Large group benefit comparison
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1 Large group benefit comparison effective January 1, 2015 A guide to choosing the right plan for your business
2 San Diegans choose Health Plan With a range of plans and provider networks, we have the right plan to meet your unique business needs. Health Plan is your first choice in San Diego for access to high-quality, affordable health care for a healthy workforce. 0 alth plan 1 Local focus As the only San Diego-based commercial health plan, all of our services, from account management to customer care, are provided locally. Highest level Excellent Accreditation Award-winning care You ll receive award-winning care from our nationally recognized doctors, medical groups and hospitals. Customizable With four provider networks, a multitude of plan designs and a broad range of pricing options, you have the ability to tailor your plan design to Highest rated customer service and member satisfaction 2 your business needs. 4 out of 4- We re proud to be a top out US of 4-star health quality rating plan 1 At Health Plan, we believe in making life better. We are honored to be one of the best health plans in the nation. 0 alth plan 1 TOP 100 US health plan Top 100 US health plan 1 Highest level Excellent Accreditation Highest-level Excellent Accreditation Highest level Highest Excellent rated Accreditation customer service and member satisfaction 2 among reporting California health plans 3 Highest-rated customer service and member satisfaction among reporting California health plans 2 Highest rated customer service and member satisfaction 2 4 out of 4-star quality rating ¹ Based on NCQA s Private Health Insurance Rankings ² Based on the 2014 California Assessment of Healthcare Providers and Systems (CAHPS ) results, Health Plan received an overall summary rating of 86% satisfaction compared to the statewide average of 76%. For customer service, Health Plan received a 90% satisfaction rating and the statewide average was not reported. The source for data contained in this publication is Quality Compass 2014 and is used with the permission of the National Committee for Quality Assurance (NCQA). Quality Compass 2014 includes certain CAHPS data. Any data display, analysis, interpretation, or conclusion based on among these reporting data is solely California that health of the plans authors, 3 and NCQA specifically disclaims responsibility for any such display, analysis, interpretation, or conclusion. Quality Compass is a registered trademark of NCQA. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). 4 out of 4-
3 Provider networks Health Plan offers four provider networks to provide flexibility while delivering high-quality, affordable health services: Choice, Value, Performance and Premier. 2,200+ Doctors 13 Hospitals 6 Medical Groups Additional benefits included with every plan We know that excellent health care is not enough it must also be easy to access. The convenience of Health Plan extends beyond San Diego and beyond standard business hours. All Health Plan members receive the following value-added benefits: Nurse Connection Best Health is one of only twelve health plan wellness programs to be accredited nationally. The program provides Health Plan members with a variety of resources, from meal plans to exercise routines to one-on-one personalized health coaching. Nurse Connection s specially trained registered nurses can talk with you about your illness or injury, help you decide where to seek care and provide advice on any health concerns you may have. Get care for minor illnesses, injuries and more through MinuteClinic, the medical clinic in select CVS/pharmacy stores in San Diego and across the nation. 1 Assist America connects Health Plan members to doctors, hospitals, pharmacies and other services when faced with a medical emergency while traveling 100 miles or more away from home, or out of the country. 1 A $40 copay will apply to most services except flu shots, which have a copay of $10.
4 Health Plan benefit comparison Calendar year deductible (per individual / per family, applies only to those covered benefits indicated) 1 Maximums There are no lifetime maximums for this plan Annual out-of-pocket maximum, including deductible (per individual / per family) 1, 2 Primary Care Physician office visit for consultation, treatment, diagnostic testing, etc. (per visit) Specialist Physician office visit for consultation, treatment, diagnostic testing, etc. (per visit) Professional Preventive care services (per visit) 3 Prenatal and postpartum office visits (per visit) Allergy injections (per visit) Allergy testing (per visit) Outpatient surgery (per procedure) Outpatient Laboratory services Advanced radiology including MRI, CT Scan, PET Scan, MRA, MRS, MUGA, SPECT (per procedure) Physical, occupational and speech therapy (per visit) Hospitalization Emergency / Urgent Care Ambulance Inpatient (per admission, except as noted) Emergency room (per visit, waived if admitted for inpatient hospital stay) Urgent care (per visit) Ambulance in connection with hospital admission or emergency services Durable medical equipment Durable Medical Equipment Diabetic supplies Prosthetics, orthotics (per visit) Mental Health 5 Chemical Dependency Inpatient (per admission, except as noted) Outpatient (per visit) Inpatient (per admission, except as noted) Outpatient (per visit) Emergency services for acute drug or alcohol detoxification (per visit) Other Skilled nursing facility services (per admission, maximum 100 days per calendar year) Plans listed do not represent our entire plan portfolio. 1 For non-hsa plans, individuals enrolled in a family plan will reach the annual deductible and/or out-of-pocket maximum amount if the member meets the individual maximum amount or any combination of enrolled family members meets the family deductible and/or out-of-pocket maximum, whichever comes first. HSA plans are accumulated differently.
5 10 / 10 / / 15 / 0 15 / 15 / / 20 / / 40 / / 25 / 500 None None None None None None n/a n/a n/a n/a n/a n/a $1,500 / $3,000 $1,500 / $3,000 $1,500 / $3,000 $2,500 / $5,000 $3,000 / $6,000 $3,000 / $6,000 $10 $15 $15 $20 $20 $25 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $10 $10 $10 $10 $10 $10 $0 $0 $125 $125 $250 $250 $0 $0 $0 $0 $0 $0 $0 $0 $100 $100 $100 $100 $100 $0 $250 $250 $500 $500 $50 $75 $100 $100 $100 $100 $50 $75 $100 $100 $100 $100 0% coinsurance 0% coinsurance 20% coinsurance 4 20% coinsurance 4 20% coinsurance 4 20% coinsurance 4 0% coinsurance 0% coinsurance 20% coinsurance 4 20% coinsurance 4 20% coinsurance 4 20% coinsurance 4 $100 $0 $250 $250 $500 $500 $100 $0 $250 $250 $500 $500 $50 $75 $100 $100 $100 $100 $0 $0 $100 $100 $150 $200 2 Copayments for supplemental benefits (Assisted Reproductive Technologies, Acupuncture, Chiropractic Services and Vision) do not apply to the annual out-of-pocket maximum.
6 25 / 35 / 500 (3-day max) 30 / 40 / 500 day 40 / 40 / 40% 40 / 50 / 750 (3-day max) 1000 ded / 30 /40 HSA 1500 ded / 30 /30 None None None None $1,000 / $2,000 $1,500 / $3,000 n/a n/a n/a n/a n/a n/a $3,500 / $7,000 $3,500 / $7,000 $4,000 / $8,000 $3,500 / $7,000 $3,500 / $7,000 $3,000 / $6,000 $25 $30 $40 $40 $30 $30 6 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $40 $30 6 $10 $10 $10 $10 $10 $30 6 $500 $500 40% coinsurance 4 $750 30% coinsurance 4,6 $150 6 $0 $0 $0 $0 $0 $10 6 $100 $100 $100 $100 $100 $50 6 $500 / day (3-day max) $500 / day 40% coinsurance 4 $750 / day (3-day max) 30% coinsurance 4,6 $250 / day 6 $100 $150 $100 $150 $150 6 $100 6 $35 $40 $40 $50 $40 $40 6 $100 $150 $100 $150 $150 6 $ % coinsurance 4 50% coinsurance 4 50% coinsurance 4 50% coinsurance 4 50% coinsurance 4 50% coinsurance 4,6 20% coinsurance 4 20% coinsurance 4 20% coinsurance 4 20% coinsurance 4 20% coinsurance 4 20% coinsurance 4,6 $500 / day (3-day max) $500 / day 40% coinsurance 4 $750 / day (3-day max) 30% coinsurance 4,6 $250 / day 6 $500 / day (3-day max) $500 / day 40% coinsurance 4 $750 / day (3-day max) 30% coinsurance 4,6 $250 / day 6 $100 $150 $100 $150 $150 6 $100 6 $200 $150 $250 $150 30% coinsurance 4,6 $ Includes preventive services with a rating of A or B from the US Preventive Services Task Force; immunizations for children, adolescents and adults recommended by the Centers of Disease Control and Prevention; and preventive care and screenings supported by the Health Resources and Services Administration for infants, children, adolescents and women. If preventive care is received at the time of other services, the applicable copayment for such services other than preventive care may apply.
7 1500 ded / 40 / ded / 40 / 40 HSA 3000 ded / 40 / 40 HSA 4500 ded / 40 / ded / 40 / 50 $1,500 / $3,000 $2,500 / $5,000 $3,000 / $6,000 $4,500 / $9,000 $4,500 / $9,000 n/a n/a n/a n/a n/a $4,000 / $8,000 $5,000 / $10,000 $6,000 / $12,000 $6,350 / $12,700 $6,000 / $12,000 $40 $40 $40 6 $40 6 $40 $0 $0 $0 $0 $0 $10 $10 $40 6 $40 6 $10 40% coinsurance 4,6 40% coinsurance 4,6 30% coinsurance 4,6 40% coinsurance 4,6 40% coinsurance 4,6 $0 $0 30% coinsurance 4,6 40% coinsurance 4,6 $0 $100 $100 30% coinsurance 4,6 40% coinsurance 4,6 $100 40% coinsurance 4,6 40% coinsurance 4,6 30% coinsurance 4,6 40% coinsurance 4,6 40% coinsurance 4,6 $150 6 $ % coinsurance 4,6 40% coinsurance 4,6 $200 6 $40 $40 $50 6 $50 6 $50 $150 6 $150 6 $100 6 $100 6 $ % coinsurance 4,6 50% coinsurance 4,6 50% coinsurance 4,6 50% coinsurance 4,6 50% coinsurance 4,6 20% coinsurance 4 20% coinsurance 4 20% coinsurance 4,6 20% coinsurance 4,6 20% coinsurance 4 40% coinsurance 4,6 40% coinsurance 4,6 30% coinsurance 4,6 40% coinsurance 4,6 40% coinsurance 4,6 $40 $40 6 $40 6 $40 $50 40% coinsurance 4,6 40% coinsurance 4,6 30% coinsurance 4,6 40% coinsurance 4,6 40% coinsurance 4,6 $150 6 $ % coinsurance 4,6 40% coinsurance 4,6 $ % coinsurance 6 40% coinsurance 4,6 $200 6 $ % coinsurance 4,6 4 Of contracted rates. 5 Coverage for the diagnosis and treatment of Severe Mental Illnesses in members of any age and Serious Emotional Disturbances in children. 6 Deductible applies.
8 Supplemental benefits available with every plan Service Plan Copayment (per visit) Visits (per year) Acupuncture American Specialty Health (ASH) Chiropractic American Specialty Health (ASH) Chiropractic and Acupuncture American Specialty Health (ASH) Vision Vision Service Plan (VSP) Assisted Reproductive Technologies (ART) AC12 $10 12 AC14 $10 15 AC16 $10 20 AC18 $15 12 AC20 $15 15 AC22 $15 20 AC10 $15 20 AC11 $15 30 B-LG $10 30 D-LG $10 20 AC2 $5 40 AC3 $10 40 AC4 $10 20 AC24 $10 12 AC26 $10 15 AC28 $10 12 AC30 $15 15 AC32 $15 20 A0 $0 Eye exam: 1 every 12 months Frames/lenses: discount based on retail costs A2 $20 Eye exam: 1 every 12 months Frames/lenses: $20 A8 $30 Eye exam: 1 every 24 months Frames/lenses: discount based on retail costs OC $0 Eye exam: 1 every 12 months Frames/lenses: $0 ART A 50% coinsurance* n/a ART B 50% coinsurance* n/a ART C 50% coinsurance* n/a Prescriptions MedImpact Plan Copayment Rx 33 $5 / $15 / $30 Rx 34 $10 / $20 / $40 Rx 39 $20 / $35 / $70 Rx 41 $15 / $25 / $50 Rx 45 $10 / $25 / $35 Rx 46 $15 / $35 / $50 Plan Copayment Rx 48 $15 / $35 / $50 plus $150 brand deductible Rx 49 $20 / $35 / $70 plus $150 brand deductible Rx 64 $20 / $35 / $70 plus $250 brand deductible Rx 65 $15 / $35 / $50 + $250 brand deductible Rx 66 $10 / $25 / $50 + $250 brand deductible Rx 67 $10 / $25 / $50 + $150 brand deductible A portfolio of dental HMO and PPO plans, provided through Premier Access Dental, is also available. For more information, please contact your Account Representative. Consider us your personal health care assistant (858) or Monday through Friday, 8 a.m. to 6 p.m. customer.service@sharp.com Fax (858) sharphealthplan.com SHPA Z 2015 SHC *Of contracted rates for covered infertility services.
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SMALL GROUP PLAN DESIGN AND BENEFITS OPEN CHOICE OUT-OF-STATE PPO PLAN - $1,000
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Coverage for: Large Group Plan Type: HMO
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
PLAN DESIGN AND BENEFITS HMO Open Access Plan 912
PLAN FEATURES Deductible (per calendar year) $1,000 Individual $2,000 Family Unless otherwise indicated, the Deductible must be met prior to benefits being payable. Member cost sharing for certain services
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
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SU Pro ( and ) Annual Deductible 1 Coinsurance Cost Sharing Definitions $200 per individual with a maximum of $400 for a family 5% of allowable amount for inpatient hospitalization - or - 50% of allowable
PLAN DESIGN AND BENEFITS - Tx OAMC 1500-10 PREFERRED CARE
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HPN Solutions HMO 15 V2 $7/35/55
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.myhpnonline.com or by calling (702) 242-7300 or 1-800-777-1840.
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$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.
Small Business Solutions Medical Plan Options
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Important Questions Answers Why this Matters:
Minimum Coverage PPO Network Name: Exclusive Coverage Period: Beginning on or after 1/1/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual + Family Plan
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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 documents at www.dbm.maryland.gov/benefits or by calling 410-767-4775
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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
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PPO Student/Affiliate Plan MIT Student/Affiliate Extended Insurance Plan Coverage Period: 2014-2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual, Couple,
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Coverage for: Individual, Family Plan Type: PPO. 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.bbsionline.com or by calling 1-866-927-2200. Important
Summary of Benefits and Coverage What this Plan Covers & What it Costs
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Coverage Period: 8/1/2013-7/31/2014 Coverage for: Insured Student+Dependent Plan Type: PPO. 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.gallagherkoster.com/colgate or by calling 1 877-371-9621.
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Bowling Green State University : Plan B Summary of Benefits and Coverage: What This Plan Covers & What it Costs
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PLAN DESIGN AND BENEFITS - Tx OAMC 2500 08 PREFERRED CARE
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