Steward Community Care Choice 2000 (HSA)
|
|
|
- Claribel Henderson
- 5 years ago
- Views:
Transcription
1 Steward Community Care Choice 2000 (HSA) Benefit Summary Benefits effective April 1, 2013 and beyond The FCHP difference FCHP Steward Community Care is a limited network HMO plan designed in partnership by Fallon Community Health Plan and Steward Health Care. Providing world-class health care where you live, FCHP Steward Community Care includes the benefits and coverage you deserve at an affordable price. It also includes the extras that FCHP members have long enjoyed, including our rich It Fits! fitness benefit, $0 wellness visits and eye exams, and other valuable member discounts. Introducing The Healthy Health Plan!* A program that rewards subscribers for being and becoming healthy. Simply click on the My Healthy Health Plan link on fchp.org, fill out your health assessment, and you will be eligible to receive up to $200 in financial incentives! See the Value-added features section for more details. How to receive care: With FCHP Steward Community Care Choice 2000, you can choose to get your care from doctors, specialists, hospitals and health care facilities in the FCHP Steward Community Care network. For a complete list of FCHP Steward Community Care providers, visit our Web site at fchp.org/steward. Obtaining specialty care When you want to visit a specialist, talk with your PCP first. He or she will help arrange specialty care for you. The following services do not require a referral when you see a provider in the FCHP Steward Community Care network: routine obstetrics/gynecology care, screening eye exams and behavioral health services. For medically necessary services that are not available at an FCHP Steward Community Care facility, you may receive care at either Brigham and Women s Hospital or Massachusetts General Hospital. For more information on referral procedures for specialty services, consult your FCHP Steward Community Care Member Handbook/Evidence of Coverage. Emergency medical care Emergency services do not require referral or authorization. When you have an emergency medical condition, you should go to the nearest emergency department or call your local emergency communications system (police, fire department or 911). For more information on emergency benefits and plan procedures for emergency services, consult your FCHP Steward Community Care Member Handbook/Evidence of Coverage. Choosing a primary care provider (PCP) Your relationship with your PCP is very important because he or she will work with FCHP to provide or arrange most of your care. As a member of FCHP Steward Community Care Choice 2000, you must select a PCP. To do this, just complete the section on your FCHP membership enrollment form. If you need help choosing a PCP, you can speak with a member of our Customer Service Department. FCHP Steward Community Care provides access to a network that is smaller than FCHP Select Care. In this plan, members have access to network benefits only from the providers in FCHP Steward Community Care. Please consult the FCHP Steward Community Care provider directory a paper copy can be requested by calling our Customer Service Department at or visit the provider search tool at fchp.org to determine which providers are included in FCHP Steward Community Care. Page 1
2 Plan specifics Benefit period The benefit period, sometimes referred to as a benefit year, is the 12-month span of plan coverage, and the time during which the deductible, out-of-pocket maximum and specific benefit maximums accumulate. Deductible A deductible is the amount of allowed charges you pay per benefit period before payment is made by the plan for certain covered services. The amount that is put toward your deductible is calculated based on the allowed charge or the provider s actual charge whichever is less. Embedded deductible Please note that once any one member in a family accumulates $2,500 of services that are subject to the family deductible, that individual member s deductible is considered met, and that family member will receive benefits for covered services less any applicable copayments. Varies by employer $2,000 individual/ $4,000 family $2,500 Out-of-pocket maximum The out-of-pocket maximum is the total amount of deductible, coinsurance and copayments you are responsible for in a benefit period. The out-of-pocket maximum does not include your premium charge or any amounts you pay for services that are not covered by the plan. Benefits Office Routine physical exams (according to MHQP preventive guidelines) $0 Office visits (primary care provider) Office visits (specialist) Office visits (limited service clinics, e.g., Minute Clinic) Routine eye exams (one every 12 months) $0 Short-term rehabilitative services (60 visits per benefit period) Prenatal care Preventive services Tests, immunizations and services geared to help screen for diseases and improve early detection when symptoms or diagnosis are not present Diagnostic services Tests, immunizations and services that are intended to diagnose, check the status of, or treat a disease or condition Imaging (CAT, PET, MRI, Nuclear Cardiology) Chiropractic care (12 visits per benefit period) $5,000 individual/ $10,000 family $40 per visit $25 first visit only Page 2
3 Benefits Prescriptions Please note: Specialty medication that falls under the medical benefit will apply towards your deductible. For more information, please contact FCHP s Customer Service Department at Prescription drugs, insulin and insulin syringes Generic contraceptives and contraceptive devices Brand contraceptives with no generic equivalent (prior authorization required) Brand contraceptives with a generic equivalent (prior authorization required) Prescription medication refills obtained through the mail order program Prilosec OTC, Prevacid 24HR, omeprazole OTC (prescription required) Inpatient hospital services Room and board in a semiprivate room (private when medically necessary) Physicians and surgeons services Physical and respiratory therapy Intensive care services Maternity care Same-day surgery Same-day surgery in a hospital outpatient or ambulatory care setting Emergencies Emergency room visit Skilled nursing Skilled care in a semiprivate room Tier 1/Tier 2/Tier 3/ Tier 4 $5/$15/$30/$50 $0 With prior authorization: $0 Tier 3: $30 Tier 4: $50 $10/$30/$60/$150 (90-day supply) $5 $100 copayment (waived if admitted) Page 3
4 Benefits Substance abuse Office visits Detoxification in an inpatient setting Rehabilitation in an inpatient setting Mental health Office visits Services in a general or psychiatric hospital Other health services Skilled home health care services Durable medical equipment Medically necessary ambulance services Value-added features It Fits!, an annual benefit period fitness reimbursement (including school and town sports programs, gym memberships, home fitness equipment, Weight Watchers, aerobics, Pilates and yoga classes) The Healthy Health Plan!*, a program that rewards subscribers for being and becoming healthy If you re already in great health, terrific! If you could use a little help to get healthier, you can choose to enroll in a customized action health plan that may include regular health coaching, wellness workshops, interactive tools and more! Oh Baby!, a program that provides prenatal vitamins, a convertible car seat, breast pump and other little extras for expectant parents all at no additional cost. Free 24/7 nurse call line Free chronic care management Free stop-smoking program Member discount program Free online access to health and wellness encyclopedia CVS Caremark ExtraCare Health Card provides 20% discount on CVS/pharmacybrand health related items. FCHP Family Fun provides discounts at Massachusetts and New Hampshire attractions 30% coinsurance $200 individual $400 family Page 4
5 Exclusions Hearing aids and the evaluation for a hearing aid (for age 22 and above) Long-term rehabilitative services Nonprescription drugs and vitamins Cosmetic surgery Experimental procedures or services that are not generally accepted medical practice Dental services not described in the FCHP Steward Community Care Member Handbook/Evidence of Coverage Routine foot care Custodial confinement Some services may require prior authorization. A complete list of benefits and exclusions is in the FCHP Steward Community Care Member Handbook/Evidence of Coverage, available by request. This is only a summary of benefits and exclusions. Questions? If you have any questions, please contact Fallon Community Health Plan Customer Service at (TTY users, please call TRS Relay 711), or visit our Web site at fchp.org. *Pending DOI Approval This health plan meets minimum creditable coverage standards and will satisfy the individual mandate that you have health insurance. As of January 1, 2009, the Massachusetts Health Care Reform Law requires that Massachusetts residents, eighteen (18) years and older, must have health coverage that meets the minimum creditable coverage standards set by the Commonwealth Health Insurance Connector. Benefits may vary by employer group. Weight Watchers is a registered trademark of Weight Watchers International, Inc. Page 5
Select Care Deductible 1200 Hybrid Benefit Summary Benefits effective January 1, 2018 and beyond
Select Care Deductible 1200 Hybrid Benefit Summary Benefits effective January 1, 2018 and beyond The Fallon difference With Select Care Deductible 1200 Hybrid, you get everything you need to live a healthy
Direct Care Deductible 2000 Hybrid Benefit Summary Benefits effective January 1, 2018 and beyond
Direct Care Deductible 2000 Hybrid Benefit Summary Benefits effective January 1, 2018 and beyond The Fallon difference Direct Care is a Limited Provider Network. With Direct Care Deductible 2000 Hybrid,
PROFESSIONAL SERVICES. 1199SEIU VIP Premier (HMO) Medicare INPATIENT HOSPITAL SERVICES. 1199SEIU VIP Premier (HMO) Medicare
PROFESSIONAL SERVICES PCP office visits Specialist office visits Annual physical exam/preventive care Physical, speech & occupational therapy Flu and pneumonia vaccinations Diagnostic services including
PLAN DESIGN AND BENEFITS - PA POS 4.2 with $5/$15/$30 RX PARTICIPATING PROVIDERS
PLAN FEATURES Deductible (per calendar year) PHYSICIAN SERVICES Primary Care Physician Visits Specialist Office Visits Maternity OB Visits Allergy Treatment Allergy Testing PREVENTIVE CARE Routine Adult
Yes, for all plans, see or call for a list of network providers.
Important Questions (Massachusetts ) (New England ) (National ) What is the overall $0.00 Are there other s for specific? Is there an out of pocket limit on my expenses? What is not included in the out
MERCY MEDICAL CENTER - DUBUQUE TRADITIONAL PPO PLAN $10/20%/40% RX PROVIDED BY PREFERRED HEALTH CHOICES EFFECTIVE JANUARY 1, 2015
MERCY MEDICAL CENTER - DUBUQUE TRADITIONAL PPO PLAN $10/20%/40% RX PROVIDED BY PREFERRED HEALTH CHOICES EFFECTIVE JANUARY 1, 2015 DEDUCTIBLE, COPAYS/COINSURANCE AND DOLLAR MAXIMUMS facilities and Aligned
PROFESSIONAL SERVICES INPATIENT HOSPITAL SERVICES OUTPATIENT FACILITY SERVICES
PROFESSIONAL SERVICES PCP office visits Specialist office visits Annual physical exam/preventive care Physical, Speech & Occupational Therapy Cardiac/Pulmonary Rehab Flu & Pneumonia Vaccinations Diagnostic
Blue Shield of California
An independent member of the Blue Shield Association City of San Jose Custom ASO PPO 100 90/70 Active Employees Benefit Summary (For groups of 300 and above) (Uniform Health Plan Benefits and Coverage
NEIGHBORHOOD HEALTH PARTNERSHIP POS SUMMARY OF BENEFITS
XV-2 $30/$60/$200/$1,000/80% R NEIGHBORHOOD HEALTH PARTNERSHIP POS SUMMARY OF BENEFITS A quick glance at this Summary of Benefits will introduce you to the Point of Service (POS) Plan you have with Neighborhood
HEALTH PLAN BENEFITS AND COVERAGE MATRIX
HEALTH PLAN BENEFITS AND COVERAGE MATRIX THIS MATRIX IS INTENDED TO BE USED TO HELP YOU COMPARE COVERAGE BENEFITS AND IS A SUMMARY ONLY. THE EVIDENCE OF COVERAGE AND PLAN CONTRACT SHOULD BE CONSULTED FOR
HMO BLUE. VALUE HMO HMO Blue New England - $500 deductible (New England Network) PPO 90 Blue Care Elect Preferred 90 Copay (National Network)
Important Questions (Massachusetts ) (New England ) (National ) What is the overall $0.00 Are there other s for specific? Is there an out of pocket limit on my expenses? What is not included in the out
Kaiser Permanente (No. and So. California) 2018 Union
Kaiser Permanente (No. and So. California) General Information Lifetime Maximum Benefit Annual Maximum Benefit Coinsurance Percentage Precertification Requirements Precertification Penalty Health Savings
OVERVIEW OF YOUR BENEFITS
OVERVIEW OF YOUR BENEFITS IMPORTANT PHONE NUMBERS Member Services Department (646) 473-9200 For answers to questions about your benefits or to be referred to another Benefit Fund department. Program for
Blue Cross Premier Bronze
An individual PPO health plan from Blue Cross Blue Shield of Michigan. You will have a broad choice of doctors and hospitals within BCBSM s unsurpassed statewide PPO network including nationwide coverage.
The HMO provider network is available by clicking on this website address: Plan Provider Directory Search<b/>
GENERAL PROVISIONS Web Site Address Find a Plan Doctor or Facility Health Plan Telephone Number NCQA Accreditation Status http://www.bcbsil.com The HMO provider network is available by clicking on this
1199SEIU Greater New York Benefit Fund OVERVIEW OF YOUR BENEFITS
1199SEIU Greater New York Benefit Fund OVERVIEW OF YOUR BENEFITS I HOSPITAL CARE This benefit is for the hospital s charge for the use of its facility only. Coverage for services rendered by doctors, labs,
Your Choice. 3-Tier Network Option Plan
Your Choice 3-Tier Network Option Plan What is Your Choice? Click Here to Watch Video Your Top Questions What is Your Choice? Are my doctors in the plan? Are my medications covered by the plan? If I get
CareFirst BlueChoice. District of Columbia
CareFirst BlueChoice District of Columbia Welcome We are pleased to offer you enrollment in our CareFirst BlueChoice Health Maintenance Organization (HMO) plan. Designed for today s health conscious and
CALIFORNIA Small Group HMO Aetna Health of California, Inc. Plan Effective Date: 04/01/2007. Aetna Value Network* HMO $30/$40
PLAN FEATURES Deductible (per calendar year) Member Coinsurance Lifetime Maximum Primary Care Physician Selection Referral Requirement PHYSICIAN SERVICES CALIFORNIA Small Group HMO Primary Care Physician
TRADITIONAL PPO PLAN FT. LAUDERDALE $10/20%/40% RX PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE JANUARY 1, 2018 AETNA INC.
TRADITIONAL PPO PLAN FT. LAUDERDALE $10/20%/40% RX PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE JANUARY 1, 2018 AETNA INC. CPOS II DEDUCTIBLE, COPAYS/COINSURANCE AND DOLLAR MAXIMUMS and Aligned Deductible
Tufts Health Plan Spirit Benefit Summary
Tufts Health Plan Spirit Benefit Summary July 1, 2017 SPIRIT PLAN - LIMITED NETWORK Benefit Summary Tufts Health Plan Spirit is an exclusive provider organization (EPO) plan that covers preventive and
$25 copay per visit annual deductible applies. $30 copay per visit annual deductible applies
Minnesota Public Employees Insurance Program (PEIP) Advantage Health Plan 2018-2019 Benefits Schedule Benefit Provision Cost Level 1 You Pay Cost Level 2 You Pay Cost Level 3 You Pay Cost Level 4 You Pay
EXCLUSIVE CARE SUMMARY OF COVERED BENEFITS Select Medicare Eligible Supplement Plan
2018 EXCLUSIVE CARE SUMMARY OF COVERED BENEFITS Select Medicare Eligible Supplement Plan Summary Table of Benefits Select Medicare Supplement Plan PLAN REIMBURSEMENT METHOD DEDUCTIBLE - Individual Medicare
HEALTH SAVINGS PPO PLAN (WITH HSA) - BOISE PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE June 1, 2017 AETNA INC. CPOS II
HEALTH SAVINGS PPO PLAN (WITH HSA) - BOISE PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE June 1, 2017 AETNA INC. CPOS II DEDUCTIBLE, COPAYS/COINSURANCE AND DOLLAR MAXIMUMS and Aligned Deductible -
WILLIS KNIGHTON MEDICAL CENTER S2763 NON GRANDFATHERED PLAN BENEFIT SHEET
BENEFIT SHEET GENERAL PLAN INFORMATION Coordination of Benefits Customized COB Dependents Children birth to 26 Filing Limit 12 months For employees that work in a WKHS location within the primary HealthPlus
FREEDOM BLUE PPO R CO 307 9/06. Freedom Blue PPO SM Summary of Benefits and Other Value Added Services
FREEDOM BLUE PPO R9943 2007 CO 307 9/06 Freedom Blue PPO SM Summary of Benefits and Other Value Added Services Introduction to Summary of Benefits for Freedom Blue January 1, 2007 - December 31, 2007 California
Your Choice 3-Tier Network Option Plan
. Your Choice 3-Tier Network Option Plan Your Top Questions What is Your Choice? Are my doctors in the plan? Are my medications covered by the plan? If I get sick, what do I do? How much will I pay out
Plan Overview. Health Net Platinum 90 HSP. Benefit description Member(s) responsibility 1,2
PureCare HSP is available through Covered CA in Kings, Madera, Sacramento, and Yolo counties, and parts of El Dorado, Fresno, Nevada, Placer, and Santa Clara counties. Plan Overview Health Net Platinum
SUMMARY OF BENEFITS. Hamilton County Department of Education Network Copay Plan. Connecticut General Life Insurance Co.
SUMMARY OF BENEFITS Connecticut General Life Insurance Co. Hamilton County Department of Education Annual deductibles and maximums Lifetime maximum Pre-Existing Condition Limitation (PCL) Coinsurance All
go with ^ Blue Shield PPO plan with Health Savings Account Blue Shield EPO plan Effective January 1, 2015 HIGHLIGHTS Plan overview 1
go with ^ Blue Shield PPO plan with Health Savings Account Blue Shield EPO plan Effective January 1, 2015 HIGHLIGHTS Plan overview 1 Pharmacy benefits 9 How to find a provider 10 Programs and services
Blue Shield Gold 80 HMO
Blue Shield Gold 80 HMO Uniform Health Plan Benefits and Coverage Matrix Blue Shield of California Effective January 1, 2017 THIS MATRIX IS INTENDED TO BE USED TO HELP YOU COMPARE COVERAGE BENEFITS AND
NY EPO OA 1-09 v Page 1
PLAN FEATURES Deductible (per calendar year) Member Coinsurance (applies to all expenses unless otherwise stated) Maximum Out-of-Pocket Limit (per calendar year) Lifetime Maximum (per member lifetime)
Irvine Unified School District ASO PPO /50
An Independent member of the Blue Shield Association Irvine Unified School District ASO PPO 500 90/50 Benefit Summary (For groups of 300 and above) (Uniform Health Plan Benefits and Coverage Matrix) THIS
UNIVERSITY OF THE CUMBERLANDS MEDICAL BENEFITS SCHEDULE
November 1, 2016 UNIVERSITY OF THE CUMBERLANDS MEDICAL BENEFITS SCHEDULE NETWORK NON-NETWORK Lifetime Maximum Benefit Unlimited Unlimited Annual Deductible (Single/Family) $500/$1,000 $1,000/$2,000 Maximum
ESSENTIAL ASSIST PPO PLAN (WITH HRA) $10/25%/50% RX PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE JANUARY 1, 2018 AETNA INC.
ESSENTIAL ASSIST PPO PLAN (WITH HRA) $10/25%/50% RX PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE JANUARY 1, 2018 AETNA INC. CPOS II DEDUCTIBLE, COPAYS/COINSURANCE AND DOLLAR MAXIMUMS and Aligned
BlueOptions - Healthy Rewards HRA Plan
BlueOptions - Healthy Rewards HRA Plan Schedule of Benefits Plan 03359 Important things to keep in mind as you review this Schedule of Benefits: This Schedule of Benefits is part of your Benefit Booklet,
This plan is pending regulatory approval.
Bronze Full PPO 3000 OffEx Benefit Summary (For groups 1 to 50) (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California Effective October 1, 2015 THIS MATRIX IS INTENDED TO BE USED
HEALTH SAVINGS PPO PLAN (WITH HSA) FT. LAUDERDALE PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE JUNE 1, 2017 AETNA INC.
HEALTH SAVINGS PPO PLAN (WITH HSA) FT. LAUDERDALE PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE JUNE 1, 2017 AETNA INC. CPOS II DEDUCTIBLE, COPAYS/COINSURANCE AND DOLLAR MAXIMUMS and Aligned Deductible
Platinum Local Access+ HMO $25 OffEx
Platinum Local Access+ HMO $25 OffEx Benefit Summary (For groups 1 to 50) (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California Effective January 1, 2015 THIS MATRIX IS INTENDED
IMPORTANT INFORMATION:
Schedule of Benefits ElevateHealth Options HMO NEW HAMPSHIRE ID: MD0000018209_A13 X Coverage under this Plan is under the jurisdiction of the New Hampshire Insurance Commissioner. IMPORTANT INFORMATION:
Benefits are effective January 01, 2018 through December 31, 2018 PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY
PLAN FEATURES Annual Deductible The maximum out-of-pocket limit applies to all covered Medicare Part A and B benefits including deductible. Hearing aid reimbursement does not apply to the out-of-pocket
CCMHG Health Deductible Plan Benefit Comparison - FY18
Deductible - applies to: In-patient Admission; Out-patient Surgery; ER, High Tech Imaging (MRI, CT, & PET) and Diagnostic Tests & Procedures. Does not apply to routine office visits or pharmacy. Per plan
BCBSM provides administrative claims services only. Your employer or plan sponsor is financially responsible for claims.
Michigan Catholic Conference Group Number: 71755 Package Code(s): 010 Section Code(s): 1000, 2000 PPO - PPO1, Hearing, Vision ( Exam only) Effective Date: 01/01/2018 Benefits-at-a-glance This is intended
Medical Plans Benefit Guide
Medical Plans Benefit Guide Employers with 1-50 employees 1.1.01 Provider network built for value and quality... Wellness rewards...3 Medical Travel Support and Air or Surface Transportation... Support
GIC Employees/Retirees without Medicare
GIC Active Employees & Retirees without Medicare 7/1/18 GIC Employees/Retirees without Medicare HMO Summary of Benefits Chart This chart provides a summary of key services offered by your Health New England
Blue Shield $0 Cost-Share HMO AI-AN
Blue Shield $0 Cost-Share HMO AI-AN This plan is only available to eligible Native Americans 1 Uniform Health Plan Benefits and Coverage Matrix Blue Shield of California Effective January 1, 2017 THIS
Schedule of Benefits-EPO
Schedule of Benefits-EPO [Plan Information] [Health Plan:] [Ambetter Balanced Care 3 (2018)-Standard Silver On Exchange Plan] [Primary Member:] [John Doe] [Member ID:] [01213456] [Date of Birth:] [08/12/62]
Gold Access+ HMO 500/35 OffEx
An Independent Member of the Blue Shield Association Gold Access+ HMO 500/35 OffEx Benefit Summary (For groups 1 to 100) (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California Effective
Summary of Benefits. Tufts Medicare Preferred HMO PLANS Tufts Medicare Preferred HMO GIC
Tufts Medicare Preferred HMO PLANS 2018 Summary of Benefits Tufts Medicare Preferred HMO GIC The benefit information provided is a summary of what we cover and what you pay. It does not list every service
Summary of Benefits CCPOA (Basic) Custom Access+ HMO
Blue Shield of California is an independent member of the Blue Shield Association Summary of Benefits CCPOA (Basic) Custom Access+ HMO CCPOA Effective January 1, 2019 HMO Benefit Plan This Summary of Benefits
SUMMARY OF P-5-5 BENEFITS AND SCHEDULE OF COPAYMENTS
SUMMARY OF P-5-5 BENEFITS AND SCHEDULE OF COPAYMENTS THIS MATRIX IS INTENDED TO BE USED TO HELP YOU COMPARE COVERAGE BENEFITS AND IS A SUMMARY ONLY. THE EVIDENCE OF COVERAGE AND PLAN CONTRACT SHOULD BE
Schedule of Benefits
Schedule of Benefits ANTHEM Small Business Health Options Program (SHOP) This is a brief schedule of benefits. Refer to your Anthem Certificate of Coverage (Booklet) for complete details on benefits, conditions,
Platinum Trio ACO HMO 0/20 OffEx
Platinum Trio ACO HMO 0/20 OffEx Benefit Summary (For groups 1 to 100) (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California Effective January 1, 2017 THIS MATRIX IS INTENDED TO
ST. MARY S HEALTHCARE SYSTEM, INC. Case # GA6476 BlueChoice HMO Benefit Summary Effective: January 1, 2018
ST. MARY S HEALTHCARE SYSTEM, INC. Case # GA6476 BlueChoice HMO Benefit Summary Effective: January 1, 2018 All benefits are subject to the calendar year deductible, except those with in-network copayments,
We re Tufts Health Plan, and our goal is better health and wellness for you.
We re Tufts Health Plan, and our goal is better health and wellness for you. Thank you for taking the time to read this short overview of Tufts Health Plan. Being willing to learn about your healthcare
Gold Access+ HMO $30 OffEx Benefit Summary (For groups 1 to 50) (Uniform Health Plan Benefits and Coverage Matrix)
Gold Access+ HMO $30 OffEx Benefit Summary (For groups 1 to 50) (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California Effective January 1, 2015 THIS MATRIX IS INTENDED TO BE USED
Effective Date 1/1/2014
Effective Date 1/1/2014 1 Tufts Health Plan Overview Tufts Health Plan in business for 30+ years Headquartered in Watertown MA, with regional offices in Providence RI, Worcester and Springfield More than
Blue Shield Gold 80 HMO 0/30 + Child Dental INF
Blue Shield Gold 80 HMO 0/30 + Child Dental INF Benefit Summary (For groups 1 to 100) (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California Effective January 1, 2017 THIS MATRIX
Summary of Benefits [Silver Access+ HMO 1750/55 OffEx] [Silver Local Access+ HMO 1750/55 OffEx]
![Summary of Benefits [Silver Access+ HMO 1750/55 OffEx] [Silver Local Access+ HMO 1750/55 OffEx]](/thumbs/86/94175655.jpg "Summary of Benefits [Silver Access+ HMO 1750/55 OffEx] [Silver Local Access+ HMO 1750/55 OffEx]")
Blue Shield of California is an independent member of the Blue Shield Association Summary of Benefits [Silver Access+ HMO 1750/55 OffEx] [Silver Local Access+ HMO 1750/55 OffEx] Group Plan HMO Benefit
See Covered Benefits below. None. $2,000 per Member per calendar year $4,000 per family per calendar year
Schedule of s Harvard Pilgrim Health Care, Inc. THE HARVARD PILGRIM HMO MAINE ID: MD0000002653_F2 X This Schedule of s summarizes your s under The Harvard Pilgrim HMO (the Plan) and states the Member Cost
Benefits and Premiums are effective January 01, 2018 through December 31, 2018 PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY
The maximum out-of-pocket limit applies to all covered Medicare Part A and B benefits including deductible. Primary Care Physician Selection Optional There is no requirement for member pre-certification.
Health plans for New Hampshire small businesses Available through the Health Insurance Marketplace
Health plans for New Hampshire small businesses Available through the Health Insurance Marketplace 1 38476NHEENABS Rev. 09/14 We can help you navigate the health care road We re here to help. In fact,
HEALTH SAVINGS ACCOUNT (HSA)
HSA FEATURES Health Savings Account Amount $600 Employee $1,000 Family Amount contributed to the HSA by the employer. Funded on a quarterly basis. HSA amount reflected is on a per calendar year basis.
Summary of Benefits Platinum Trio HMO 0/25 OffEx
Blue Shield of California is an independent member of the Blue Shield Association Summary of Benefits Platinum Trio HMO 0/25 OffEx Group Plan HMO Benefit Plan This Summary of Benefits shows the amount
CA Group Business 2-50 Employees
PLAN FEATURES Network Primary Care Physician Selection Deductible (per calendar year) Member Coinsurance Copay Maximum (per calendar year) Lifetime Maximum Referral Requirement PHYSICIAN SERVICES Primary
2017 Summary of Benefits
H5209 004_DSB9 23 16 File & Use 10/14/2016 DHS Approved 10 7 2016 This is a summary of drug and health services covered by Care Wisconsin Medicare Dual Advantage Plan (HMO SNP) January 1, 2017 to December
CAPE COD MUNICIPAL HEALTH GROUP IMPORTANT - PLEASE READ
CAPE COD MUNICIPAL HEALTH GROUP IMPORTANT - PLEASE READ The attached benefit comparison chart is a high level overview of the plans offered by CCMHG. The plan documents available to registered users on
Benefits and Premiums are effective January 01, 2018 through December 31, 2018 PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY
Benefits and Premiums are effective January 01, 2018 through December 31, 2018 PLAN FEATURES Network & Out-of- Annual Deductible This is the amount you have to pay out of pocket before the plan will pay
First Look: Plan Benefit Filings
July 30, 2014 First Look: Plan Filings Maryland and Washington, D.C. 1 Disclaimers MedStar does not currently have a contract with CMS for the State of MD nor any special needs plans in Washington, D.C.
17.1 PRODUCT INFORMATION. Fidelis Care s Metal-Level Products
PRODUCT INFORMATION Fidelis s Metal-Level Products Following the implementation of the Patient Protection and Affordable Act, Fidelis offers Metal-Level Products covering Essential Health Benefits as defined
Summary of Benefits Full PPO Savings Two-Tier Embedded Deductible 1500/2700/3000
Summary of Benefits Full PPO Savings Two-Tier Embedded Deductible 1500/2700/3000 Group Plan PPO Savings Benefit Plan This Summary of Benefits shows the amount you will pay for Covered Services under this
$10 copay. $10 copay. $10 copay $5 copay $10 copay $5 copay. $10 copay. No charge. No charge. No charge
PLAN FEATURES * ** Deductible (per calendar ) Member Coinsurance Copay Maximum (per calendar ) Lifetime Maximum Unlimited Primary Care Physician Selection Required Upon enrollment to a Vitalidad Plus plan,
SUMMARY OF BENEFITS. Cigna Health and Life Insurance Co. For Employees of - Digital Risk, LLC Open Access Plus Plan
SUMMARY OF BENEFITS Cigna Health and Life Insurance Co. For Employees of - Digital Risk, LLC Open Access Plus Plan Notice of Grandfathered Plan Status This plan is being treated as a "grandfathered health
Summary of Benefits Platinum Full PPO 0/10 OffEx
Blue Shield of California is an independent member of the Blue Shield Association Summary of Benefits Platinum Full PPO 0/10 OffEx Group Plan PPO Benefit Plan This Summary of Benefits shows the amount
Blue Care Network Geared perfectly for your needs. Enroll by calling Retiree Health Care Connect (contact information inside)
Blue Care Network Geared perfectly for your needs Enroll by calling Retiree Health Care Connect (contact information inside) November 2011 Dear UAW Trust Member: The UAW Retiree Medical Benefits Trust
DDP: PPO, CDHP, and EPO (EPO for PA residents only) DDNY: PPO and CDHP. Effective January 1, plans: HIGHLIGHTS Medical benefits 11
2016 plans: DDP: PPO, CDHP, and EPO (EPO for PA residents only) DDNY: PPO and CDHP Effective January 1, 2016 HIGHLIGHTS Medical benefits 11 How to find a provider 12 Programs and services 13 Benefit summaries
Health plan Open Enrollment
2017-2018 Health plan Open Enrollment Offered through Day care council - local 205, DC 1707 Welfare Fund GOLDCARE MetroPlus.org/GoldCare 1.877.475.3795 2017-2018 HEALTH PLAN FOR DAY CARE WORKERS This is
2019 Summary of Benefits
2019 Summary of Benefits H6351 This is a summary of drug and health services covered by January 1, 2019 - December 31, 2019. is Medicare Advantage HMO Plan (HMO stands for Health Maintenance Organization)
Stanislaus County Medical Benefits EPO Option. In-Network Benefits (Stanislaus County Partners in Out-of-Network Benefits
Stanislaus County Medical EPO Option The following summary of benefits is a brief outline of the maximum amounts or special limits that may apply to benefits payable under the Plan. For a detailed description
TUFTS HEALTH PLAN SPIRIT BENEFIT SUMMARY JULY 1, 2018 SPIRIT PLAN - LIMITED NETWORK
TUFTS HEALTH PLAN SPIRIT BENEFIT SUMMARY JULY 1, 2018 SPIRIT PLAN - LIMITED NETWORK Benefit Summary Tufts Health Plan Spirit is an exclusive provider organization (EPO) plan that covers preventive and
Covered Services List
CAREPLUS Covered Services List For CeltiCare Health with MassHealth CarePlus Coverage This is a list of all covered services and benefits for MassHealth CarePlus enrolled in CeltiCare Health. The list
Your Out-of-Pocket Type of Service
Calendar Year Deductible (CYD) 1 $3,000 single/ 3x family Out-of-Pocket Maximum - Deductibles and copays all accrue towards the out-of-pocket $6,200 single/ 2x family maximum. With respect to family plans,
Benefits are effective January 01, 2017 through December 31, 2017
Benefits are effective January 01, 2017 through December 31, 2017 PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY PLAN FEATURES Network & Out-of- Annual Deductible $0 This is the amount
Summary of Benefits. January 1, 2018 December 31, Providence Medicare Dual Plus (HMO SNP)
Summary of Benefits January 1, 2018 December 31, 2018 Providence Medicare Dual Plus (HMO SNP) This plan is available in Clackamas, Multnomah and Washington counties in Oregon for members who are eligible
Federal Employees. Benefits at a Glance for 2018 Plans. Featuring: - $0 Primary Care Physician Visits - $0 Lab Tests & X-rays
Federal Employees Benefits at a Glance for 2018 Plans Featuring: - $0 Primary Care Physician Visits - $0 Lab Tests & X-rays MFEDBG18 GlobalHealth, Inc. P.O. Box 2393 Oklahoma City, OK 73101-2393 www.globalhealth.com/fehb
Aetna Health of California, Inc.
Easily locate PrimeCare participating providers at www.aetna.com/docfind/primecare PLAN FEATURES Deductible (per calendar year) Member Coinsurance Lifetime Maximum Primary Care Physician Selection Referral
SUMMARY OF BENEFITS. It's Your Health. Features that Add Value. You Can Depend on CIGNA HealthCare. Quality Service Is Part of Quality Care
SUMMARY OF BENEFITS Your CIGNA HealthCare HMO plan Features that Add Value The CIGNA HealthCare 24-Hour Health Information Line SM connects you to registered nurses and a library of hundreds of recorded
Aetna Fixed Indemnity Plan Helps pay for the costs of everyday medical expenses
Aetna Fixed Indemnity Plan Helps pay for the costs of everyday medical expenses Extra benefits when you need them Do you have security in knowing you have help handling your medical expenses? You can with
Regence Engage Plan Highlights For Groups of /1/2016
Plan Features Provider choice: Members have direct access to their choice of providers. Category 1 are Preferred; Category 2 are Participating; and Category 3 are Non-contracted providers. Simplicity:
The MITRE Corporation Plan
Benefit Type Plan Year Type Calendar Year Annual Medical Out of (for certain services) Employee Employee + 1 Family Annual Prescription Drug Out of Employee Employee + 1 Family Copayments: One copay per
2018 Summary of Benefits
2018 Summary of MVP Health Plan, Inc. (HMO-POS) (HMO-POS) (HMO-POS) H3305: Plan 022, Plan 021 and Plan 020 This is a summary of drug and health services covered by MVP Health Plan January 1, 2018 - December
Blue Shield of California s PPO Plan
Blue Shield of California s PPO Plan If keeping your relationship with your current doctors is important, our PPO plan may be a good choice for you. You can continue to see your doctors, even if they aren
RSNA EMPLOYEE BENEFIT TRUST PLAN II S2502 NON GRANDFATHERED PLAN BENEFIT SHEET
BENEFIT SHEET GENERAL PLAN INFORMATION Coordination of Benefits Standard COB Dependents Children birth to age 26 Filing Limit 1 year from date of service Mailing Address & PPO Company. Remit claims to:
Choice PPO Retired Employees Health Program Non-Medicare Eligible Retired Members
Choice PPO Retired Employees Health Program Non-Medicare Eligible Retired Members DEDUCTIBLE (per calendar year) Annual in-network deductible must be paid first for the following services: Imaging, hospital
Amherst Central School District First Choice Health Plan. Non-First Choice Providers and Out-of-Network Providers
Health: Hospital Services provided by First Choice Preferred Provider Network Medical Services Radiology, Ultrasounds 20% after $500 individual or Laboratory Testing 20% after $500 individual or MRI and
CLASSIC BLUE SECURE/BLUE CROSS BLUE SHIELD COMPLEMENTARY Monroe County Benefit Summary/Comparison (Over 65 Retirees)
WHO IS COVERED Enrollment Requirement Members must be enrolled in both Medicare Parts A and B Members must be enrolled in both Medicare Parts A and B Type of Tier Single only Single only Dependent/Student
FCPS BENEFITS COMPARISON FOR PLAN YEAR 2018 Active Employees and Retirees Under 65
BENEFIT Medical Lifetime Maximum Unlimited Unlimited Unlimited Unlimited Unlimited Individual Annual Deductible $250 $500 $250 $500 None Family Annual Deductible $500 $1,000 $500 $1,000 None Medical Plan
Summary of Benefits. New York: Bronx, Kings, New York, Queens and Richmond Counties
Summary of Benefits New York: Bronx, Kings, New York, Queens and Richmond Counties January 1, 2006 - December 31, 2006 You ve earned the right to live life on your own terms. And that includes the right
Kaiser Permanente Group Plan 301 Benefit and Payment Chart
301 Kaiser Permanente Group Plan 301 Benefit and Payment Chart 10119 CITY AND COUNTY OF SAN FRANCISCO About this chart This benefit and payment chart: Is a summary of covered services and other benefits.
2016 OPEN ENROLLMENT MEDICAL PLANS
2016 OPEN ENROLLMENT MEDICAL PLANS Table of Contents Section I. Enrollment Guidelines Page 3 Health Plan Comparison Chart Page 4 Health Plan Premiums and Employee Cost-Sharing Page 5 Section II. Blue Shield