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Traditional PPO Plans
(Health Choice and
Health Today Plans) |
Qualified High Deductible Health Plan (Health Saver 2800) |
Economy PPO Plan
(Basic Health 5000 Plan) |
Preventive care services |
Eligible in-network preventive care services (per Preventive Care Schedule) covered at 100%, not subject to copay or deductible. |
Eligible in-network preventive care services (per Preventive Care Schedule) covered at 100%, not subject to deductible. |
Eligible in-network preventive care services (per Preventive Care Schedule) covered at 100%, not subject to deductible. |
Primary care and specialist office visits |
You pay only your copay for routine, non-invasive office visits. |
You pay the cost for all provider care until you meet your deductible. Then you pay a coinsurance (20% for in-network care) for all eligible claims up to the annual coinsurance maximum. |
For primary care office visits, you pay a $25 copay for visits 1-3. For every additional visit, you pay 50% of costs after a $45 copay. For specialist office visits, you pay 100% of costs until you meet your deductible. Then you pay 50% of costs. |
Prescription benefits |
You pay a copay for covered drugs after you meet your prescription drug deductible (if applicable). |
You pay all prescriptions and medical claims until you meet your combined medical and prescription drug deductible. Then you pay your coinsurance for all eligible claims up to the annual coinsurance maximum. |
For generic drugs, you pay a copay for covered drugs after you meet your prescription drug deductible. For preferred and non-preferred drugs, you must first meet your prescription drug deductible. Then you pay 33% of drug costs up to a maximum amount per prescription. |
Inpatient services and outpatient surgery facilities |
You pay a coinsurance percentage for care after you meet your deductible. (In addition to the coinsurance percentage, Health Today requires a $100 copay instead of a deductible.) |
You pay a coinsurance percentage for care after you meet your deductible. |
You pay a coinsurance percentage (50%) for care after you meet your deductible. |
Individual deductible |
The plan pays benefits for eligible claims for a participant with individual coverage once that person has met his individual deductible. (Copays and prescription drugs do not count toward the deductible.) |
The plan pays benefits for eligible claims for a participant with individual coverage once that person has met his individual deductible. The deductible may be met with healthcare and prescription
drug claims. |
The plan pays benefits for eligible claims for a participant with individual coverage once that person has met his individual deductible. (Copays and prescription drugs do not count toward the deductible.) |
Family deductible |
"Embedded" deductible for family coverage. The plan pays benefits for eligible claims for each individual once that person has met his individual deductible. Then, the plan pays benefits for the family when two or more members together meet the family deductible. For each individual, no more than the individual deductible amount will count toward the family deductible. (Copays and prescription drugs do not count toward the deductible.) Example: Family coverage in
Health Choice1000. - Participant meets his individual deductible of $1,000 in April. Child #1 meets his individual deductible in July. The family deductible has been met since two family members met their individual deductibles.
- Alternatively, participant meets his individual deductible of $1,000 in April. Child #1 has $500 in claims in July, and the spouse has $500 in claims in August. The deductible has been met since two or more family members contributed toward the family deductible.
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"Aggregate" deductible for family coverage, or those with family coverage. The family deductible must be met before benefits are paid for any individual in the family.The family deductible may be met with healthcare and prescription drug claims from one or multiple family members. The individual deductilbe applies only to those with individual coverage (no dependents), and must be met before the plan pays benefits for eligible claims. . Example: Family coverage in
Health Saver 2800. - Family has $200 per month in prescriptions. Participant has a $200 doctor visit in May. Spouse has $1,000 in diagnostic tests in June. Child #1 has $2,600 claim in September. The family deductible has been met in September by their combined claims equaling $5,600. Coinsurance applies to all eligible claims for the rest of the year for all family members.
- Alternatively, one family member has a hospital stay with claims exceeding $5,600. The family deductible has been met for all family members.
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Each individual must meet a $5,000 deductible. Once an individual has met his individual deductible, the plan pays benefits for eligible claims. (Copays and prescription drugs do not count toward the deductible). |
In-network savings |
You receive greater benefits if you use doctors and facilities in the Preferred Provider Organization (PPO) network. |
You receive greater benefits if you use doctors and facilities in the Preferred Provider Organization (PPO)network. |
You receive greater benefits if you use doctors and facilities in the Preferred Provider Organization (PPO) network. |
Eligibility for HSA |
Not eligible for an HSA. |
The Health Saver 2800 is a tax-advantaged, federally-qualified HDHP, which means qualifying participants are eligible to open an HSA. |
Not eligible for an HSA. |