High Deductible/ Basic Plans
Health Savings Account Plans
Prescription Drug Plans
Short Term Medical Plans
Dental Plans
Life Insurance
Financial Services LTC
Disability Insurance
| Plan 100 SM | Plan 80 SM | NEW! Saver 80 SM | |
| Design Basics | |||
| Plan Type | Preferred or Savings Based Network | Preferred or Savings Based Network | Preferred or Savings Based Network |
| Deductible Options max. 2 per family, per year |
$1,000, $1,500, $2,500 $3,500, $5,000 | $1,000, $1,500, $2,500 $3,500, $5,000 | $500, $1,000, $1,500 $2,500, $3,500, $5,000 |
| Coinsurance Options per covered person, per calendar year |
100% | 80/20 to $15,000, then 100% | 80/20 to $15,000, then 100% |
| Lifetime Maximum Benefit per covered person |
$3 million | $3 million | $3 million |
| Initial Rate Guarantee subject to benefit and address changes |
12 months | 12 months | 12 months |
| Inpatient Expense Benefits Coverage percentages below are effective AFTER deductibles have been met unless otherwise indicated. |
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| Room and Board, Intensive Care Unit, Operating Room, and Recovery Room | 100% | 80% | 80% |
| Professional Fees of Doctors, Surgeons, Nurses | 100% | 80% | 80% |
| Radiation, Chemotherapy, and Inpatient Drugs | 100% | 80% | 80% |
| Inpatient Diagnostic Testing | 100% | 80% | 80% |
| Other Covered Inpatient Services | 100% | 80% | 80% |
| Outpatient Expense Benefits | |||
| Surgeon, Assistant Surgeon, and Facility Fees | 100% | 80% | 80% |
| Hemodialysis, Radiation, Chemotherapy, and Organ Transplant Drugs | 100% | 80% | 80% |
| Cat Scans, MRIs | 100% | 80% | 80% |
| Outpatient X-ray and Lab performed in the doctor’s office or elsewhere |
100% | 80% | 80% if performed within 14 days of surgery or confinement |
| Emergency Room Fees | 100% -- additional $100 copay for illness if not admitted | 80% - additional $100 copay for illness if not admitted | 80% -- additional $500 copay if not admitted |
| Other Covered Outpatient Expenses | 100% | 80% | See plan details |
| Routine Health Benefits | |||
| Doctor Office Visit Fees | 100% | 80% | Not Covered |
| Outpatient Prescription Drugs Preferred Price Card included with all plans |
100% | 100% | Not Covered -- Preferred Price Card Included |
| Mammography, Pap Smear, and PSA Testing | 100% | 80% | 80% |
|
Adult Preventive Care Covers up to $150 per year after 12 months for each adult 19 or older |
100% | 80% | 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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