2016 Plan HSA $6,000. $6,000 individual/$12,000 family. $6,000 individual/$12,000 family
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- Winifred Thompson
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1 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 Comparison by Insurance Company for more details. Some plans are no longer available in. Employees will be automatically enrolled in the plan shown in the comparison below. Below are the benefit differences between the plan and plan. HSA $6,000 $12,000 individual/$24,000 family $24,000 individual/$48,000 family HSA $6,500 $6,500 individual/$13,000 family $6,500 individual/$13,000 family $13,000 individual/$26,000 family $26,000 individual/$52,000 family Maximum Out of Pocket t(in Network) HSA $4,000/50% HSA $5,000/50% $4,000 individual/$8,000 family $6,450 individual/$12,900 id family $6,550 individual/$13,100 id 100 family $8,000 individual/$16,000 family $10,000 individual/$20,000 family $12,900 individual/$25,800 family $13,100 individual/$26,200 family HSA $2,750/10% HSA $2,800/20% $2,750 individual/$5,500 family $2,800 individual/$5,600 family 10% after deductible 20% after deductible $5,500 individual/$11,000 family $5,600 individual/$11,200 family
2 Maximum Out of Pocket (In Network) Specialist Outpatient Surgery Annual Routine Vision Exam Out of Network Maximum Out of Pocket POS $30 $2,500/50% $2,500 individual/$5,000 family $12,000 individual/$24,000 family POS $35/$50 $4,000/50% $4,000 individual/$8,000 family $7,150 individual/$14,300 family Hospital Setting: ; Preferred Facility: $500 copay $8,000 individual/$16,000 family $14,300 individual/$28,600 family Maximum Out of Pocket (In Network) Emergency Room General X Ray Ambulance Services Out of Network Maximum Out of Pocket POS $35/$50 $2,850/30% POS $30/$50 $3,000/25% $2,850 individual/$5,700 family 30% after deductible $6,950 individual/$13, 900 family 30% coinsurance to $500 max 25% coinsurance to $350 max ConnectiCare: ; Harvard Pilgrim: 30% coinsurance $5,700 individual/$11,400 family ConnectiCare: ; Harvard Pilgrim:
3 Ambulance Ambulance Speech Therapy POS $35/$50 $3,500/25% $3,500 individual/$7,000 family Connecticare: Harvard Pilgrim: 25% coinsurance $7,000 individual/$14,000 POS $30/$45 $3,000/20% 20% after deductible $6,850 individual/$13,700 family $30 Connecticare: Harvard Pilgrim: 20% coinsurance $13,700 indivdual/$27,400 family POS $30/$50 $3,000/25% $6,950 individual/$13,900 family Connecticare: Harvard Pilgrim: $6,00 individual/$12,000 family POS $30/$50 $3,000/25% $6,950 individual/$13,900 family Connecticare: Harvard Pilgrim:
4 Medical Office Visits Advanced Imaging Outpatient Surgery Emergency Room Services Urgent Care Ambulence Physical & Occupational Therapy Speech Therapy Annual Routine Vision Exam POS $30/$45 $4,000 POS $35/$50 $4,000/50% $7,150 individual/$14,300 family 0% after deductible $30; Specialist $45 $35; Specialist $50 after deductible $75 copay after deductible after deductible 0% after deductible Hospital setting; Preferred facility: $500 copay $150 copay $75 copay $14,300 individual/$28,600 family
5 The plan names below remain the same for, however, some benefit changes will apply for the new year. POS $30/$45 $1,500 Outpatient Surgery Preferred Facility Ambulance ConnectiCare POS $25/$40 $2,000 Ambulance ConnectiCare $250 copay $25 copay $2,500 individual/$5,000 family $500 copay $200 copay $10 copay $40 copay $3,100 individual/$6,200 family $6,200 individual/$12,400 family $10 copay $200 Pharmacy Changes Harvard Pilgrim Health Care Tier 2: 30% to $35 ConnectiCare Preventive Rx for all HSA Plans Durable Medical Equipment (DME) Harvard Pilgrim All Plans 4 tier copay levels Not included Varied by plan Tier 2: 30% to $50 6 tier copay levels All HSA compatible plans include a pharmacy benefit that encourages the use of certain preventive medications to manage chronic conditions. This means that many covered preventive drugs are not subject to the plan deductible. Copays and coinsurance still apply. To find out which conditions and drugs this benefit applies to for participating carriers, visit cbia.com/ieb/rx. All plans:
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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 https://eoc.anthem.com/eocdps/aso or by calling 1-800-445-7490.
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