2015 Aetna MD Bronze, Silver and Gold OAMC
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1 Insurance Company Insurance Product Whole Health - SCCIPA Whole Health - Connecticut Preferred Health Network Whole Health - Hartford HealthCare and Value Care Alliance Whole Health - Maine Whole Health - Duke Medicine Whole Health - Coastal Virginia Health Partners Whole Health - VA Preferred - Roanoke DC Bronze, Silver and Gold HMO DC Bronze, Silver and Gold HNOnly 2015 DC Bronze, Silver and Gold OAMC 2015 DE Bronze, Silver and Gold HNOnly 2015 DE Bronze, Silver and Gold HNOption 2015 MD Bronze, Silver and Gold HMO 2015 MD Bronze, Silver and Gold OAMC 2016 DC Bronze, Silver and Gold Open Access Health Network Only 2016 DC Bronze, Silver and Gold Open Access Managed Choice 2016 DE Bronze, Silver and Gold Open Access Health Network Option 2016 MD Bronze and Gold Open Access Health Network Only 2016 MD Bronze and Gold PPO NAP (National Advantage Plan) Choice POS (Open Access) Choice POS II ( HealthFund ) Choice POS II (Open Access) Choice POS II on the Altius Network Health Network Only (Open Access) Health Network Only(SM) (Open Access) on the Altius Network Health Network Option(SM) (Open Access) on the Altius Network Health Network Option Plan (HMO / Open Access HMO) Plan (PPO) Open Access Elect Choice EPO ( HealthFund ) Open Access Managed Choice POS ( HealthFund ) Premier Care - Arizona Care Network Premier Care - Banner Health Network Premier Care - Baylor Scott & White Quality Alliance Premier Care - Colorado Front Range Network Premier Care - Innovation Health Premier Care - Memorial Hermann Accountable Care Network Premier Care - Mercy Health Cincinnati Premier Care - Seton Health Alliance Select Page 1
2 Cigna Cigna Elderplan Elderplan Select(SM) (Open Access) on the Altius Network Value Performance Network Voluntary Plans Elect Choice EPO (Open Access) Elect Choice EPO Elect Choice EPO (Open Access) on the Altius Network HMO (Open Access) HMO Healthy New York HMO Joplin (KS & MO) Preferred Choice POSII Joplin (KS & MO) Preferred Managed Choice (Open Access) Joplin (KS & MO) Preferred Managed Choice POS Joplin (KS & MO) Preferred Open Choice (PPO) Managed Choice (Open Access) Managed Choice POS Managed Choice (Open Access) on the Altius Network Open Choice PPO ( HealthFund ) Open Choice PPO Open Choice PPO on the Altius Network PCP Referral Plan (TX members only) Peak Preference HNOnly (Open Access) on the Altius Network Peak Preference HNOption (Open Access) on the Altius Network QPOS Wichita Preferred Managed Choice (Open Access) Wichita Preferred QPOS Open Access Plus PPO HMO/SNP Classic 2000 Emblem Health CBP EPO Emblem Health CBP PPO Network Access Plan Emblem Health ASO Emblem Health PPO Dual Eligible (PPO)SNP Emblem Health CompreHealth EPO Emblem Health CompreHealth PPO Access I/Prime POS Prime/Prime EPO/Select PPO HMO/Prime PPO/Select PPO Access I/Prime POS Prime/Prime EPO/Select EPO Page 2
3 Emblem- VHMS HMO/Prime PPO/Select PPO Emblem Health Essential (HMO) Emblem Health VIP High Option (HMO) Supplemental (cost plan) Emblem Health HMO Emblem Health Dual assurance FIDA Plan ArchCare Community Advantage FIDA Plan GuildNet Gold Plus FIDA Plan POS Vytra HMO Vytra ASO HMO & POS Advantage PPO 2015 NYSOH Marketplace Plans- NY 2016 NYSOH Marketplace Plans- NY Empire HMO, Bronze (Individual via Exchange)- NY Empire HMO, Bronze- NY Empire HMO, Catastrophic (Individual via Exchange)- NY Empire HMO, Catastrophic- NY Empire HMO, Gold (Individual via Exchange Empire HMO, Gold, a Multi- State Plan (Individual via Exchange)- NY Empire HMO, Gold- NY Empire HMO, Platinum (Individual via Exchange)- NY Empire HMO, Platinum- NY Empire HMO, Silver (Individual via Exchange)- NY Empire HMO, Silver, a Multi- State Plan (Individual via Exchange)- NY Empire HMO, Silver- NY National PPO (BlueCard PPO Basic)- National PPO (BlueCard PPO)- Tradition Plus Comprehensive- NY Tradition Plus Wraparound- NY Access(SM) HMO- NY Direct HMO- NY Empire Bronze Pathway EPO Plus- NY Empire Core Guided Access Plus w/hsa (Pathway/ Small Group)- NY Empire Ded First Prism EPO- NY Empire Ded First Prism PPO- NY Empire Direct POS- NY Empire DirectShare POS- NY Empire EPO Essential- NY Empire EPO Stepped- NY Page 3
4 Empire EPO- NY Empire Essential Guided Access Plus (Pathway/ Small Group)- NY Empire Essential Guided Access Plus w/dental (Pathway/ Small Group)- NY Empire Essential Guided Access Plus w/hsa (Pathway/ Small Group)- NY Empire Gold Healthy New York Pathway HMO- NY Empire Gold Pathway HMO Plus w/hsa (Pathway/ Small Group)- NY Empire Gold Pathway HMO Plus- NY Empire HMO (Health Maintenance Organization)- NY Empire Hospital/Medical (Trad)- NY Empire Hospital- NY Empire POS (Alternate Network)- NY Empire POS (Point of Service)- NY Empire PPO - NS- LIJ- NY Empire PPO Plus- NY Empire PPO- NY Empire Prism Deductible First EPO - Blue Priority- NY Empire Prism EPO - Blue Priority- NY Empire Prism EPO INN Costshare - Blue Priority- NY Empire PRISM EPO Select- NY Empire Prism EPO- NY Empire Prism PPO- NY Empire Silver Pathway EPO Plus- NY Empire Total Blue EPO HRA - Blue Priority- NY Empire Total Blue EPO HSA - Blue Priority- NY Empire TotalBlue(SM) Choice- NY Empire TotalBlue(SM) EPO- NY Empire TotalBlue(SM) Select- NY Healthy New York (Pathway/ Small Group)- NY National PPO (BlueCard PPO Basic)- National PPO (BlueCard PPO)- PPO/EPO- NY PPO- NY Traditional- Unite Here Health- Plan 100 (POS / Employer Group)- NY Unite Here Health- Plan 100 (PPO / Employer Group)- NY Unite Here Health- Plan 100 (PPO/EPO / Employer Group)- NY Blue Advantage (PPO)- Empire Dual Advantage (HMO SNP)- NY Empire MediBlue (HMO)- NY Empire MediBlue Access (PPO)- NY Empire MediBlue Core (HMO)- NY Empire MediBlue Dual Advantage (HMO SNP)- NY Page 4
5 , Inc Health First (HFIC) Health First (HFIC) MagnaCare MagnaCare Wellcare Wellcare Empire MediBlue Essential (HMO)- NY Empire MediBlue Freedom (PPO)- NY Empire MediBlue Freedom I (PPO)- NY Empire MediBlue Plus (HMO)- NY Empire MediBlue Select (HMO)- NY - HARP BHP CHP Commercial Plans, including QHP Commercial Plans Advantage - Advantage Advantage Plus Commercial Plans, including AHP Advantage WC, No- Fault, PIP, and/or AR Programs / Managed Care Programz Railroad Dual Complete Advantage Dual Advantage Adantage Benefit Plans New York CHIP Benefit Plans Childrens Health Insurance Program New York CHIP Benefits Plan New York Benefit Plans for the Uninsured New York Family Health Plus Benefits Plan Metro Freedom Liberty Advantage Plan Compensation Page 5
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$243.41 $34.69 16.62% 29497DE0090001 Aetna Bronze $15 Copay PPO Bronze 26 $ 212.88
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