HMO Option with Maternity- This plan has no annual deductible and a $2,000 annual copay/coinsurance maximum. Primary Care Physician visits have $10 copays and specialist visits have a $20 copay. Prescription drugs are subject to a $10 copay for generics, a $35 copay for preferred brand name drugs, and a $60 copay for non-preferred generic or brand name drugs. Monthly premium rates depend on age and health condition.
HMO Option without Maternity- This plan has no annual deductible and a $4,000 annual copay/coinsurance maxiumum. Primary Care Physician visits have $25 copays and specialist visits have $50 copays. Prescription drugs are subject to a $10 copay for generics, $35 copay for preferred brand name drugs, and a $60 copay for non-preferred generic or brand name drugs. Monthly premium rates depend on age and health condition.
POS Tier 1- This plan has no annual deductible or annual copay/coinsurance maximum. Primary Care Physician visits have $15 copays and specialists visits have a $30 copay. Prescription drugs are subject to a $10 copay for generics, $35 copay for preferred brand name drugs, and $60 copay for non-preferred generic or brand name drugs. Monthly premium rates depend on age and health condition.
POS Tier 2- This plan has an annual deductible of $500 and a $2,000 annual copay/coinsurance maximum. Primary Care Physician visits have $30 copays and specialist visits have a $45 copay. Prescription drugs are subject to a $10 copay for generics, $35 copay for preferred brand name drugs, and $60 copay for non-preferred generic or brand name drugs. Monthly premium rates depend on age and health condition.
POS Tier 3- This plan has an annual deductible of $500 and a $4,000 annual copay/coinsurance maximum. Primary Care Physician visits are subject to 40% of EME after the calendar year deductible is met. Prescription drugs are subject to a $10 copay for gnereics, $35 copay for preferred brand name drugs, and $60 copay for non-preferred generic or brand name drugs. Monthly premium rates depend on age and health conditions. |