High Deductible/ Basic Plans
Health Savings Account Plans
Prescription Drug Plans
Short Term Medical Plans
Dental Plans
Life Insurance
Financial Services LTC
Disability Insurance
| HSA 100 SM | NEW! HSA SaverSM | |
| Design Basics | ||
| Plan Type | Preferred or Savings Based Network | Preferred or Savings Based Network |
| Coinsurance after Deductible | 100% | 100% |
| Lifetime Maximum Benefit per covered person |
$3 million | $3 million |
| Initial Rate Guarantee subject to benefit and address changes |
12 months | 12 months |
| Inpatient Expense Benefits Coverage percentages below are effective AFTER deductibles have been met unless otherwise indicated. |
||
| Room and Board, Intensive Care Unit, Operating Room, and Recovery Room | 100% | 100% |
| Professional Fees of Doctors, Surgeons, Nurses | 100% | 100% |
| Radiation, Chemotherapy, and Inpatient Drugs | 100% | 100% |
| Inpatient Diagnostic Testing | 100% | 100% |
| Other Covered Inpatient Services | 100% | 100% |
| Outpatient Expense Benefits | ||
| Surgeon, Assistant Surgeon, and Facility Fees | 100% | 100% |
| Hemodialysis, Radiation, Chemotherapy, and Organ Transplant Drugs | 100% | 100% |
| Cat Scans, MRIs | 100% | 100% |
| Outpatient X-ray and Lab |
100% | 100% if performed within 14 days of surgery or confinement |
| Emergency Room Fees | 100% | 100% if admitted; if not admitted -- limited to $250/person/year |
| Other Covered Outpatient Expenses | 100% | See covered expenses for details |
| Routine Health Benefits | ||
| Doctor Office Visit Fees | 100% | Not Covered |
| Outpatient Prescription Drugs Preferred Price Card included with all plans |
100% | Not Covered - Preferred Price Card included |
| Mammography, Pap Smear, and PSA Testing | 100% | 100% |
|
Adult Preventive Care Covers up to $150 per year after 12 months for each adult 19 or older |
100% | Not Covered |
This chart only summarizes standard covered expenses, exclusions, and limitations of each plan. To be considered for reimbursement, expenses must qualify as covered expenses. Expenses are also subject to reasonable and customary limits, unless you use a network. We recommend review of the more detailed plan information with your agent.
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