2017 Health Plan Comparison Chart
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- Lesley Tate
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1 207 Health Plan Comparison Chart Tenet Network: Tenet-employed physicians, Tenet-owned facilities, Tenet ACO/CIO physicians In-Network: Physician or facility within carrier network Out-of-Network: Physician or facility outside of carrier network Annual Deductible (individual/family) Applies to out-of-pocket max. Annual Out-of-Pocket Maximum (individual/family) Medical Account (individual/family) Physician Care Office visit; IP/OP/ER; basic X-ray/lab Preventive Services Tenet Network $0 $0 $0 $,300/$2,600 In-Network $800/$2,400 $800/$2,400 $,600/$3,200 $,300/$2,600 Out-of-Network N/A $,600/$4,800 $3,200/$6,400 $2,400/$4,800 Tenet Network $4,000/$2,000 $4,000/$2,000 $6,450/$2,900 $5,200/$0,400 In-Network $4,000/$2,000 $4,000/$2,000 $6,450/$2,900 $5,200/$0,400 Out-of-Network N/A Unlimited Unlimited Unlimited All Networks N/A N/A Health Reimbursement Account (HRA) Tenet will contribute $300/$600 Tenet Network Physician $30 co-pay In-Network Physician $30 co-pay Health Savings Account (HSA) Annual company contribution: $50/$00 0% 0% 0% after 20% after 20% after 20% after Out-of-Network N/A 60% after 75% after 60% after Tenet Network $0 0% 0% 0% In-Network $0 0% 0% 0% Out-of-Network N/A Full cost Full cost Full cost
2 207 Health Plan Comparison Chart Inpatient Tenet Network Facility $0* Facility 0%* Professional 0% In-Network Facility $500 co-pay per Facility 0% after Out-of-Network N/A Facility 60% after Outpatient Tenet Network Facility $0* Facility 0%* Professional 0% In-Network Facility $250 co-pay Facility 0% after Out-of-Network N/A Facility 60% after Facility 0%* Professional 0% Facility 20% after Facility 75% after Facility 0%* Professional 0% Facility 20% after Facility 75% after Facility 0% after * Professional 0% after Facility 0% after Facility 60% after Facility 0% after * Professional 0% after Facility 0% after Facility 60% after 2
3 207 Health Plan Comparison Chart Maternity Care Tenet Network Facility $0* Physician $30 co-pay (initial visit only) (initial visit only) Facility 0%* Professional 0% Prenatal care 0% In-Network Facility $500 Facility 0% after Physician $30 co-pay Prenatal care 20% after Out-of-Network N/A Facility 60% after Prenatal care 60% after Facility 0%* Professional 0% Prenatal care 0% Facility 20% after Prenatal care 20% after Facility 75% after Prenatal care 75% after Facility 0% after * Professional 0% after Prenatal care 0% after Facility 0% after Prenatal care 20% after Facility 60% after Prenatal care 60% after 3
4 207 Health Plan Comparison Chart Emergency Care Tenet Network Emergency Room $00 ER fee (waived if admitted) + 0%* Ambulance $0 In-Network Emergency Room $00 ER + 0% after Ambulance $0 Emergency Room $00 ER fee (waived if admitted) + 0%* Ambulance 20% Emergency Room $00 ER + 0% after Out-of-Network N/A Emergency Room $00 ER + 0% after Emergency Room $00 ER fee (waived if admitted) + 0%* Ambulance 0% Emergency Room $00 ER + 0% after Ambulance 0% Emergency Room $00 ER + 0% after Ambulance 0% Emergency Room $00 ER fee (waived if admitted) + 0% after * Emergency Room $00 ER + 0% after Emergency Room $00 ER + 0% after Facility 0% after * Urgent Care Tenet Network $45 per visit* 0%* Facility 0%* Professional 0% Professional 0% after In-Network $45 per visit 20% after Facility 20% after Facility 20% after Out-of-Network N/A 60% after Facility 75% after Facility 60% after 4
5 207 Health Plan Comparison Chart Acupuncture/ Chiropractic Care Max. 20 visits per calendar year Outpatient Physical/ Occupational/ Speech Therapy Max. 60 visits per calendar year Home Healthcare Max. 20 visits per calendar year Durable Medical Equipment (DME) Mental Health/ Substance Abuse Inpatient; outpatient; office Tenet Network $45 co-pay 0% 0% 0% after In-Network $45 co-pay 20% after 20% after 20% after Out-of-Network N/A 60% after 75% after 60% after Tenet Network $45 co-pay 0% 0% 0% after In-Network $45 co-pay 20% after 20% after 20% after Out-of-Network N/A 60% after 75% after 60% after Tenet Network $0 0% 0% 0% after In-Network $0 20% after 20% after 20% after Out-of-Network N/A 60% after 75% after 60% after Tenet Network $0 0% 0% 0% after In-Network $0 20% after 20% after 20% after Out-of-Network N/A 60% after 75% after 60% after Tenet Network Inpatient $500 co-pay per 0% 0% 0% after Outpatient $250 co-pay per Office visit $30 co-pay In-Network Inpatient $500 co-pay per 0% 0% 0% after Outpatient $250 co-pay per Office visit $30 co-pay Out-of-Network N/A 60% after 75% after 60% after 5
6 207 Health Plan Comparison Chart Pharmacy Benefits Comparison Chart * Retail (30-day supply) Mail Order (90-day supply) Generic $5 co-pay $5 co-pay $5 co-pay $5 co-pay after medical Formulary 35% ($30 min., $00 max.) 35% ($30 min., $00 max.) 35% ($30 min., $00 max.) 35% ($30 min., $00 max.) after medical Non-Formulary 50% ($40 min., $50 max.) 50% ($40 min., $50 max.) 50% ($40 min., $50 max.) 50% ($40 min., $50 max.) after medical Generic $0 co-pay $0 co-pay $0 co-pay $0 co-pay after medical Formulary 35% ($75 min., $200 max.) 35% ($75 min., $200 max.) 35% ($75 min., $200 max.) 35% ($75 min., $200 max.) after medical Non-Formulary 50% ($00 min., $300 max.) 50% ($00 min., $300 max.) 50% ($00 min., $300 max.) 50% ($00 min., $300 max.) after medical * Certain preventive medications are available at the co-pay/co-insurance level prior to the satisfaction of the. For a complete listing of these medications, contact CVS/Caremark at Non-preventive prescription costs apply to the medical plan and out-of-pocket maximum. Diabetic supplies may be covered under the medical plan and/or under the prescription drug program. Under the prescription drug program supplies are subject to formulary guidelines. Please contact the pharmaceutical carrier to see if your supplies are part of the formulary. 6
2017 Health Plan Comparison Chart
207 Health Plan Comparison Chart Tenet Network: Tenet-employed physicians, Tenet-owned facilities, Tenet ACO/CIO physicians In-Network: Physician or facility within carrier network Out-of-Network: Physician
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
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
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
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
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
2014 Side-by-side comparison between the Aetna CDHP and the Aetna PPO for Medical Coverage
2014 Side-by-side comparison between the and the for Medical Coverage Medical Coverage Carrier Aetna Aetna Aetna Aetna Deductible Individual $1,750 $3,250 $750 $2,250 Family $3,500 $6,500 $1,500 $4,500
Medical Plan Summary: PPO Core Plan
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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
2015 Health Plan Coverage Tool
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Important Questions Answers Why this Matters:
Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: All Coverage Levels Plan Type: High- This is only a summary. If you want more detail about your coverage and costs,
Yes, written or oral approval is required, based upon medical policies.
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.uhc.com/calpers or by calling 1-877-359-3714. Important
PEIA PPB Plan A Benefits At a Glance
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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.myiuhealthplans.com or by calling 1.866.895.5975 Important
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.myiuhealthplans.com or by calling 1.866.895.5975. Important
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
Western Kentucky University Anthem BlueCross BlueShield Basic PPO Plan Coverage Period: 01/01/ /31/2018 Summary of Benefits and Coverage:
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 1-888-650-4047.
Important Questions Answers Why this Matters:
Anthem BlueCross Value HMO 25/40/20% Select Plus HMO / $10/$30/$45/20% Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 01/01/2015-12/31/2015 Coverage For: Individual/Family
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 https://eoc.anthem.com/eocdps/fi or by calling (855) 333-5735.
BENEFITS CHI. Summary of Benefits Coverage. Basic Blue Cross Blue Shield of Illinois. Effective January 1, 2015
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Anthem BlueCross Value HMO 20/30/20% Select Plus HMO / $10/$30/$45/20% Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 01/01/2014-12/31/2014 Coverage For: Individual/Family
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.myiuhealthplans.com or by calling 1.866.895.5975. Important
BENEFITS CHI. Summary of Benefits Coverage. Integrated Core QualChoice. Effective January 1, 2015
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Anthem BlueCross BlueShield Christian Care Communities Blue Access PPO Coverage Period: 01/01/ /31/2015 Summary of Benefits and Coverage:
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.anthem.com or by calling 1-888-650-4047. Important Questions
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 https://eoc.anthem.com/eocdps/aso or by calling 1-888-650-4047.
Important Questions Answers Why this Matters:
BlueCross BlueShield Healthcare Plan of Georgia Blue Open Access POS - OAP5 1.5K/80 B / Rx Option B Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 07/01/2014-06/30/2015
2016 Benefits Overview
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BlueCross BlueShield Healthcare Plan of Georgia Premier Plus POS Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 01/01/2013-01/01/2014 Coverage For: Individual/Family
Your Plan: 2018 HMO Plan (2940) Your Network: California Care HMO
Anthem Blue Cross Your Plan: 2018 HMO Plan (2940) Your : California Care HMO ACWA JPIA C00361 This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This
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Plan highlights and rates
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Coverage for: All Coverage Tiers Plan Type: POS. 1 of 9
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.paramounthealthcare.com or by calling 1-800-462-3589.
Important Questions Answers Why this Matters:
Anthem BlueCross Solution PPO 1500/15/20 / $15/$30/$50/30% Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 11/01/2014-10/31/2015 Coverage For: Individual/Family
Important Questions Answers Why this Matters: IU Health $1,500/$3,000*; Encore and PHCS $2,000/$4,000*; Out-of-Network $2,500/$5,000*
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.myiuhealthplans.com or by calling 1.800.873.2022. Important
Important Questions Answers Why this Matters: For PPO Providers: $1,500 Member/$3,000 Family For Non-PPO Providers:
Anthem Blue Cross Life and Health Insurance Company ACWA / JPIA: Account Based Health Plan (EV85) Coverage Period: 01/01/2015-12/31/2015 Summary of Benefits and Coverage: What this Plan Covers & What it
Anthem BlueCross PPO $25 Copay GenRx Plan What this Plan Covers & What it Costs Coverage Period: 12/01/ /30/2013 Individual/Family PPO
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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 document at www.summacare.com or by calling 1-800-996-8701. Important
Important Questions Answers Why this Matters:
This is only a summary. Medical benefits are covered through Anthem Blue Cross and Blue Shield. If you want more detail about your coverage and costs for health benefits, you can get the complete terms
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Your Plan: 2017 HMO Value Plan (0KGJ) Your Network: California Care HMO
Anthem Blue Cross Your Plan: 2017 HMO Value Plan (0KGJ) Your : California Care HMO ACWA JPIA C00361 This summary of benefits is a brief outline of coverage, designed to help you with the selection process.
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 https://eoc.anthem.com/eocdps/ca/aso or by calling 1-877-442-4686.
Important Questions Answers Why this Matters: For In-Network Providers $0 Individual/ $0 Family For Out-of-Network Providers
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.anthem.com/ca or by calling 1-855-333-5730. Important
IU Health Plans: Southern Indiana Physicians HSA Medical Saver Plan Coverage Period: 01/01/ /31/2018 Summary of Benefits and Coverage:
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.myiuhealthplans.com or by calling 1.866.895.5975. Important
Important Questions Answers Why this Matters:
Anthem BlueCross BlueShield MMEBG Blue Access PPO Coverage Period: 07/01/2015-06/30/2016 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual/Family Plan Type:
(30- to 34-day supply) 100% after $40 copay; significant or new therapeutic class drugs: 50%
C O U N T Y S I N T R A N E T S I T E : H T T P : / / I N T R A N E T. C O. R I V E R S I D E. C A. U S 25 Exclusive Care Select Medicare Coordination Plan Tier 1: Exclusive Care Network Tier 2: Any Provider
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Anthem BlueCross BlueShield Blue Access PPO Option 20 / Rx Option 7 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 01/01/2015-12/31/2015 Coverage For: Individual/Family
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Important Questions Answers Why this Matters:
Anthem BlueCross BlueShield Blue Access PPO Option 14 / Rx Option AE Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 01/01/2015-12/31/2015 Coverage For: Individual/Family
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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 document at www.myiuhealthplans.com or by calling 1.866.895.5975. Important
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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 document at www.arcsvs.com or by calling 1-877-309-2955. Important Questions
You must pay all of the costs for these services up to the specific deductible amount before the plan begins to pay for these services.
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.anthem.com or by calling 1-800-552-9159. Important Questions
Important Questions Answers Why this Matters:
Anthem BlueCross Solution 5000 PPO Plan Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 10/15/2013-10/14/2014 Coverage For: Individual/Family Plan Type: PPO This
Anthem Blue Cross Your Plan: Anthem Elements Choice HMO 1500 (Essential Formulary $5/$20/$50/$65/30% $500 Deductible) Your Network: Select HMO
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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.anthem.com or by calling 1-855-603-7982. Important Questions
Important Questions Answers Why this Matters:
Anthem BlueCross BlueShield Blue Access PPO Option D54 / Rx Option 7 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 04/01/2013-03/31/2014 Coverage For: Individual/Family
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Anthem BlueCross BlueShield Lumenos Health Savings Account (with copays) Option 1 Rx 9 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 10/01/2014-09/30/2015 Coverage
Anthem Blue Cross Your Plan: Value HMO 30/40/30% Your Network: California Care HMO
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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 https://eoc.anthem.com/eocdps/aso or by calling (855) 333-5735.
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.empireblue.com or by calling 1-855-333-5734. Important
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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 document at https://eoc.anthem.com/eocdps/fi or by calling 1-800-542-9402.
What is the overall deductible?
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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.myiuhealthplans.com or by calling 1.800.873.2022. Important
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2018 Retiree Medical Premiums and Coverage Summary MAP Plus - Option 1 Low Deductible
MAP Plus - Option 1 Low Deductible You and your SP of Record/DP of Record both are Pre-Medicare Eligible Retiree + + $462.00 $923.00 $923.00 $1,385.00 You are Medicare Eligible and your SP of Record/ DP
Anthem BlueCross Classic $40 HMO What this Plan Covers & What it Costs Coverage Period: 12/01/ /30/2013 Individual/Family HMO
Anthem BlueCross Classic $40 HMO What this Plan Covers & What it Costs Coverage Period: 12/01/2012-11/30/2013 Individual/Family HMO This is only a summary. If you want more detail about your coverage and
Anthem BlueCross BlueShield Eastern Kentucky University Economy Coverage Period: {01/01/ /31/2013} Summary of Benefits and Coverage:
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.anthem.com or by calling 1-888-650-4047. For prescription
Anthem Blue Cross Your Plan: Modified Anthem Elements Choice HMO 5900 Your Network: Select HMO
Anthem Blue Cross Your Plan: Modified Anthem Elements Choice HMO 5900 Your : Select HMO This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This summary
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
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.summacare.com or by calling 1-800-996-8701. Important
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.anthem.com or by calling 1-888-650-4047. Important Questions
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
You don t have to meet deductibles for specific services.
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2019-12/31/2019 Highmark Blue Cross Blue Shield: BlueCare HMO Coverage for: Individual/Family
You don t have to meet deductibles for specific services.
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2019-12/31/2019 Highmark Blue Shield: PPO Blue Coverage for: Individual/Family Plan Type:
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
ST. MARY S HEALTHCARE SYSTEM, INC.-CASE # GA6476 Blue Choice HI PPO Benefit Summary Effective: January 1, 2019
ST. MARY S HEALTHCARE SYSTEM, INC.-CASE # GA6476 Blue Choice HI PPO Benefit Summary Effective: January 1, 2019 All benefits are subject to the calendar year deductible, except those with in-network copayments,
Important Questions Answers Why this Matters: What is the overall deductible?
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.anthem.com/ca/sisc or by calling 1-800-825-5541. Important