide Service. 2016 OGB Medical Home HMO Plan. OGB Approved. VHP517 R090415 Approved
Vantage Health Plan 2016 OGB Medical Home HMO Plan Nationwide Coverage. Nationwide Care. Nationwide Service. VHP517 R090415 Approved OGB Approved Welcome to Vantage Dear OGB Member: Vantage Health Plan
CATEGORY AFSCME Comprehensive Plan OU PPO
APPENDIX B BENEFIT PLAN SUMMARY CHART CATEGORY AFSCME Comprehensive Plan OU PPO Premiums 2010-2011 Plan Year 2010-2011 Plan Year Annual Wages: $0 - $34,600 $13.50 EE only $24.00 EE + Child $24.00 EE +
MHDO CompareMaine Updated: 9/17/2015
Office Visits -- Adult Preventative Care Office Visit (or Wellness Office Visit) 99385 New patient preventive care visit for adult, ages 18 to 39 99386 New patient preventive care visit for adult, ages
SHIIP Combo Form. 1-855-408-1212 www.ncshiip.com. North Carolina Department of Insurance Wayne Goodwin, Commissioner
SHIIP Combo Form Seniors Health Insurance Information Program North Carolina Department of Insurance Wayne Goodwin, Commissioner 1-855-408-1212 www.ncshiip.com What is SHIIP? Seniors Health Insurance Information
An ANALYSIS of Medicare Benefits per the 2016 Medicare and You Handbook & The State of Delaware's Special Medicfill Plan Benefits
An ANALYSIS of Medicare Benefits per the 2016 Medicare and You Handbook & The State of Delaware's Special Medicfill Plan Benefits The chart below presents the list of benefits covered by Medicare, and
COVERAGE SCHEDULE. The following symbols are used to identify Maximum Benefit Levels, Limitations, and Exclusions:
Exhibit D-3 HMO 1000 Coverage Schedule ROCKY MOUNTAIN HEALTH PLANS GOOD HEALTH HMO $1000 DEDUCTIBLE / 75 PLAN EVIDENCE OF COVERAGE LARGE GROUP Underwritten by Rocky Mountain Health Maintenance Organization,
Michigan Electrical Employees Health Plan Benefits & Eligibility-at-a Glance Supplement to Medicare - Medicare Enrollees
Medicare Coverage BCBSM Supp Coverage Preventive Services 12 months, if age 50 and older Colonoscopy - one per calendar year 1 0 years (if at high risk every 24 months) approved amount**, once per flu
PREVENTIVE CARE SERVICES Detailed descriptions
PREVENTIVE CARE SERVICES Detailed descriptions How often and what kind of preventive care services you need depends upon your age, gender, health and family history. Not all items on this list are covered
Preventive health guidelines As of May 2014
To learn more about your plan, please see anthem.com/ca. To learn more about vaccines, please see the Centers for Disease Control and Prevention (CDC) website: cdc.gov. Preventive health guidelines As
[2015] SUMMARY OF BENEFITS H1189_2015SB
![[2015] SUMMARY OF BENEFITS H1189_2015SB](/thumbs/32/15705129.jpg "[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
$10.00 PRESCRIPTION PROGRAM DETAILS
$10.00 PRESCRIPTION PROGRAM DETAILS 1. The $10.00 program applies only to certain generic drugs at commonly prescribed 90 day usage dosages. (See list). 2. The Program may change without notification and
2016 Guide to Understanding Your Benefits
2016 Guide to Understanding Your Benefits Additional information about covered benefits available from Health Net Gold Select (HMO)Plan Riverside and San Bernardino counties, CA Lisa Pasillas-Le, Health
Member Services A Primary and Urgent Care Concierge Service
Our Medical Membership provides you and your family with medical care within the scope of MDSTAT's Urgent/Primary Care facility. Once active, members can bring their membership card to any MDSTAT clinic
2016 Summary of Benefits
2016 Summary of Benefits Health Net Healthy Heart (HMO) Alameda and Stanislaus counties, CA Benefits effective January 1, 2016 H0562 Health Net of California, Inc. H0562_2016_0171 CMS Accepted 09172015
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
Preventive health guidelines
Preventive health guidelines As of May 2015 What is your plan for better health? Make this year your best year for wellness. Your health plan may help pay for tests to find disease early and routine wellness
$4, 30-day $10, 90-day
$4 Prescriptions - Choose from hundreds of generic drugs and over the counter medications. Free Home Delivery Mailed right to your home Free shipping Prescription Program includes up to a 30-day supply
2016 Guide to Understanding Your Benefits
2016 Guide to Understanding Your Benefits Additional information about covered benefits available from Health Net Ruby Select (HMO) Plan San Francisco, County CA Lisa Pasillas-Le, Health Net We re part
Summary 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
2015 Medicare Advantage Summary of Benefits
2015 Medicare Advantage Summary of Benefits HNE Medicare Premium No Rx and HNE Medicare Basic No Rx January 1, 2015 - December 31, 2015 H8578_2015_034 Accepted HNE MEDICARE ADVANTAGE ENROLLMENT KIT 2015
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
Preventive health guidelines As of May 2015
Preventive health guidelines As of May 2015 What is your plan for better health? Make this year your best year for wellness. Your health plan may help pay for tests to find disease early and routine wellness
Retail Prescription Program Drug List
Retail Prescription Program Drug List Price Matters New Men s Health Category Convenience Free Home Delivery Our 4 prescriptions have saved our customers over 3 billion The program is available to everyone,
Preventive Services Explained
Preventive Services Explained Medicare covers many preventive care services without charge. Most of these services have been recommended by the U.S. Preventive Services Task Force. However, which beneficiaries
2016 Guide to Understanding Your Benefits
2016 Guide to Understanding Your Benefits Additional information about covered benefits available from Health Net Healthy Heart (HMO) Plan Alameda, Stanislaus counties, CA Lisa Pasillas-Le, Health Net
PASSPORT TO WOMEN S HEALTH
PASSPORT TO WOMEN S HEALTH Introduction W omen are extraordinary. Daughters, sisters, mothers, aunts, cousins, friends, wives. Saint John s Health Center recognizes the importance of women and that women
CareATC Generic Formulary Medications Available (2015)
Allergic Reactions EPINEPHRINE** Ephinephrine, EpiPen CETIRIZINE 10MG Zyrtec FEXOFENADINE180MG TABS 100ct Allegra Allergies LORATADINE 10MG Claritin MONTELUKAST 4MG 30CT Singulair PROMETHAZINE 25MG AMP
Prevents future health problems. You receive these services without having any specific symptoms.
Preventive Care To help you live the healthiest life possible, we offer free preventive services for most Network Health members. Please refer to your member materials, which you received when you enrolled
Preventive Health Guidelines
Preventive Health Guidelines As of April 2010 What is your plan for better health? Make this year your best year for overall wellness. Your health benefits plan may cover early detection screenings and
Summary of Benefits. King, Pierce, Snohomish, Spokane and Thurston Counties. premera.com/ma
Summary of Benefits 2016 HMO King, Pierce, Snohomish, Spokane and Thurston Counties premera.com/ma Plus Section 1 Introduction to the and Plus This booklet gives you a summary of what we cover and what
HNE Premier 1 (HMO) and HNE Premier 2 (HMO)
2016 Medicare Advantage Summary of Benefits HNE Premier 1 (HMO) and HNE Premier 2 (HMO) January 1, 2016 - December 31, 2016 H8578_2016_429 Accepted HNE MEDICARE ADVANTAGE ENROLLMENT KIT 2016 SECTION I
Coverage Overview. Preventive Care. For complete details, please call Aetna at 1-800-423-9752.
Coverage Overview The following charts highlight our most commonly used services under the Progressive medical plans administered by Aetna. Please be aware that certain covered services are subject to
Home Delivery Prescription Program Drug List
Home Delivery Prescription Program Drug List Low-cost prescriptions, right in your mailbox. Now you can have your generic prescriptions mailed right to your home, no matter where you live. Because we think
2015 Summary of Benefits
2015 Summary of Benefits January 1, 2015 December 31, 2015 Houston/Beaumont Area Y0067_PRE_H4506_SETX_SB41_0814 CMS Accepted 09/13/2014 HMO-SETX-SB K41 2015 Section I Introduction to Summary of Benefits
School Board of Broward County
School Board of Broward County Open Enrollment 2013 Table of Contents Preventive Care Coverage...1 Knowing where to go can help you save on health care costs...2 Coventry WellBeing...3 WellBeing has its
Nationwide Life Insurance Co.: University of Phoenix NJ Coverage Period: 9/24/13-8/23/14
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.chpstudent.com or by calling 1-800-633-7867. Important
Tribute. 2015 Summary of Benefits. Health Plan of Oklahoma. Tribute Health Plan of Oklahoma HMO SNP
Tribute Health Plan of Oklahoma Tribute Health Plan of Oklahoma HMO SNP 2015 Summary of Benefits This booklet gives you a summary of what we cover and what you pay. It doesn t list every service that we
2015 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
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
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
Coverage for preventive care
Coverage for preventive care Understanding your preventive care coverage Preventive care, like screenings and immunizations, helps you and your family stay healthier and can help lower your overall out-of-pocket
2015 Summary of Benefits
2015 Summary of Benefits Plans 003 and 004 H6298_14_027 accepted Summary of Benefits January 1, 2015 - December 31, 2015 This booklet gives you a summary of what we cover and what you pay. It doesn t list
January 1, 2015 December 31, 2015 Summary of Benefits. Advantra (HMO) H3928-001 80.06.360.1-LA1
January, 205 December 3, 205 Summary of Benefits H3928-00 80.06.360.-LA Y0022_205_H3928_00_LA Accepted 9/204 Summary of Benefits January, 205 December 3, 205 This booklet gives you a summary of what we
2015 Summary of Benefits
2015 Summary of Benefits Value (HMO-POS) Essentials Rx (HMO-POS) (H4270) January 1, 2015 - December 31, 2015 Western Wisconsin (26 Counties) H4270_082914_1 CMS Accepted (09032014) SECTION I INTRODUCTION
Independent 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
Summary Table of Benefits Select Medicare Supplement Plan
2016 EXCLUSIVE CARE SUMMARY OF COVERED BENEFITS Select Medicare Eligible Supplement Plan Summary Table of Benefits Select Medicare Supplement Plan PLAN REIMBURSEMENT METHOD DEDUCTIBLE - Individual Medicare
PPO Insured Standard Network Deductible
BENEFIT HIGHLIGHTS Prepared for City of Seguin- Active BlueChoice Network This is a general summary of your benefits. Please refer to your Summary of and Coverage (SBC), or you may request a copy of the
CDPHP CLASSIC (PPO) CDPHP CORE RX (PPO) CDPHP CLASSIC RX (PPO) CDPHP PRIME RX (PPO)
Introduction to the Summary of Benefits Report for CDPHP CLASSIC (PPO) CDPHP CORE RX (PPO) CDPHP CLASSIC RX (PPO) CDPHP PRIME RX (PPO) January 1, 2015 December 31, 2015 CAPITAL, CENTRAL, SOUTHERN TIER,
SCAN Health Plan. 2015 Summary of Benefits
SCAN Health Plan 2015 Summary of Benefits Y0057_SCAN_8713_2014F File & Use Accepted 09032014 SCAN Classic (HMO) (a Medicare Advantage Health Maintenance Organization (HMO) offered by SCAN Health Plan with
January 1, 2015 December 31, 2015
BLUESHIELD FOREVER BLUE MEDICARE PPO VALUE AND BLUESHIELD MEDICARE PPO 750 (PPO) (a Medicare Advantage Preferred Provider Organization (PPO) offered by HEALTHNOW NEW YORK INC. with a Medicare contract)
FIRSTCAROLINACARE 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
2016 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
PPO-Insured-Standard-with Network Deductible
B E N E F I T H I G H L I G H T S P r e p a r e d f o r T T U H S C - E L P A S O a n d O D E S S A B l u e C h o i c e N e t w o r k This is a general summary of your benefits. Please refer to your benefit
CHOOSE A PLAN DEDUCTIBLE PLANS DEDUCTIBLE PLANS. What deductible plans offer and how they work IN THIS BROCHURE. n How our deductible plans work
DEDUCTIBLE PLANS CHOOSE A PLAN DEDUCTIBLE PLANS What deductible plans offer and how they work IN THIS BROCHURE n How our deductible plans work n Understanding deductibles and out-of-pocket maximums n Benefit
We know that you value your employees. Thank you for considering Optima Health to meet your employees healthcare needs.
We know that you value your employees. Thank you for considering Optima Health to meet your employees healthcare needs. Optima Health Products and Services Our Value Statement 1 TABLE OF CONTENTS 2 CONSUMER-DIRECTED
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
Quick Guide 2016. Peoples Health Choices 65 #14 (HMO) Jefferson, Orleans and Plaquemines parishes
Quick Guide 2016 $0 mium* Plan Pre Peoples Health Choices 65 #14 (HMO) Jefferson, Orleans and Plaquemines parishes *You must continue to pay your Medicare Part B premium. H1961_PH16C65S1QG Accepted Thank
2015 Summary of Benefits
2015 Summary of Benefits January 1, 2015 December 31, 2015 Kit 02 Y0067_PRE_H2816_SBK02_0814 CMS Accepted 09/13/2014 NPFFS-SB K02 2015 Section I Introduction to Summary of Benefits You have choices about
Carnegie Mellon University Policy #02424 Benefits at a Glance Effective Date: January 1, 2014
Carnegie Mellon University is offering Medical, Dental, Vision, Pharmacy, Medical Evacuation and Repatriation benefits through Cigna Global Health Benefits to our employees. This comprehensive international
Summary 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
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
VISITING MEMBER SERVICES. Getting care away from home. For travel in other Kaiser Permanente areas
2016 VISITING MEMBER SERVICES Getting care away from home For travel in other Kaiser Permanente areas Getting care in Kaiser Permanente service areas This brochure will help you get a wide range of care
Health Plans Coverage Summary
www.hr.msu.edu/openenrollment Faculty & Staff Health Plans Coverage Summary PREVENTIVE SERVICES Health Maintenance Exam (1) Annual Gynecological Exam Pap Smear Screening (lab services only) Mammography
2015 Preventive Health Care Guidelines. Free preventive care to help you be your healthiest.
2015 Preventive Health Care Guidelines Free preventive care to help you be your healthiest. Guidelines may change throughout the year based on new research and recommendations. Get the most up-to-date
Even though you pay these expenses, they don t count toward the out-ofpocket limit.
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.studentplanscenter.com or by calling 1-800-756-3702.
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
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.
Medicare Options For Retiree/Direct Bill Members
Open Enrollment 2014 State Employee Health Plan Medicare Options For Retiree/Direct Bill Members Comparison Chart 2 2013 **Cover photo is titled Road into the Field from the Postcards from Kansas collection
The School Board of Broward County, FL
The School Board of Broward County, FL Open Enrollment 2015 Your Choices. Your Benefits. Your Health. Your Choices. Your Benefits. Your Health. Table of Contents Completing Your Annual Biometric Wellness
Summary of Benefits. Offered by. H5826_MA_194_2012_v_01_SB006 CMS Approved 08.24.2011
2012 Summary of Benefits Offered by H5826_MA_194_2012_v_01_SB006 CMS Approved 08.24.2011 Section I Introduction to the Summary of Benefits for Community HealthFirst MA Plan (HMO) January 1, 2012 - December
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
Blue Shield 65 Plus (HMO) summary of benefits
Blue Shield 65 Plus (HMO) summary of benefits Group Medicare Advantage-Prescription Drug Plan for San Francisco Health Service System (SFHSS) January 1, 2016 to December 31, 2016 Blue Shield of California
-----------------None-------------------------------
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the Benefit Booklet at www.ucop.edu/ucship or by calling 1-866-940-8306. Important Questions
Your Guide to Medicare s Preventive Services
Your Guide to Medicare s Preventive Services C E N T E R S F O R M E D I C A R E & M E D I C A I D S E R V I C E S This is the official government booklet with important information about: What disease
2015 Summary of Benefits
2015 Summary of Benefits Health Net Healthy Heart (HMO) Placer and Sacramento counties, CA Benefits effective January 1, 2015 H0562 Health Net of California, Inc. Material ID # H0562_2015_0273 CMS Accepted
What is the overall deductible? Are there other deductibles for specific services?
Small Group Agility MS200 Coverage Period: Beginning on or after 01/01/2015 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
University of Michigan Group: 007005187-0000, 0001 Comprehensive Major Medical (CMM) Benefits-at-a-Glance
University of Michigan Group: 007005187-0000, 0001 Comprehensive Major Medical (CMM) Benefits-at-a-Glance This is intended as an easy-to-read summary and provides only a general overview of your benefits.
LABORATORY and PATHOLOGY SERVICES
LABORATORY and PATHOLOGY SERVICES Policy Neighborhood Health Plan reimburses participating clinical laboratory and pathology providers for tests medically necessary for the diagnosis, treatment and prevention
PREFERRED GENERIC DRUG LIST
These discount programs are NOT health insurance policies and are not intended as a substitute for insurance. The programs do not qualify as a minimum creditable coverage under Massachusetts law or where
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
Blue Shield 65 Plus Choice Plan (HMO) Blue Shield 65 Plus (HMO) summary of benefits
summary of benefits Los Angeles (partial) & Orange Counties January 1, 2015 to 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
SCAN Classic (HMO) San Joaquin County 2016 Summary of Benefits. Y0057_SCAN_9240_2015F File & Use Accepted
SCAN Classic (HMO) San Joaquin County 2016 Summary of Benefits Y0057_SCAN_9240_2015F File & Use Accepted SCAN Classic (HMO) (a Medicare Advantage Health Maintenance Organization (HMO) offered by SCAN Health
Summary of Benefits. Prime (HMO-POS) and Value (HMO) January 1, 2015 December 31, 2015 G ENERATIONS A DVANTAGE 1-888-408-8285 (TTY: 711)
Summary of s and January 1, 2015 December 31, 2015 G ENERATIONS A DVANTAGE For more information about benefits or enrollment, call us or visit our website at www.martinspoint.org/medicare. 1-888-408-8285
THE CLEVELAND CLINIC. personal. Health. Management. Program
THE CLEVELAND CLINIC personal Health Management Program Our Personal Health Management Program offers a comprehensive examination in a package tailored to meet your unique medical needs. Expert Care The
2016 Summary of Benefits
HMO and 2016 Summary of Benefits Western Pennsylvania H3957_15_0265 Accepted SUMMARY OF BENEFITS January 1, 2016 - December 31, 2016 This booklet gives you a summary of what we cover and what you pay.
2015 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
Legacy Health Medicare Advantage Plan
Legacy Health Medicare Advantage Plan Thank you for your interest in applying for the Legacy Health Medicare Advantage plan powered by Moda Health. Below are links to the items which are part of the Enrollment
Preventive Care Recommendations THE BASIC FACTS
Preventive Care Recommendations THE BASIC FACTS MULTIPLE SCLEROSIS Carlos Healey, diagnosed in 2001 The Three Most Common Eye Disorders in Multiple Sclerosis Blood Pressure & Pulse Height & Weight Complete
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
Carnegie Mellon University Benefits at a Glance Policy #02424A Effective Date: 1/1/2015
Carnegie Mellon University Benefits at a Glance Policy #02424A Effective Date: 1/1/2015 Carnegie Mellon University offers Medical, Pharmacy, Medical Evacuation and Repatriation, Vision, and Dental benefits
State Health Plan: High Deductible Health Plan 50/50 Coverage Period: 01/01/2016 12/31/2016
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 http://www.shpnc.org and click on High Deductible Health
Oklahoma Higher Education Employee Insurance Group Educational Meeting Welcome!
Oklahoma Higher Education Employee Insurance Group Educational Meeting Welcome! The benefit information provided herein is a brief summary, but not a comprehensive description of available benefits. Additional
Important Questions Answers Why this Matters: In-network: $0/Individual; $0/Family Out-of-network: $500/Individual; $1,000/Family
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 1-800-445-7490. Important Questions
SCAN Health Plan. 2015 Summary of Benefits
SCAN Health Plan 2015 Summary of Benefits Y0057_SCAN_8712_2014F File & Use Accepted 09032014 ( a Medicare Advantage Health Maintenance Organization (HMO) offered by SCAN Health Plan with a Medicare contract)
Schedule of Benefits HARVARD PILGRIM LAHEY HEALTH VALUE HMO MASSACHUSETTS MEMBER COST SHARING
Schedule of s HARVARD PILGRIM LAHEY HEALTH VALUE HMO MASSACHUSETTS ID: MD0000003378_ X Please Note: In this plan, Members have access to network benefits only from the providers in the Harvard Pilgrim-Lahey
Health care reform update
Preventive services coverage Kaiser Foundation Health Plan of the Northwest has always offered broad, affordable coverage options that encourage members to seek care before a health condition becomes serious.
Comparison of Health Care Plans Metro Interagency Insurance Program Effective Date: July 1, 2015
Comparison of Health Care Plans Metro Interagency Insurance Program Effective Date: July 1, 2015 Wellmark Blue Cross Blue Shield Customer Service: 1-800-277-8380 Participating Provider Directory Information: