Highlights of your Health Care Coverage Washington Counties Insurance Fund

Similar documents
Highlights of your Health Care Coverage Washington Counties Insurance Fund

Highlights of your Health Care Coverage Washington Counties Insurance Fund

Highlights of your Health Care Coverage

Preferred Choice: Flex Advantage $2,000/$4,000

Preferred Choice: Flex Advantage $1,500/$3,000

Preferred Choice: Flex Advantage $500/$1,000

Highlights of your Health Care Coverage

Highlights of your Health Care Coverage

Highlights of your Healthcare Coverage: Qualified High Deductible Health Plan

Highlights of your Health Care Coverage

Highlights of your Healthcare Coverage: EasyChoice A

Highlights of your Health Care Coverage

Highlights of your Health Care Coverage

Balance 3 up to Allowed Amount 4 after BCBSF pays up to $50. $0 CYD % Coinsurance 6

IMPORTANT NOTICE. Please read this information carefully and contact us at if you have any questions.

PEIA PPB Plan A Benefits At a Glance

MEDICAL SCHEDULE OF BENEFITS COPAY GOLD

MEDICAL SCHEDULE OF BENEFITS HDHP $4,000 PLAN

MEDICAL SCHEDULE OF BENEFITS VALUE BRONZE

Regence Selections 90/60/20 Major Features Monthly Contribution Rate $ Full Family $ Full Family Copayments Office Visits ER Visits

Schedule of Benefits (GR-9N-S DE)

Medical Benefit Guide. Oregon Groups 51 or more employees

MEDICAL SCHEDULE OF BENEFITS COPAY GOLD

MEDICAL SCHEDULE OF BENEFITS COPAY GOLD

MEDICAL SCHEDULE OF BENEFITS VALUE GOLD

This is an ERISA plan, and you have certain rights under this plan. Please contact your Employer for additional information.

MEDICAL SCHEDULE OF BENEFITS HDHP $1350 PLAN

Super Blue Plus QHDHP 1 HDHP Non Emb 100%

MEDICAL SCHEDULE OF BENEFITS HDHP $2600 PLAN

For: 80/20 Plan for Retired Employees Over Age 65 and Dependents

OUT-OF-POCKET MAXIMUM ([Per Calendar Year][Per Policy Year]) Family Status Tier 1 Tier 2 Per Enrollee $6,250 $7,150 Per Family $12,500 $14,300

Member Services

For: Traditional Choice - Over Age 65 Corning Retirees - Comprehensive Medical Only - MAP Plus Option 1

Plan changes are in red In-Network 2015 Out-of-Network

Super Blue Plus QHDHP HDHP Non Emb 100%

Adventist Health System Schedule of Benefits for Adventist Health System Effective January 1, 2018

Not applicable Optional. CHE PREFERRED CARE (Home Host) Covered 100%

Aetna Choice POS II Medical Plan PLAN FEATURES NETWORK OUT-OF-NETWORK. Individual Deductible* $3,500 $5,000. Family Deductible* $7,000 $10,000

Aetna Choice POS II Medical Plan PLAN FEATURES NETWORK OUT-OF-NETWORK. Individual Deductible* $1,000 $2,000. Family Deductible* $2,000 $4,000

Blue Cross Select Silver 94 Blue Cross Preferred Silver 94

HEALTH PLAN BENEFITS AND COVERAGE MATRIX

Aetna Choice POS II Medical Plan PLAN FEATURES NETWORK OUT-OF-NETWORK

SUPPLEMENT TO BROWN UNIVERSITY STUDENT HEALTH INSURANCE PROGRAM SUMMARY BROCHURE

This is an ERISA plan, and you have certain rights under this plan. Please contact your Employer for additional information.

Attachment C - Schedule of Benefits. PremierBlue Plan A52

Schedule of Benefits (GR-29N OK)

Blue Cross Silver, a Multi-State Plan 94

Summary of Coverage. $6,350 / $12,700 (Includes Deductibles, Copays and Coinsurance Amounts) Preventive Care Covered at 100%

UNIVERSITY OF VIRGINIA HEALTH PLAN 2015 SCHEDULE OF BENEFITS VALUE HEALTH

Blue Cross Silver, a Multi-State Plan 87

(30- to 34-day supply) 100% after $40 copay; significant or new therapeutic class drugs: 50%

UNIVERSITY OF VIRGINIA HEALTH PLAN 2016 SCHEDULE OF BENEFITS VALUE HEALTH

2018 MEDICARE. summary of benefits. advantage plan. Serving Members in Josephine & Jackson Counties

Not applicable. Immunizations 1 exam per 12 months for members age 18 to age 65; 1 exam per 12 months for adults age 65 and older.

Your Plan: 2018 HMO Plan (2940) Your Network: California Care HMO

This is an ERISA plan, and you have certain rights under this plan. Please contact your Employer for additional information.

Your Plan: 2018 Advantage PPO Plan (S828 and Z0KC) Your Network: Prudent Buyer PPO

BCBSM provides administrative claims services only. Your employer or plan sponsor is financially responsible for claims.

$8,300 $24,900 Maximum Lifetime Benefit

2018 Medical Benefits Highlights - City of Seattle Employees/Seattle Housing Authority

Summary of Benefits Prominence HealthFirst Small Group Health Plan

This is an ERISA plan, and you have certain rights under this plan. Please contact your Employer for additional information.

WEA Select Qualified High Deductible Health Plan (QHDHP)

Amendment to Plan of Benefits

Benefits-at-a-Glance for MSU Student Health Plan

PLAN DESIGN & BENEFITS. $100 Individual/$200 Family $500 Individual/$1000 Family

Summary of Benefits Prominence Preferred Health Insurance Small Group Health Plan

CHE PREFERRED CARE (Home Host)

$0 $0 $2,000 $4, % after deductible 80% after deductible Medical Care (including inpatient visits and consultations)/surgical Expenses

Anthem Blue Cross Your Plan: Premier HMO 10/100% - MUST Trust Your Network: California Care HMO

Y o u r B e n e f i t s a t a G l a n c e Y o u r B e n e f i t s a t a G l a n c e

2014 Side-by-side comparison between the Aetna CDHP and the Aetna PPO for Medical Coverage

Lee s Summit School District

Anthem Blue Cross Your Plan: Classic HMO 20/40/250 Admit /125 OP Your Network: Select HMO

Benefit In-network Out-of-network 1

$15 copay $25 copay. - Silver&Fit copays are not included in the Annual Out-Of- Pocket Maximum

2017 Medical Benefits Highlights - City of Seattle/SHA Retirees Under Age 65

WA Bronze PPO Saver /50 (1/14)

Anthem Blue Cross Your Plan: Premier HMO 20/200 admit/100 OP (Essential Formulary $10/$25/$45/30%) Your Network: California Care HMO

$15 copay $25 copay. in a specialist office. - Silver&Fit copays are not included in the Annual Out-Of- Pocket Maximum

Anthem Blue Cross Your Plan: Custom Anthem HSA /40 Embedded (HSA291) - Actives Your Network: Prudent Buyer PPO

South Central Ohio Insurance Consortium

BCBSM provides administrative claims services only. Your employer or plan sponsor is financially responsible for claims.

BCBSM provides administrative claims services only. Your employer or plan sponsor is financially responsible for claims.

Anthem Blue Cross Your Plan: Modified Value HMO 30/40/30% Your Network: California Care HMO

Individual Deductible* $950 $950. Family Deductible* $1,900 $1,900

$4,800 $9,600 Maximum Lifetime Benefit

Anthem Blue Cross Effective: January 1, 2018 Your Plan: University of California UC Care Plan Your Network: UC Select and Anthem Preferred

Anthem Blue Cross Effective: January 1, 2018 Your Plan: University of California Health Savings Plan (HSP) Your Network: Anthem Prudent Buyer PPO

Anthem Blue Cross Your Plan: Lumenos HSA 2000/ /40 (LHSA2153) Your Network: Prudent Buyer PPO

BENEFITS FACT SHEET. Coverage Options 2017 Bi-Weekly Employee Contribution

This is an ERISA plan, and you have certain rights under this plan. Please contact your Employer for additional information.

Personal Choice Trinity Health

BCBSM provides administrative claims services only. Your employer or plan sponsor is financially responsible for claims.

Summary of Benefits Prominence HealthFirst Small Group Health Plan

This is an ERISA plan, and you have certain rights under this plan. Please contact your Employer for additional information.

and cardiac diagnostic procedures utilizing nuclear medicine) Bariatric surgery Not Covered Not Covered

Aetna Select Medical Plan PLAN FEATURES NETWORK OUT-OF-NETWORK. Plan Maximum Out of Pocket Limit excludes precertification penalties.

SHL Solutions PPO 25/750/80%

Your Plan: 2018 Classic PPO Plan (1122 and ZOJZ) Your Network: Prudent Buyer PPO

Transcription:

Highlights of your Health Care Coverage Washington Counties Insurance Fund Any deductibles, copays, and coinsurance percentages shown are amounts for which you're responsible. Medical Benefits apply after the calendar-year deductible is met unless otherwise noted, or if the cost share is a copay. Effective Date: 01/01/2018 MEDICAL PLAN MEDICAL COST SHARE OPTIONS Individual Deductible PCY (Family aggregate deductible 2x Individual) Coinsurance (Member's percentage of costs after deductible based on allowable charges) Individual Out of PCY, includes deductible, coinsurance, copay and pharmacy if applicable (Family aggregate OOP Max 2X Individual) Office Visit Cost Share PREVENTIVE CARE OPTIONS AND HEALTH EDUCATION Preventive Office Visit (Unlimited, subject to standard medical guidelines) Immunizations (Unlimited, subject to standard medical guidelines) Health Education (HE) (Unlimited) Nicotine Dependency Programs (ND) (Unlimited) Diabetes Health Education (DE) (Unlimited) Individual Deductible: $1,500; Family aggregate Deductible: $3,000 Shared with In-Network 20% 50% Individual OOP Max: $3,400; Family aggregate OOP Maximum $6,800 Covered In Full Shared with In-Network Out of Pocket Maximum 1-9J08HA Rev #1 Q 8/18/2017 11:05 AM Page 1 of 7

PROFESSIONAL CARE Professional Office Visit Inpatient Professional Services Contraceptive Management Services (Unlimited) DIAGNOSTIC SERVICE OPTIONS Preventive Professional Diagnostic Imaging and Laboratory Services - Including Mammogram and PAP/PSA Other Professional Diagnostic Imaging Other Professional Diagnostic Laboratory/Pathology Diagnostic Mammography FACILITY CARE OPTIONS Inpatient Facility Outpatient Surgery Facility Skilled Nursing Facility (90 Days PCY) Hospice Inpatient Facility (14 Days; 6 month limit per lifetime) EMERGENCY CARE AND TRANSPORTATION OPTION Covered In Full Covered In Full Deductible, then covered in full, applies to Out of Deductible, then covered in full, applies to Out of 1-9J08HA Rev #1 Q 8/18/2017 11:05 AM Page 2 of 7

Emergency Care Emergency Room Physician Urgent Care Center Ambulance Transportation (Unlimited) Air Ambulance (Unlimited) OTHER SERVICES Allergy/Therapeutic Injections Mental Health Inpatient Facility Care (Unlimited) Mental Health Outpatient Professional Care (Unlimited) Chemical Dependency Inpatient Facility Care (Unlimited) Chemical Dependency Outpatient Professional Care (Unlimited) Rehab Inpatient Facility (30 days PCY) Rehab Outpatient Care, Including Physical, Occupational, Speech and Massage Therapy, and Chronic Pain (45 visits PCY) or Family aggregate Out of or Family aggregate Out of or Family aggregate Out of or Family aggregate Out of 1-9J08HA Rev #1 Q 8/18/2017 11:05 AM Page 3 of 7

Rehab Outpatient Care Chronic Conditions, Including Cardiac, Pulmonary Rehab, and Cancer Medical Supplies, Equipment, Prosthetics (Unlimited) Foot Orthotics, Orthopedic Shoes and Accessories ($300 PCY; Includes orthotics and orthopedic shoes) Home Health Visits (130 visits PCY) Hospice Care (Respite 240 hours; 6 months lifetime max) TMJ (Temporomandibular Joint Disorders) (Unlimited (Medical and Dental services - Medical and Dental cost shares based on type of service)) Transplants (Unlimited; $7,500 travel and lodging limits) Drug List Prescription Drugs - Retail (Specific preventive drugs and legend Retail: 90 day supply/mail: 90 day supply/specialty: 30 day supply) Prescription Drugs - Mail (Specific preventive drugs and legend Retail: 90 day supply/mail: 90 day supply/specialty: 30 day supply) Specialty Pharmacy (Mandatory) ALTERNATIVE CARE Manipulations (Spinal and other) (Spinal Manipulations 20 Visits PCY Massage Therapy 12 Visit PCY separate from Spinal Manipulations) Acupuncture (12 Visits PCY) SUPPLEMENTAL BENEFITS Deductible, then covered in full, applies to the Out of Covered as any other service Covered as any other service Open A1 No Tiers Covered as any other service Open A1 No Tiers Not Covered Not Covered 1-9J08HA Rev #1 Q 8/18/2017 11:05 AM Page 4 of 7

Routine Vision Exam (1 PCY) Pediatric Vision Exam (1 PCY under age 19) ANNUAL PLAN MAXIMUM Annual Plan Maximum Unlimited Unlimited Prior Authorization is required for many services to be covered. For more information please refer to your benefit booklet. PCY = Per Calendar Year. Balance billing may apply if a provider is not contracted with Premera Blue cross. Members are responsible for amounts in excess of the allowable charge. This is not a complete explanation of covered services, exclusions, limitations, reductions or the terms under which the program may be continued in force. This benefit highlight is not a contract. For full coverage provisions, including a description of waiting periods, limitations and exclusions please contact Customer Service. 1-9J08HA Rev #1 Q 8/18/2017 11:05 AM Page 5 of 7

1-9J08HA Rev #1 Q 8/18/2017 01:29 PM Page 6 of 7

1-9J08HA Rev #1 Q 8/18/2017 01:29 PM Page 7 of 7

2024 © financedocbox.com Privacy Policy | Terms of Service | Feedback