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Company

Plan Type

Plan ID

Plan Name

Deductibles

PCP Office Visit

Specialist Office Visit

ObGyn Wellness

Lifetime Max

Application

Aetna PPO - details 11538 MCOA 2500 2500.0000 / 5000 $40 copay, deductible waived $50 copay, deductible waived No charge, deductible waived, no waiting period or calendar year max, Annual Pap/Mammogram N/A application
PPO - details 10495 MCOA 2500 2500.0000 / 5000 $40 copay, deductible waived $50 copay, deductible waived No charge, deductible waived, no waiting period or calendar year max, Annual Pap/Mammogram N/A application
PPO - details 11539 MCOA 5000 5000.0000 / 10000 $40 copay, deductible waived $50 copay, deductible waived No charge, deductible waived, no waiting period or calendar year max, Annual Pap/Mammogram N/A application
PPO - details 10496 MCOA 5000 5000.0000 / 10000 $40 copay, deductible waived $50 copay, deductible waived No charge, deductible waived, no waiting period or calendar year max, Annual Pap/Mammogram N/A application
HSA - details 10493 MCOA High Deductible 3500 (HSA Compatible) 3500.0000 / 7000 10% after deductible 10% after deductible No charge, deductible waived, no waiting period or calendar year max, Annual Pap/Mammogram N/A application
HSA - details 11540 MCOA High Deductible 3500 (HSA Compatible) 3500.0000 / 7000 10% after deductible 10% after deductible No charge, deductible waived, no waiting period or calendar year max, Annual Pap/Mammogram N/A application
HSA - details 11541 MCOA High Deductible 5500 (HSA Compatible) 5500.0000 / 11000 No charge after deductible No charge after deductible No charge, deductible waived, no waiting period or calendar year max, Annual Pap/Mammogram N/A application
HSA - details 10494 MCOA High Deductible 5500 (HSA Compatible) 5500.0000 / 11000 No charge after deductible No charge after deductible No charge, deductible waived, no waiting period or calendar year max, Annual Pap/Mammogram N/A application
PPO - details 11544 MCOA Value 10000 10000.0000 / 20000 $40 copay for 1st 3 visits, deductible waived. Member pays 100% for subsequent visits but Aetna discount applies 20% after deductible No charge, deductible waived, no waiting period or calendar year max, Annual Pap/Mammogram N/A application
PPO - details 11542 MCOA Value 5000 5000.0000 / 10000 $40 copay for 1st 3 visits, deductible waived. Member pays 100% for subsequent visits but Aetna discount applies 20% after deductible No charge, deductible waived, no waiting period or calendar year max, Annual Pap/Mammogram N/A application
PPO - details 10497 MCOA Value 5000 5000.0000 / 10000 $40 copay for 1st 3 visits, deductible waived. Member pays 100% for subsequent visits but Aetna discount applies 20% after deductible No charge, deductible waived, no waiting period or calendar year max, Annual Pap/Mammogram N/A application
PPO - details 11543 MCOA Value 7500 7500.0000 / 15000 $40 copay for 1st 3 visits, deductible waived. Member pays 100% for subsequent visits but Aetna discount applies 20% after deductible No charge, deductible waived, no waiting period or calendar year max, Annual Pap/Mammogram N/A application
HSA - details 11545 Preventive and Hospital Care 2750 (HSA Compatible) 2750.0000 / 5500 Not covered Not covered No charge, deductible waived, no waiting period or calendar year max, Annual Pap/Mammogram N/A application
HSA - details 10492 Preventive and Hospital Care 2750 (HSA Compatible) 2750.0000 / 5500 Not covered Not covered No charge, deductible waived, no waiting period or calendar year max, Annual Pap/Mammogram N/A application
Humana PPO - details 12502 Humana Basic 6350/ChoiceCare PPO Plus Children's Dental 6350.0000 / 12700 For the first 3 visits, $35 Copay before deductible. Then No Charge after deductible. No charge after deductible No charge application
PPO - details 12504 Humana Bronze 4850/ChoiceCare PPO Plus Children's Dental 4850.0000 / 9700 For the first 3 visits, $55 Copay before deductible. Then 20% after deductible. This combined copay limit of 3 per member per year includes PCP or Specialist or Urgent Care. For the first 3 visits, $80 Copay before deductible. Then 20% after deductible. This combined copay limit of 3 per member per year includes PCP or Specialist or Urgent Care No charge application
PPO - details 12503 Humana Bronze 6300/ChoiceCare PPO Plus Children's Dental 6300.0000 / 12600 No charge after deductible No charge after deductible No charge application
PPO - details 12506 Humana Silver 3650/ChoiceCare PPO Plus Children's Dental 3650.0000 / 7300 No charge after deductible No charge after deductible No charge application
PPO - details 12505 Humana Silver 4250/ChoiceCare PPO Plus Children's Dental 4250.0000 / 8500 $35 copay $60 copay No charge application
UnitedHealthcare Life Insurance Company PPO - details 12263 Bronze Copay Select 5500.0000 / 5500 $50 copay, deductible does not apply. 4 visit limit - Per covered person, per calendar year. Additional visits subject to deductible and coinsurance $100 copay, deductible does not apply No charge, 100% covered in network application
PPO - details 12262 Bronze HSA 100 6350.0000 / 6350 No charge after deductible No charge after deductible No charge, 100% covered in network application
PPO - details 12264 Catastrophic Select Saver 6350.0000 / 6350 $0 copay, deductible does not apply. 3 visit limit - Per covered person, per calendar year. Additional visits subject to deductible No charge after deductible No charge, 100% covered in network application
PPO - details 12257 Gold Copay Select 1 1000.0000 / 1000 $25 copay, deductible does not apply $30 copay, deductible does not apply No charge, 100% covered in network application
PPO - details 12256 Gold Copay Select 2 1500.0000 / 1500 $15 copay, deductible does not apply $30 copay, deductible does not apply No charge, 100% covered in network application
PPO - details 12261 Silver Copay Select 1 5000.0000 / 5000 $35 copay, deductible does not apply $60 copay, deductible does not apply No charge, 100% covered in network application
PPO - details 12259 Silver Copay Select 2 2500.0000 / 2500 $35 copay, deductible does not apply. 4 visit limit - Per covered person, per calendar year. Additional visits subject to deductible and coinsurance $70 copay, deductible does not apply No charge, 100% covered in network application
PPO - details 12260 Silver Copay Select 3 3500.0000 / 3500 $35 copay, deductible does not apply. 4 visit limit - Per covered person, per calendar year. Additional visits subject to deductible and coinsurance $70 copay, deductible does not apply No charge, 100% covered in network application
PPO - details 12258 Silver HSA 100 3650.0000 / 3650 No charge after deductible No charge after deductible No charge, 100% covered in network application