Access Health CT 2019 Alternative Standard Silver Plan Design Exhibit Individual Market. Page

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Transcription:

Access Health CT 2019 Alternative Standard Silver Plan Design Exhibit Individual Market 1

2019 - Ind Market Silver Coinsurance Plan, 70% AV 2019 Individual Market Silver 70% Plan Medical Deductible $3,500 (2x family) $7,400 (2x family) Rx Deductible $250 (2x family) $500 (2x family) Coinsurance 30% 40% Out-of-pocket Maximum $7,900 (2x family) $15,800 (2x family) Primary Care 30% 40% (after Specialist Care Urgent Care Emergency Room 30% (after 30% (after in-network Ambulance 30% (after 30% (after in-network Inpatient Hospital Outpatient Hospital Advanced Radiology (CT/PET Scan, MRI) Laboratory Mammography Ultrasound maximum, separate for each type Diabetic Supplies & Equipment Durable Medical Equipment Home Health Care 2019 Individual Market Silver 70% Plan Preventive 0% 50% (after Basic Pediatric Vision: Routine Eye Exam by Specialist (one exam per 30% (after 50% (after 40% (after 50% (after 50% (after 50% (after 30% (after Not Covered All Other Medical 30% 40% (after $5 * / 30% / 30% / 30% ded., $200 max per spec. 2018 AVC Results 2019 AVC Results 70.11% - 70.89% 2

2019 - Ind Market Silver Coinsurance Plan, 73% AV 2019 Individual Market Silver 73% Plan Coinsurance Medical Deductible $2,600 (2x family) $7,400 (2x family) Rx Deductible $250 (2x family) $500 (2x family) Coinsurance 30% 40% Out-of-pocket Maximum $6,300 (2x family) $15,800 (2x family) Primary Care 30% 40% (after Specialist Care Urgent Care Emergency Room 30% (after 30% (after in-network Ambulance 30% (after 30% (after in-network Inpatient Hospital Outpatient Hospital Advanced Radiology (CT/PET Scan, MRI) Laboratory Mammography Ultrasound Diabetic Supplies & Equipment Durable Medical Equipment Home Health Care 2019 Individual Market Silver 73% Plan Preventive 0% 50% (after Basic Pediatric Vision: Routine Eye Exam by Specialist (one exam per 30% (after 50% (after 40% (after 50% (after 50% (after 50% (after 30% (after Not Covered All Other Medical 30% 40% (after $5 * / 30% / 30% / 30% ded., $100 max per spec. 2018 AVC Results 2019 AVC Results 73.52% 3

2019 - Ind Market Silver Coinsurance Plan, 87% AV 2019 Individual Market Silver 87% Plan Coinsurance Medical Deductible $500 (2x family) $7,400 (2x family) Rx Deductible $50 (2x family) $500 (2x family) Coinsurance 20% 40% Out-of-pocket Maximum $2,300 (2x family) $15,800 (2x family) Primary Care 20% 40% (after Specialist Care 20% (after 40% (after Urgent Care 20% (after 40% (after Emergency Room 20% (after 20% (after in-network Ambulance 20% (after 20% (after in-network Inpatient Hospital 20% (after 40% (after Outpatient Hospital 20% (after 40% (after Advanced Radiology (CT/PET Scan, MRI) 20% (after 40% (after 20% (after 40% (after Laboratory 20% (after 40% (after Mammography Ultrasound 20% (after 40% (after 20% (after 40% (after 20% (after 40% (after Diabetic Supplies & Equipment 20% (after 40% (after Durable Medical Equipment 20% (after 40% (after Home Health Care 2019 Individual Market Silver 87% Plan Preventive 0% 50% (after Basic Pediatric Vision: Routine Eye Exam by Specialist (one exam per 30% (after 50% (after 40% (after 50% (after 50% (after 50% (after 20% (after Not Covered 20% (after 40% (after All Other Medical 20% 40% (after $5 * / 20% / 20% / 20% ded., $60 max per spec. 2018 AVC Results 2019 AVC Results 87.52% 4

2019 - Ind Market Silver Coinsurance Plan, 94% AV 2019 Individual Market Silver 94% Plan Coinsurance Medical Deductible $0 $7,400 (2x family) Rx Deductible $0 $500 (2x family) Coinsurance 20% 40% Out-of-pocket Maximum $750 (2x family) $15,800 (2x family) Primary Care 20% 40% (after Specialist Care 20% 40% (after Urgent Care 20% 40% (after Emergency Room 20% 20% Ambulance 20% 20% Inpatient Hospital 20% 40% (after Outpatient Hospital 20% 40% (after Advanced Radiology (CT/PET Scan, MRI) 20% 40% (after 20% 40% (after Laboratory 20% 40% (after Mammography Ultrasound 20% 40% (after 20% 40% (after 20% 40% (after Diabetic Supplies & Equipment 20% 40% (after Durable Medical Equipment 20% 40% (after Home Health Care 2019 Individual Market Silver 94% Plan Preventive 0% 50% (after Basic Pediatric Vision: Routine Eye Exam by Specialist (one exam per 30% (after 50% (after 40% (after 50% (after 50% (after 50% (after 20% Not Covered 20% 40% (after All Other Medical 20% 40% (after $5 * / 20% / 20% / 20% ($60 max per spec. 2018 AVC Results 2019 AVC Results 94.76% 5

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