2-50 Market Segment Guide Effective 1/1/13
|
|
|
- Randolph Caldwell
- 5 years ago
- Views:
Transcription
1 2-50 Market Segment Guide Effective 1/1/13 1 A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.
2 2 BestChoice PPO BlueChoice Network
3 00/$ %/50% $1500 RS17 $20/35/50 $1500 RS16 $15/40/55 75%/50% $1500 RS15 $15/30/45 $20 $1500 RS14 $20/35/50 00/$ RS11 Urgent Care 00/$ %/50% 0 RS10 $20/35/50 0 RS09 $15/30/45 90%/70% 0 RS08 $15/30/45 00/00 $20 0 RS07 $15/30/45 $0/$8000 $20 0 RS06 $15/30/45 $20 $750 RS05 $20/35/50 00/00 $20 0 RS04 $15/30/45 $2000/00 $15 0 RS03 $15/30/45 $2000/00 90%/70% $15 0 RS02 $15/30/45 0/$ %/70% $15 0 RS01 Pharmacy Coins Stoploss Coins % ER Office Ded Comb Health Plan # 3
4 00/00 75%/50% $65 $7500 RS33 00/00 70%/50% $65 00 RS32 $3500/$7000 $65 00 RS31 $10/40/60 $0/00 00 RS30 00/00 70%/50% $65 00 RS28 $7500/$ %/50% $65 00 RS29 00/00 70%/50% $65 00 RS26 $10/40/60 00 RS22 $20//$60 70%/50% 00 RS23 00/$ %/50% 00 RS24 $15/40/55 $20 $2000 RS18 $15/40/55 75%/50% $2000 RS19 $10/40/60 $0/00 00 RS25 Urgent Care 00/$ %/50% $2000 RS20 Pharmacy Coins Stoploss Coins % ER Office Ded Comb Health Plan # 4
5 Health Plan # Ded Comb Office Urgent Care ER Coins % Coins Stoploss Pharmacy RS34 00 $65 75%/50% 00/00 RS36 $ %/80% $0/$8000 $20/35/50 RS37 00 $0/00 RS38 00 $0/00 $15/30/45 RS40 $7500 $0/00 $15/40/60 RS41 00 $0/00 $15/40/60 RS42 0 $20 $15/30/45 RS43 0 /35/50 RS44 $ %/70% $15/30/45 RS45 00 $70 70%/50% 00/00 RSB1 ± 0 $20 $15/40/55 RSB2 ± 00 00/$8000 RSB3 00 $10/40/60 RSB4 00 $65 70%/50% 00/00 RL100 0 Ded & Coins Not Available $150 $20/35/50 5 ± applies to the Physician Office Visit Only and Lab & X-Ray paid after coinsurance applies to the Physician Office Visit Only and Lab & X-Ray paid after deductible and coinsurance
6 6 BestChoice PPO Four Tier Rx Plans BlueChoice Network
7 Health Plan # Ded Comb Office Urgent Care ER Coins % Coins Stoploss Pharmacy* RSF1 00 $0/00 $8/35/75/150 RSF2 0 $20 $0/$8000 $8/35/75/150 RSF3 $2000 $20 $8/35/75/150 RSF4 00 $65 70%/50% 00/00 $8/35/75/150 RSF5 0 $8/35/75/150 RSF $65 70%/50% 00/00 $10/35/75/150 RSF7 $ $10/35/75/150 RSF8 $2000 $20+ $10/35/75/150 *Preferred Drug List 1 applies to all Small Group Plans except Four Tier Rx Plans which are subject to Preferred Drug List 2. + applies to the physician office visit only. 7
8 Health Savings Account* Plans BlueChoice Network *Please be reminded that Health Savings Account (HSA s) have tax and legal ramifications. Blue Cross and Blue Shield of Texas does not provide legal or tax advice, and nothing herein should be construed as legal or tax advice. These materials, and any tax-related statements in them, are not intended or written to be used, and cannot be used or relied on, for the purpose of avoiding tax penalties. Tax-related statements, if any, may have been written in connection with the promotion or marketing of the transaction(s) or matter(s) addressed by these materials. You should seek advice based on your particular circumstances from an independent tax advisor regarding the tax consequences of specific health insurance plans or products. 8
9 Embedded Deductible Plans Health Plan # Ded Individual Ded Family Office Coins % Out of Pocket Maximum* Indiv/Family Pharmacy RSH1 00/00 00/00 Ded & Coins 00/00 100% after cal year deductible RSH2 $6000/$12000 Ded & Coins 100% after cal year deductible RSH3 00/00 00/$20000 Ded & Coins 00/00 100% after cal year deductible RSH6 $3500/$7000 $7000/$14000 Ded & Coins 00/00 80% after cal year deductible RSH7 00/00 00/00 Ded & Coins 00/00 80% after cal year deductible RSH8 00/$8000 $8000/$16000 Ded & Coins 00/$ % after cal year deductible RSH9 $3500/$7000 $7000/$14000 Ded & Coins $3500/$ % after cal year deductible *Deductible plus Coinsurance Stoploss equals Out of Pocket Maximum The individual deductible amount must be satisfied by every participant covered, each calendar year. If dependents are covered, all charges applied to the individual deductible amount will be applied toward the family deductible amount. When the family deductible is reached, no further individual deductibles will have to be satisfied for the remainder of that calendar year. No participant will contribute more than the individual deductible amount to the family deductible amount. 9
10 Aggregate Deductible Plans Health Plan # Ded Individual Ded Family Office Coins % Out of Pocket Maximum* Indiv/Family Pharmacy RSH4 $1500/00 Ded & Coins 00/$ % after cal year deductible RSH5 $6000/$12000 Ded & Coins *Deductible plus Coinsurance Stoploss equals Out of Pocket Maximum 100% after cal year deductible If family coverage is selected, the family deductible amount must be satisfied before any benefits are available under the HSA plan. The family deductible amount may be satisfied by one participant or a combination of two or more participants. 10
11 BestChoice 100% Contribution Plans* *Employer required to contribute 100% of the premium for each eligible participating employee. 11
12 PPO Plan Health Plan # Ded Combined Office Coins % Coins Stoploss Pharmacy RSE1 00 $0/00 $10/40/60 HSA Plan Health Plan # Ded Individual Ded Family Office Coins % Out of Pocket Maximum* Indiv/Family Pharmacy RSHE1 00/00 00/00 Ded & Coins *Deductible plus Coinsurance Stoploss equals Out of Pocket Maximum 00/00 100% after cal year deductible The individual deductible amount must be satisfied by every participant covered, each calendar year. If dependents are covered, all charges applied to the individual deductible amount will be applied toward the family deductible amount. When the family deductible is reached, no further individual deductibles will have to be satisfied for the remainder of that calendar year. No participant will contribute more than the individual deductible amount to the family deductible amount. 12
13 13 HMO Blue Texas Plans
14 Health Plan # Office Visit In-Hospital ER Out of Pocket Maximum PDP RPlan09 $20 PCP/$20 Specialist 0 per admission $75 per visit $1500/00 PD10 $10/25/40 RPlan11 PCP/ Specialist $750 per admission $75 per visit 00/00 PD11 $15/30/45 RPlan12 PCP/ Specialist 0 per admission $75 per visit PD12 $20/35/50 RPlan13 $10 PCP/ Specialist $350 per admission per visit $1500/00 PD10 $10/25/40 RPlan14 $15 PCP/$35 Specialist 0 per admission $125 per visit $2000/00 PD11 $15/30/45 RPlan15 $20 PCP/ Specialist $600 per admission $150 per visit 00/00 PD11 $15/30/45 RPlan16 PCP/ Specialist 0 per admission $150 per visit PD12 $20/35/50 RPlan17 PCP/ Specialist $1250 per admission $150 per visit PD13 RPlan18 $35 PCP/ Specialist $1250 per admission $150 per visit 00/$8000 PD13 RPlan19 PCP/$60 Specialist $1500 per admission $150 per visit 00/$8000 PD13 RPlan99 per visit 0 per day/00 max $150 per visit 00/00 PD 99 $20/35/50 14
15 15 HMO Options
16 Option Description PD99* DM1 DM2 IM1 IM2 IM4 O2 IC SH IV $20/35/50 (MAC III) DME - No ment DME - 20% ment Inpatient Mental Health - Covered Same As Any Other Illness Inpatient Mental Health - 50% ment Inpatient Mental Health (If MHPAE applies) Same as hospital copay, no day limits Vision Exam Only - $10 copay every 12 months; lens exam - $20 every 12 months No Hardware Vision Services Eyeglass exam is $5 copay every 12 months; lens exam included in cost of lenses w/exam every 12 months. Standard frames $5 copay every 24 months and non-standard frames have higher copays Speech and Hearing Benefit (Not available with HMO Plan 99) Texas mandated offering In Vitro Fertilization Benefit (Not available with HMO Plan 99) Texas mandated offering Included SM1 Optional SMI SM2 Required if public entity *Does not include, in whole or in part, coverage for State Mandated prescription contraceptive drugs and devices and related drugs (Oral Contraceptives not excluded). Available with HMO Plan 99 only. 16
17 17 Consumer Choice Plans PPO: BlueChoice Network HMO: HMO Blue Texas Network
18 PPO Plan: Consumer Choice RL100 Plan does not include, in whole or in part, coverage for the following State Mandated health care benefits: treatment of Chemical Dependency, Prescription Contraceptive drugs and devices and related drugs (Oral Contraceptives not excluded), In-Vitro Fertilization, Serious Mental Illness (non-public entities only), Speech and Hearing, and Home Health Care. HMO Plan: Consumer Choice RPlan 99 Plan does not include, in whole or in part, coverage for the following State Mandated health care benefits: treatment of Chemical Dependency, Prescription Contraceptive drugs and devices and related drugs (Oral Contraceptives not excluded), In-Vitro Fertilization, Serious Mental Illness (non-public entities only) and Speech and Hearing. 18
19 HMO Prescription Drug Rider: Consumer Choice PD 99 Plan does not include, in whole or in part, coverage for the following State Mandated health care benefits: Prescription Contraceptive Drugs and devices and related drugs (Oral Contraceptives not excluded). PD 99 is the only Prescription Drug Option available for HMO Consumer Choice Plan
20 20 BlueCare Freedom Dental Plans
21 21 50%/0 Deluxe 100/80/50 0 /$ D821 50%/$2000 Deluxe 100/80/50 $2000 /$ D803 0%/$0 Deluxe 100/80/50 0 /$ D811 50%/0 Deluxe 100/80/50 $1500 /$ D822 50%/$1500 Deluxe 100/80/50 $2000 /$ D802 50%/$1500 Deluxe 100/80/50 $1500 /$ D801 50%/$1500 Value 100/80/50 $1500 /$ D702 50%/0 Value 100/80/50 $1500 /$ D701 0%/$0 Value 100/80/50 $1500 /$ D602 0%/$0 Value 100/80/50 0 /$ D601 0%/$0 Value 100/80/0 $750 /$75 2+ D501 Ortho %/ LifeMax Allocation of Services Benefit Level Annual Max Deductible Indiv/Family Enrollees Plan
22 Available Health Plan Options: Plan Type Description PPO One PPO or HSA plan. HMO One HMO Plan. Dual Option PPO Multiple Option Product (MOP) Triple Option Product Any two plans PPO or HSA Four Tier Rx Plans can be paired with another Four Tier plan or an HSA One PPO (excluding Four Tier Rx Plans) or HSA and an HMO plan. Three HSA plans are allowed. One of the following is required: HSA plan, RS32, RS33 or RS34. Only one HMO plan is allowed. Four Tier Rx Plans can only be offered with an HSA. 22
23 Available Dental Plan Options: Plan Type Description Dental Dual Option Dental Select one Dental plan depending on group size. Allowable combinations for group sizes 2-9: D501 and D601 D501 and D602 Allowable combinations for group sizes 10-50: D501 and any other plan D601 and D801, D802, D803, D821 or D822 D602 and D801, D802, D803, D821 or D822 23
Market Segment Guide Effective 1/1/13
51-150 Market Segment Guide Effective 1/1/13 1 A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. 2 PPO
Fuhr Industrial. Small Group Proposal
Small Group Proposal Options and Offers: IM2 DM2 TEFRA: N Maternity: Y Name DOB mm/dd/yyyy Age Gender Zip M/F Code Type EF Last Name 06/08/1979 30 M 76065 EF EF Last Name 03/05/1973 36 F 76002 EF ES Last
Our goal is to serve your health insurance needs through all of life s changes. If you have any questions, our team stands ready to help.
September 2013 Dear [First Name] [Last Name], Thank you for your trust in Blue Cross and Blue Shield of Texas (BCBSTX), and in the strength of the health coverage and customer service we provide you. You
Home Infusion Therapy (must be preauthorized) In Vitro Fertilization Services
BENEFIT HIGHLIGHTS BlueChoice Network This is a general summary of your benefits. Please refer to your benefit booklet for additional details and a description of the plan requirements and benefit design.
Medical Plan Payroll Deductions (semi-monthly)
Medical Plan Payroll Deductions (semi-monthly) HSA 300 Base Plan Rates Employee Only $0.00 Employee + Child $58.67 Employee + Children $129.08 Employee + Spouse $293.38 Employee + Family $363.79 BENEFIT
Lee s Summit School District
Plan Type Plan Description (Visit our website at www.bluekc.com to receive a complete listing of network hospitals and physicians) Lee s Summit School District Effective Date: 1/1/16 Health Benefit Plan
In Vitro Fertilization Services
BENEFIT HIGHLIGHTS BlueChoice Network This is a general summary of your benefits. Please refer to your benefit booklet for additional details and a description of the plan requirements and benefit design.
Penalty for failure to preauthorize services None $250 Medical/Surgical Expenses. In Vitro Fertilization Services
BENEFIT HIGHLIGHTS Prepared for Austin ISD PPO3 9/1/2013 BlueChoice Network This is a general summary of your benefits. Please refer to your benefit booklet for additional details and a description of
2019 Benefits Open Enrollment. High Deductible Health Plan (HDHP) with Health Savings Account (HSA) Deep Dive
2019 Benefits Open Enrollment High Deductible Health Plan (HDHP) with Health Savings Account (HSA) Deep Dive LEWIS & CLARK COLLEGE WHAT IS A HDHP? An IRS-qualified, High Deductible Health Plan (HDHP) is
Affordable coverage for Oklahoma small businesses. okstatechamber.com
Affordable coverage for Oklahoma small businesses okstatechamber.com Blue Cross and Blue Shield of Oklahoma (BCBSOK) and The State Chamber of Oklahoma are working together to make it easy for small businesses
2018 Summary of Benefits
2018 Summary of Benefits Gateway Health Medicare Assured Diamond (HMO SNP) Gateway Health Medicare Assured Ruby (HMO SNP) Gateway Health Medicare Assured Select (HMO MA-PD) Gateway Health Medicare Assured
Your Plan: Anthem Silver PPO 3400/0%/3400 w/hsa Your Network: Anthem PPO
Your Plan: Anthem Silver PPO 3400/0%/3400 w/hsa Your Network: Anthem PPO This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This summary does not
KNOW your BENEFITS. Do you have questions about your medical or prescription drug coverage?
2015 BENEFITS GUIDE We are pleased to announce that we will be renewing our medical and pharmacy benefit plans with Florida Blue for 2015. This Benefit Guide provides important information and details
2018 Health, Dental and Vision Monthly Contributions
2018 Health, Dental and Vision Monthly Contributions Benefit Plan Monthly Contributions for Active Regular Full-Time and Part-Time Employees Employee Only Spouse Child(ren) Family Dental: Cigna PPO $ 13
Benefit Summaries Small Business Private Exchange
Benefit Summaries Small Business Private Exchange For Groups of 1-100 Employees Gold/Silver CONTENTS Gold HMO...2 Gold HSP... 4 Gold PPO...16 Silver HMO...20 Silver HSP... 22 Silver PPO... 34 Silver EPO...
benefits know your 2018 City of Jacksonville Benefits Guide Do you have questions about your medical or prescription drug coverage?
2018 B E N E F I T S G U I D E We are pleased to announce that we will be renewing our medical and pharmacy benefit plans with Florida Blue for 2018. This Benefit Guide provides important information and
Summary of Benefits. Community Blue Medicare Plus PPO. Northeastern Pennsylvania. January 1, 2018 December 31, Service Area
Northeastern Pennsylvania Community Blue Medicare Plus PPO Summary of Benefits January 1, 2018 December 31, 2018 Service Area Our service area includes the following counties in Pennsylvania: Clinton,
Plan changes are in red In-Network 2015 Out-of-Network
General Information Lifetime Maximum Benefit Unlimited Unlimited Annual Maximum Benefit Unlimited Unlimited Coinsurance Percentage 80.00% 50.00% Precertification Requirements Precertification Penalty Covered
NV Silver Health Network HMO 2000 $30/60. In Network In Network In Network $0/$0 $2,000/$4,000 $5,000/$10,000
HMO NV Gold Health Network HMO $30/60 NV Silver Health Network HMO 2000 $30/60 NV Silver Health Network HMO 5000 $25/60 In Network In Network In Network Deductible (Individual/Family) Out-of-pocket limit
Anthem Blue Cross and Blue Shield Your Plan: Anthem Gold PPO 2000/20%/4000 Your Network: PPO
Anthem Blue Cross and Blue Shield Your Plan: Anthem Gold PPO 2000/20%/4000 Your Network: PPO This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This
Choice 100+ A defined contribution plan can help control your costs and offer your 100+ employees more options
Choice 100+ A defined contribution plan can help control your costs and offer your 100+ employees more options With Choice 100+, employees choose the plan that best meets their needs from the options you
QualChoice Advantage. Classic Plus Rx (HMO), Plan 001
QualChoice Advantage (HMO), Plan 001 This is a summary of drug and health services covered by QualChoice Advantage January 1, 2017 - December 31, 2017 QualChoice Advantage is an HMO plan with a Medicare
Anthem Blue Cross and Blue Shield Your Plan: Anthem Bronze PPO 6000/30%/7150 Your Network: PPO
Anthem Blue Cross and Blue Shield Your Plan: Anthem Bronze PPO 6000/30%/7150 Your Network: PPO This summary of benefits is a brief outline of coverage, designed to help you with the selection process.
2015 Benefits Overview
2015 Benefits Overview ASPIRE HEALTH ADVANTAGE VALUE (HMO) BENEFIT Monthly Plan Premium Out-of-Pocket Limit (In-Network Medicare-covered benefits) Annual Part C Deductible (all services except for Prescription
NC Aetna Gold PPO /50 NC Aetna Gold PPO /50 NC Aetna Gold PPO /50 NC Aetna Gold PPO /70 HSA Umb
PPOMedical NC 01/01/2016 NC Aetna Gold PPO 500 80/50 NC Aetna Gold PPO 1000 80/50 NC Aetna Gold PPO 1500 80/50 NC Aetna Gold PPO 1750 100/70 HSA Umb Plan year (Individual/Family) /$1,000 $3,000/$6,000
Your Plan: Anthem Bronze PPO 3250/50%/6550 Plus w/hsa Your Network: Anthem PPO
Your Plan: Anthem Bronze PPO 3250/50%/6550 Plus w/hsa Your Network: Anthem PPO This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This summary does
Anthem Blue Cross and Blue Shield Your Plan: Anthem Bronze Pathway PPO 5000/30%/7150 Your Network: Pathway PPO
Anthem Blue Cross and Blue Shield Your Plan: Anthem Bronze Pathway PPO 5000/30%/7150 Your Network: Pathway PPO This summary of benefits is a brief outline of coverage, designed to help you with the selection
Let us help you choose the health insurance plan that fits you best
Let us help you choose the health insurance plan that fits you best Call 800-531-4456, visit bcbstx.com or contact an independent Blue Cross and Blue Shield of Texas agent to get a quote today. Life is
Anthem Blue Cross Your Plan: Custom Classic PPO 500/20/20 (RX $5/$10/$25/30%) Your Network: Prudent Buyer PPO
Anthem Blue Cross Your Plan: Custom Classic PPO 500/20/20 (RX $5/$10/$25/30%) Your Network: Prudent Buyer PPO This summary of benefits is a brief outline of coverage, designed to help you with the selection
Benefit Summaries Small Business Private Exchange
Benefit Summaries Small Business Private Exchange For Groups of 1-100 Employees Silver/Bronze CONTENTS Silver HMO...2 Silver HSP... 4 Silver PPO...16 Silver EPO...18 Bronze HSP...20 Bronze HMO... 22 Bronze
Anthem Blue Cross Your Plan: Modified Value HMO 30/40/30% Your Network: California Care HMO
Anthem Blue Cross Your Plan: Modified Value HMO 30/40/30% Your Network: California Care HMO This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This
2016 Plan HSA $6,000. $6,000 individual/$12,000 family. $6,000 individual/$12,000 family
Benefit Changes This is an overview of some of the benefit changes for. For complete details about plans, refer to the carrier documents provided to the member upon enrollment. Refer to CBIA's Benefit
2019 Benefits Open Enrollment. High Deductible Health Plan (HDHP) with Health Savings Account (HSA) Deep Dive LEWIS & CLARK COLLEGE
2019 Benefits Open Enrollment High Deductible Health Plan (HDHP) with Health Savings Account (HSA) Deep Dive LEWIS & CLARK COLLEGE AGENDA What is a High Deductible Health Plan (HDHP) with Health Savings
Medical out-of-pocket limit 1 (See separate prescription drug out-of-pocket limit for UMP Classic.)
2017 Medical Benefits Cost Comparison The chart below briefly compares the per-visit costs of some in-network benefits for PEBB plans. Some copays and coinsurance do not apply until after you have paid
Deductible credit from prior carrier (applied on initial group enrollment only) Yes Yes
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 policy or plan document for additional details and a description
Through It All. Health Coverage for Individuals and Families. Plans that fit every need, lifestyle and budget bcbsil.
Health Coverage for Individuals and Families Plans that fit every need, lifestyle and budget. Through It All. 800-477-2000 bcbsil.com SM Call 800-477-2000, visit bcbsil.com, or contact an independent Blue
2016 Benefits Overview
2016 Benefits Overview ASPIRE HEALTH ADVANTAGE VALUE (HMO) BENEFIT Monthly Plan Premium Out-of-Pocket Limit (In-Network Medicare-covered benefits) Annual Part C Deductible (all services except for Prescription
Your Plan: Anthem Silver Blue Access PPO 2000/50%/6350 Your Network: Blue Access
Your Plan: Anthem Silver Blue Access PPO 2000/50%/6350 Your Network: Blue Access This summary of benefits is a brief outline of coverage, designed to help y ou with the selection process. This summary
Your Plan: Anthem Bronze PPO 6350/30%/6850 Plus Your Network: Anthem PPO
Your Plan: Anthem Bronze PPO 6350/30%/6850 Plus Your Network: Anthem PPO This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This summary does not
Anthem Blue Cross Your Plan: Custom Anthem HSA /40 Embedded (HSA291) - Actives Your Network: Prudent Buyer PPO
Anthem Blue Cross Your Plan: Custom Anthem HSA 2700 20/40 Embedded (HSA291) - Actives Your Network: Prudent Buyer PPO This summary of benefits is a brief outline of coverage, designed to help you with
Auxiliary Organizations Association
Auxiliary Organizations Association Your Plan: Modified Premier HMO 20/200 admit/100 OP (Modified RX $5/$20/$60/20%) Your Network: California Care HMO This summary of benefits is a brief outline of coverage,
Retirees with Medicare (RETIREMENT DATE BEFORE March 1, 2015) Benefits Comparison Benefits effective January 1, December 31, 2019
Network Eligible OGB Members Pelican HRA1000 Blue Cross and Blue Shield of Louisiana Preferred Care Providers & Blue Cross National Providers Magnolia Local Plus Blue Cross and Blue Shield of Louisiana
Retirees with Medicare (RETIREMENT DATE ON or AFTER March 1, 2015) Benefits Comparison Benefits effective January 1, December 31, 2019
Pelican HRA1000 Magnolia Local Plus Network Blue Cross and Blue Shield of Louisiana Preferred Care Providers & Blue Cross National Providers Blue Cross and Blue Shield of Louisiana Preferred Care Providers
Your Plan: Bronze Pathway X HMO Plus w/hsa Your Network: Pathway X HMO
Your Plan: Bronze Pathway X HMO Plus w/hsa Your Network: Pathway X HMO This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This summary does not reflect
2017 Benefits Open Enrollment
2017 Benefits Open Enrollment Benefits Open Enrollment Is October 31 November 11, 2016. Ready to Choose? As recently announced by President Zach Green, Colas Inc. continues to align aspects of its business.
2010 Group Smart Solutions from The Blues
2010 Group Smart Solutions from The Blues Community-rated Medicare offerings for new groups. Products available for new IBC Medicare customers and existing customers adding additional lines of coverage.
Retirees with Medicare (RETIREMENT DATE ON or AFTER March 1, 2015) Benefits Comparison Benefits effective January 1, December 31, 2017
Pelican HRA1000 Magnolia Local Plus Network Blue Cross and Blue Shield of Louisiana Preferred Care Providers & Blue Cross National Providers Blue Cross and Blue Shield of Louisiana Preferred Care Providers
Aetna 1-50 HealthNetworkOnlyOpenAccess NV 01/01/2019
HealthNetworkOnlyOpenAccess NV 01/01/2019 Plan Name NV Silver HNOnly 3500 70% $40 In Network Deductible (Individual/Family) $3,500/$7,000 Out-of-pocket limit (Individual/Family) $7,500/$15,000 Deductible/out-of-pocket
Anthem Blue Cross Your Plan: CSEBO HMO 10 (Custom Premier HMO 10/100%) Your Network: California Care HMO
Anthem Blue Cross Your Plan: CSEBO HMO 10 (Custom Premier HMO 10/100%) Your Network: California Care HMO This summary of benefits is a brief outline of coverage, designed to help you with the selection
Washington Counties Insurance Fund 2017 Benefit Plan Comparison for Retirees
Washington Counties Insurance Fund 2017 Benefit Plan Comparison for Retirees Retiree Medical Plans for Under Age 65 (former WCIF medical enrollees only) Retiree Medical Plans for Over Age 65 (all eligible
Benefit Summaries Small Business Private Exchange
Benefit Summaries Small Business Private Exchange For Groups of 1-100 Employees CONTENTS About this Guide...2 Platinum HMO...3 Gold HMO...13 Gold HSP...15 Gold PPO... 27 Silver HMO...31 Silver HSP... 33
Anthem Blue Cross Your Plan: Classic HMO 20/40/250 Admit /125 OP Your Network: Select HMO
Anthem Blue Cross Your Plan: Classic HMO 20/40/250 Admit /125 OP Your Network: Select HMO This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This
2018 Summary of Benefits. BlueCross Secure SM (HMO)
2018 Summary of Benefits BlueCross Secure SM (HMO) Jan. 1, 2018 Dec. 31, 2018 855-204-2744 TTY 711 Seven Days a Week, 8 a.m. to 8 p.m. (Oct. 1, 2017, to Feb. 14, 2018) Monday-Friday, 8 a.m. to 8 p.m. (All
PLAN CHOICES. What You Need to Know. Pennsylvania Service Areas. This is a summary of drug and health services for January 1, 2017 December 31, 2017
PLAN CHOICES What You Need to Know This is a summary of drug and health services for January 1, 2017 December 31, 2017 The benefit information provided is a summary of what we cover and what you pay. It
Anthem Blue Cross Your Plan: Premier HMO 20/200 admit/100 OP (Essential Formulary $10/$25/$45/30%) Your Network: California Care HMO
Anthem Blue Cross Your Plan: Premier HMO 20/200 admit/100 OP (Essential Formulary $10/$25/$45/30%) Your Network: California Care HMO This summary of benefits is a brief outline of coverage, designed to
Non-Medicare Retirees (RETIREMENT DATE BEFORE March 1, 2015) Benefits Comparison Benefits effective January 1, December 31, 2019
Network Pelican HRA1000 Blue Cross and Blue Shield of Louisiana Preferred Care Providers & Blue Cross National Providers Magnolia Local Plus Blue Cross and Blue Shield of Louisiana Preferred Care Providers
Plan highlights and rates. Effective January to June 2011
Plan highlights and rates Effective January to June 2011 2011 Small Business RATE AREA 4 Contents 2 3 4 5 6 7 8 9 10 11 12 13 14 15 17 Copayment plans Predictable out-of-pocket costs and no annual deductible
Your Plan: Anthem Bronze PPO 6000/0%/6000 w/hsa Your Network: Prudent Buyer PPO
Your Plan: Anthem Bronze PPO 6000/0%/6000 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
2018 Independence Blue Cross Medicare Group Options
2018 Independence Blue Cross Medicare Group Options Medical Coverage Keystone 65 Select HMO Value Standard Enhanced CovID H672, 10010705, QN, Y H673, 10010706, QN, Y H675, 10013103, QN, Y Plan premium
Balance 3 up to Allowed Amount 4 after BCBSF pays up to $50. $0 CYD % Coinsurance 6
Understanding Your Share for Covered Services This health insurance policy 1 provides you with routine health care services, such as physician office services, as well as basic protection against major
Your Plan: Anthem Gold Blue Access PPO 500/20%/3500 Your Network: Blue Access
Your Plan: Anthem Gold Blue Access PPO 500/20%/3500 Your Network: Blue Access This summary of benefits is a brief outline of coverage, designed to help y ou with the selection process. This summary does
Medical Plan Options - Retirees Age 65 or Over/ Disabled Participants with Medicare Coverage
l Plan Options - Retirees Age 65 or Over/ Disabled Participants with re Program Name Group Prime Solution Group Prime Solution for Seniors for Seniors Type of Policy re Cost Plan with re Prescription Drug
Garden Grove Unified School District. Retiree Health and Welfare Benefits
Garden Grove Unified School District Retiree Health and Welfare Benefits 2016-2017 Medical Premium for Retirees Under 65 Retiree Only $450 yearly Retiree & Spouse / Domestic Partner $900 yearly Rates for
2017 Denver Employees Retirement Plan Non-Medicare Medical Plan Summary
HDHP* 2017 Denver Employees Retirement Plan Non-Medicare Summary Colorado HDHP HDHP** DHMO* Colorado DHMO Navigate (Colorado only) Annual Deductible Single $1,350 $1,350 $1,350 $500 $500 $500 Family $2,700
Your Plan: Anthem Bronze Select PPO 6350/0%/6350 w/hsa Your Network: Select PPO
Your Plan: Anthem Bronze Select PPO 6350/0%/6350 w/hsa Your Network: Select PPO This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This summary does
Participating MEMBER RESPONSIBILITY
Deductible 80% $500 Preferred Provider Organization Underwritten by Coventry Health and Life Insurance Company (d.b.a. HealthAmerica) DEDUCTIBLES AND MAXIMUMS Annual Deductible Individual $500 $1,000 Family
Summary of Benefits. Join the WELLfluent Miami-Dade County. AvMed Medicare Choice HMO H1016, Plan 001 GET FIT. EAT RIGHT. CONNECT. GROW.
Join the WELLfluent GET FIT. EAT RIGHT. CONNECT. GROW. Summary of Benefits 2018 Miami-Dade County AvMed Medicare Choice HMO H1016, Plan 001 This is a summary of drug and health services covered by AvMed
Your Plan: Anthem Gold Select HMO 35/25%/6600 Your Network: Select HMO
Your Plan: Anthem Gold Select HMO 35/25%/6600 Your Network: Select HMO This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This summary does not reflect
Penalty for failure to preauthorize services None $250 Medical/Surgical Expenses
**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 policy or plan document for additional details and a description of the
Anthem Blue Cross Your Plan: Lumenos HSA 2000/ /40 (LHSA2153) Your Network: Prudent Buyer PPO
Anthem Blue Cross Your Plan: Lumenos HSA 2000/4000 20/40 (LHSA2153) Your Network: Prudent Buyer PPO This summary of benefits is a brief outline of coverage, designed to help you with the selection process.
Anthem Blue Cross Your Plan: Premier HMO 15/100% (RX $10/$20/$35) Your Network: California Care HMO
Anthem Blue Cross Your Plan: Premier HMO 15/100% (RX $10/$20/$35) Your : California Care HMO This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This
Summary of Benefits. Join the WELLfluent Broward County. AvMed Medicare Choice HMO H1016, Plan 021 GET FIT. EAT RIGHT. CONNECT. GROW.
Join the WELLfluent GET FIT. EAT RIGHT. CONNECT. GROW. Summary of Benefits 2019 Broward County AvMed Medicare Choice HMO H1016, Plan 021 This is a summary of drug and health services covered by AvMed Medicare
NEW CASTLE COUNTY COMPARISON OF PRE-65 RETIREES/PENSIONERS BENEFITS PLAN YEAR 2019
Deductible Per Calendar Year (Individual/Family) $200 Individual $400 Family (DME, Prosthetics and Hearing Aids only) $200 per Individual $400 per Family $200 per Individual $400 per Family $200 per Individual
ALL RETIRED LABORERS AND THEIR ELIGIBLE DEPENDENTS COVERED UNDER THE RETIRED LABORERS PLAN EFFECTIVE NOVEMBER 1, 2017
Laborers Health and Welfare Trust Fund for Northern California 220 Campus Lane * Fairfield, California 94534-1498 Telephone: (707) 864-2800 Toll-Free: (800) 244-4530 Website: www.norcalaborers.org TO:
UNDER AGE 65 HEALTH PLANS FOR PARTICIPANTS. Kern County 2019 Retiree
Kern County 2019 Retiree HEALTH PLANS FOR PARTICIPANTS UNDER AGE 65 For current participating physician information, please contact each plan directly. This summary is for information purposes only. Members
Operations Bulletin Date: December 26, 2012 To: Participating Providers Subject: Geisinger Gold 2013
Operations Bulletin Date: December 26, 2012 To: Participating Providers Subject: Geisinger Gold 2013 Meridian Health and Geisinger Health Plan are pleased to introduce the 2013 Geisinger Gold Medicare
Retirees with Medicare (RETIREMENT DATE BEFORE March 1, 2015) Benefits Comparison Benefits effective January 1, December 31, 2017
Network Eligible OGB Members Pelican HRA1000 Blue Cross and Blue Shield of Louisiana Preferred Care Providers & Blue Cross National Providers (retirement date BEFORE 3/1/2015) Magnolia Local Plus Blue
Calendar year deductible (Individual/Family) $250/$500 $750/$1,500 $500/$1,000 $1,500/$3,000 $1,000/$2,000 $3,000/$6,000 $1,350/$2,700 $3,750/$7,500
2016 PPO Medical PPO is available statewide. Rainier Health PPO is available in King and Pierce counties. PacMed PPO is available in King county. Prov/Swed PPO is available in King and Snohomish counties.
Small Business. Small Group Product Portfolio
Small Business Small Group Product Portfolio 2014 HPN Small Group HMO Metallic Benefit Standards Silver Standards: Lab and X-ray: $20-25/$40-50 ER: $500 OP ASC: $150 + $150 Physician; OP @ Facility: CYD
Health Care Coverage You Need. A Company You Know.
Health Care Coverage You Need. A Company You Know. 2018 Call 800-531-4456, visit bcbstx.com or contact an independent, authorized agent to get a quote today. When It s Time to Get Health Care Coverage,
Plan highlights and rates
Plan highlights and rates Effective January to June 2010 2010 Small Business Rate area 7 welcome to kaiser permanente On these pages, you ll find an overview of available plan benefits for small businesses.
Plan highlights and rates
Plan highlights and rates Effective January to June 2010 2010 Small Business Rate area 5 welcome to kaiser permanente On these pages, you ll find an overview of available plan benefits for small businesses.
Aetna 1-50 PPOMedical WA 01/01/2019
Plan Name WA Gold PPO 500 80/50 WA Gold PPO 1000 80/50 WA Silver PPO 2000 70/50 Deductible (Individual/Family) $500/$1,000 $5,000/$10,000 $1,000/$2,000 $5,000/$10,000 $2,000/$4,000 $8,000/$16,000 Out-of-pocket
OPERATING ENGINEERS HEALTH & WELFARE FUND BENEFIT PLANS SUMMARY COMPARISON FOR ACTIVES and EARLY RETIREES
PPO Plan For Non-PPO Providers Employee Premium None None None None None Explanation of Plans and Options Available to You Deductible Annual Out-of-Pocket Maximum Medical and ¹Pediatric Dental & Vision
Anthem Blue Cross of California Your Plan: Anthem Gold Select HMO 500/20%/6500 Your Network: Select HMO
Anthem Blue Cross of California Your Plan: Anthem Gold Select HMO 500/20%/6500 Your Network: Select HMO This summary of benefits is a brief outline of coverage, designed to help you with the selection
Your Plan: Anthem Gold Blue Choice PPO 1500/20%/4000 Your Network: Blue Choice PPO
Your Plan: Anthem Gold Blue Choice PPO 1500/20%/4000 Your Network: Blue Choice PPO This summary of benefits is a brief outline of coverage, designed to help y ou with the selection process. This summary
Anthem Blue Cross and Blue Shield Your Plan: Lumenos Health Savings Account (HSA-Compatible) Plan $ /20 Your Network: PPO
Anthem Blue Cross and Blue Shield Your Plan: Lumenos Health Savings Account (HSA-Compatible) Plan $3500 80/20 Your Network: PPO This summary of benefits is a brief outline of coverage, designed to help
Aetna 1-50 HMO DC 01/01/2018
HMO DC 01/01/2018 Plan Name DC Gold HMO 70% DC Gold HMO 500 90% DC Gold HMO 1600 100% HSA T DC Silver HMO 3000 100% HSA E DC Silver HMO 4500 80% DC Bronze HMO 5000 80% HSA E In Network In Network In Network
Cost if you use a Non-Network Provider. Cost if you use an In-Network Provider. Covered Medical Benefits
Anthem Blue Cross California State University Risk Management Authority Your Plan: Custom Premier HMO 20/200 admit/100 OP (Custom Rx $5/$20/$60/20%) Your Network: California Care HMO This summary of benefits
PLAN DESIGN AND BENEFITS - PA POS HSA COMPATIBLE NO-REFERRAL 2.4 ($2,500 Ded) PARTICIPATING PROVIDERS
PLAN FEATURES Deductible (per plan year) $2,500 Individual NON- $5,000 Individual $5,000 Family $10,000 Family Unless otherwise indicated, the Deductible must be met prior to benefits being payable. All
Your Plan: Empire Gold Healthy New York Pathway HMO 600/0%/4000 Your Network: Pathway
Your Plan: Empire Gold Healthy New York Pathway HMO 600/0%/4000 Your Network: Pathway This summary of benefits is a brief outline of coverage, designed to help y ou with the selection process. This summary
PLAN DESIGN AND BENEFITS - PA POS COST-SHARING 3.4 ($1,500 DED) PARTICIPATING PROVIDERS. $1,500 Individual
Plan Coinsurance * Out-of-Pocket Maximum (per calendar year, includes deductible) $3,000 Individual $6,000 Family 50% $6,000 Individual $12,000 Family Amounts over the Recognized Charge, failure to pre-certification
PLAN DESIGN AND BENEFITS - PA POS COST-SHARING NO-REFERRAL 4.4 ($2,000 DED) $2,000 Individual
Plan Coinsurance * Out-of-Pocket Maximum (per calendar year, includes deductible) $4,000 Individual $8,000 Family 50% $8,000 Individual $16,000 Family Amounts over the Recognized Charge, failure to pre-certification
Anthem Blue Cross Your Plan: Modified Anthem PPO HSA-H 2000/ /40 Your Network: Prudent Buyer PPO
Anthem Blue Cross Your Plan: Modified Anthem PPO HSA-H 2000/6000 20/40 Your Network: Prudent Buyer PPO This summary of benefits is a brief outline of coverage, designed to help you with the selection process.
Cost if you use a Non-Network Provider. Cost if you use an In-Network Provider. Covered Medical Benefits
Anthem Blue Cross Life and Health Insurance Company Student Health Plan: Samuel Merritt University Your Plan: Custom PPO 300/20/40/20 Your Network: Prudent Buyer PPO This summary of benefits is a brief
Connecticut Small Group Benefit Designs. January 1, 2018 through March 31, 2018
Connecticut Small Group Benefit Designs January 1, 2018 through March 31, 2018 HMO Copay 25/35 Platinum MD0000004520 RX0000001433 Best Buy HMO Hospital 2000 MD0000004513 RX0000001520 Best Buy HMO 2000
Your Plan: Anthem Silver PPO 2000/35%/6850 Your Network: Prudent Buyer PPO
Your Plan: Anthem Silver PPO 2000/35%/6850 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
Anthem Blue Cross of California Your Plan: Anthem Gold HMO 40/20%/6500 Your Network: California Care HMO
Anthem Blue Cross of California Your Plan: Anthem Gold HMO 40/20%/6500 Your Network: California Care HMO This summary of benefits is a brief outline of coverage, designed to help you with the selection
Anthem Blue Cross Your Plan: Custom Classic HMO 20/250 Admit (Rx $15/$30/$45/$45) Your Network: Select HMO
Anthem Blue Cross Your Plan: Custom Classic HMO 20/250 Admit (Rx $15/$30/$45/$45) Your Network: Select HMO This summary of benefits is a brief outline of coverage, designed to help you with the selection
2017 PLAN UPDATES. What s new for 2017 Oregon small business group plans. account.kp.org
2017 PLAN UPDATES O R E G O N 2017 What s new for 2017 Oregon small business group plans This booklet contains a summary of important information you will want to know about our 2017 small group plans.