2015 MA HMO PATRIOT SMALL GROUP PLAN PORTFOLIO COMPARISON CHART

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Abigail Hancock
5 years ago
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1 2015 MA HMO PATRIOT SMALL GROUP HMO PLANS Basic w/child $500/$1,000 $3,000/$6,000 Plus w/child $1,000/$2,000 $5,000/$10, w/child $1,500/$3,000 $5,000/$10, w/child $1,200/$2,400 $6,600/$13,200 Plus w/child $6,600/$13, w/child Basic 2050 w/child Plus w/child 1750 w/child 2050 w/child HSA 2050 w/child $5,800/$11,600 $800/$600 $2,050/$4,100 $6,600/$13,200 $6,600/$13,200 $6,600/$13,200 OT (60 visits) $20 $35 $35* $35* 30%* 30%* 30%* 30%* Yes Tier 1 - $15 $30 $45 $45* $45* $150* $250* $500* $200* Yes $25 $40 $40* $40* $150* $250* $250* $150* Yes Tier 1 - $15 Tier 2 - $25 $30 $50* $50* $50* $350* $750* $1,000* $400* Yes $15* $45* $45* $45* $350* $750* $1,000* $400* Yes Tier 1 - $10 (3 visits) 1 * * $30 $50* $50* $50* $350* $750* $1,000* $400* Yes $30 $50 $50* $50* $350* $750* $1,000* $400* Yes Tier 2 - $40 Tier 3 - $70 $50 $80* $80* $80* $750* 35%* 35%* $1,000* Yes $50* $80* $80* $80* $750* 35%* 35%* $1,000* Yes * $80* $80* $80* $750* 35%* 35%* $1,000* Yes * $2,050/$4,100 $6,600/$13,200 $50* (3 visits) 1 $2,050/$4,100 $6,450/$12,900 $50* $75* $75* $75* $750* $750* $1,000* $1,000* Yes * Tier 2 - $50 * * Tier 2 - $80 Tier 3 - $210 * * * 1. First three non-routine visits are not subject to the deductible

2 MA /1/2015 PATRIOT SMALL GROUP HMO PLANS 1000 w/child 1500 Plus w/child 2000 w/child 2050 w/child OT (60 visits) $1000/2000 $3000/6000 $20 $40 $40* $40 $150* Sbj to ded Sbj to ded $100* Yes Tier 1 - $15 $1500/3000 $3000/6000 $20 $40 $40 $40 $150* Sbj to ded Sbj to ded $150* Yes Tier 1 - $15 $2000/4000 $2000/4000 Sbj to ded Sbj to ded Sbj to ded Sbj to ded Sbj to ded Sbj to ded Sbj to ded Sbj to ded Yes Tier 1 - $15 $2050/4100 $4000/8000 $25 $50 Sbj to ded $50 $150* Sbj to ded Sbj to ded Sbj to ded Yes Tier 1 - $15

3 2015 MA SELECT PPO PATRIOT SMALL GROUP SELECT PPO PLANS Silver 1200 w/child OT (60 visits) $1,200/$2,400 $6,600/$13,200 $30 $50* $50* $50* $350* $750* $1,000* $400* Yes () $4,200/$8,400 $10,250/$16,500 $30 $50* $50* $50* $350* $750* $1,000* $400* Yes Silver Plus w/child $45* $45* $45* $350* $750* $1,000* $400* Yes Tier 1 - $10 $6,600/$13,200 $15* (3 visits) 1 * * () $4,750/$9,500 $10,250/$16,500 $15* $45* $45* $45* $350* $750* $1,000* $400* Yes Silver 1750 w/child $5,800/$11,600 $800/$1,600 $30 $50* $50* $50* $350* $750* $1,000* $400* Yes () $4,750/$9,500 $10,250/$16,500 $30* $50* $50* $50* $350* $750* $1,000* $400* Yes * * Bronze Plus w/child $6,600/$13,200 $50 $80* $80* $80* $750* 35%* 35%* $1,000* Yes () $4,750/$9,500 $10,250/$16,500 $50* $80* $80* $80* $750* 55%* 55%* $1,000* Yes 1. First three non-routine visits are not subject to the deductible

4 2015 MA NATIONAL PPO PATRIOT SMALL GROUP NATIONAL PPO PLANS Silver HSA 1500 w/ child OT (60 visits) $1,500/$3,000 $5,000/$10,000 20%* 20%* 20%* 20%* 20%* 20%* 20%* 20%* Yes * () $3,000/$6,000 $10,000/$16,000 40%* 40%* 40%* 40%* 20%* 40%* 40%* 40%* Yes Bronze Basic HSA w/ child $2,000/$4,000 $6,450/$12,900 $50* $75* $50* $75* $750* $1,000* $1,000* $1,000* Yes * () $4,000/$8,000 $11,000/$23,000 20%* 20%* 20%* 20%* $750* $1, %* $1, %* 20%* Yes Bronze 2050 w/child $80* $50* $80* $750* 20%* 20%* $750* Yes $2,050/$4,100 $5,000/$10,000 $50* (3 visits) 1 () $5,050/$10,100 $10,000/$16,000 20%* 20%* 20%* 20%* $750* 40%* 40%* 40%* Yes Bronze HSA 3350 w/ child $3,350/$6,650 $6,450/$12,900 20%* 20%* 20%* 20%* 20%* 20%* 20%* 20%* Yes * () $6,300/$13,000 $11,000/$23,000 40%* 40%* 40%* 40%* 20%* 40%* 40%* 40%* Yes * * * 1. First three non-routine visits are not subject to the deductible

5 2015 MA PPO - ERVIEW CHART Product Providers Service Area Medical Benefits and Cost- Share MA NATIONAL PPO In-Plan Minuteman Health Network MHI s 7 county network in MA. Members incure the lowest outof-pocket cost. In-Plan First Health Providers National network that includes hospitals, ancillary facilities and health care professionals. Outside of MHI s 7 county network in MA and nation wide. Members incur the lowest out of pocket costs. Referrals Pharmacy Benefits Member must select a. Not Required Catamaran Not Required Not Required Catamaran First Health Providers -- Inside of MHI s 7 county network Members have higher out of pocket costs, but providers accept MHI s negotiated fees and cannot balance bill members. Other Providers Any provider who does not participate in MHI network or First Health. Any provider who does not participate in MHI network or First Health. Members have higher out of pocket costs. Providers charge their full rates and can balance bill members. MA SELECT PPO In-Plan Minuteman Health Network MHI s 7 county network in MA. Members incure the lowest outof-pocket cost. First Health Providers National network that includes hospitals, ancillary facilities and health care professionals. -- Members have higher out of pocket costs, but providers accept MHI s negotiated fees and cannot balance bill members. Member must select a. Not Required Catamaran Other Providers Any provider who does not participate in MHI network or First Health. -- Members have higher out of pocket costs. Providers charge their full rates and can balance bill members.

6 MA 2015 CONSTITUTION SMALL GROUP OT (60 visits) HMO PLANS Basic $500/$1,000 $3,000/$6,000 $20 $35 $35* $35* 30%* 30%* 30%* 30%* No Plus $1,000/$2,000 $5,000/$10,000 $30 $45 $45* $45* $150* $250* $500* $200* No 1500 $1,500/$3,000 $5,000/$10,000 $25 $40 $40* $40* $150* $250* $250* $150* No Plus $6,600/$13,200 $15* (3 visits) 1 Basic $2,000/$4,000 $6,350/$12,700 $30 $50 $50* $50* $350* $750* $1,000* $400* No Plus $6,600/$13,200 $50 $80* $80* $80* $750* 35%* 35%* $1,000* No Basic HSA $2,000/$4,000 $6,350/$12,700 $50* $75* $75* $75* $750* $1,000* $1,000* $1,000* No Tier 1 - $15 Tier 1 - $15 Tier 2 - $25 Tier 1 - $10 * * Tier 2 - $40 Tier 3 - $70 * Tier 2 - $50 * * Tier 2 - $80 Tier 3 - $210 * 1. First three non-routine visits are not subject to the deductible.

7 MA 2015 CONSTITUTION SMALL GROUP OT (60 visits) PPO Silver Plus $6,600/$13,200 $15* (3 visits) 1 No () $4,750/$9,500 $10,250/$16,500 $15* $45* $45* $45* $350* $750* $1,000* $400* No Silver 1750 $5,800/$11,600 $800/$1,600 $30 $50* $50* $50* $350* $750* $1,000* $400* No () $4,750/$9,500 $10,250/$16,500 $30 * $50* $50* $50* $350* $750* $1,000* $400* No Tier 1 - $10 * * * * 1. First three non-routine visits are not subject to the deductible. atric Essential Health Benefit: These policies DO NOT include coverage for pediatric services as required under the federal Patient Protection and Affordable Care Act. They will only be offered when Minuteman Health is reasonably assured that an individual buying health insurance on his/her own or within a small group is covered by a stand-alone plan with the required level of coverage for pediatric services. If not reasonably assured an individual or small group member has compliant coverage, Minuteman Health will require him/her to purchase an Exchange-certified stand-alone plan bundled with the Minuteman Health medical plan. This is a Benefits Summary only. For full benefits and coverage details please visit or call 855-MHI-1776.

HSA & HRA Health Plans at a Glance Small Group (1-50)

HSA & HRA Health Plans at a Glance Small Group (1-50) California Small Group HSA & HRA Plans Aetna - Bronze MC HSA 2500 50/50 $2,500 Bronze MC HSA 3500 70/50 $3,500 Bronze EPO 3000 70 HSA $3,000 Bronze MC HSA HDHP 6300 100/50 Anthem Blue Cross Gold Select