for brand drugs) $15 $20

Transcription

1 Reading AARP MedicareComplete HMO Premiums/month $14 Max Out of Pocket, In- $6,700 Primary Care Dr. Visits $15 Specialist Office Visit $45 Urgent Care $30-40 Mental Health, Subst Abuse $345 per day Out-patient Surgery 20% coinsurance Ambulance $225 Emergency Care $80 $160 per day (Days 21-62) $10 X-Rays $14 High Tech Imaging 20% coinsurance Diabetic Supplies $0 Durable Medical Equipment 20% PT/OT/Cardiac Rehab $40/40/45 Prescription Drugs Preferred Pharmacies: NA Yes ($230 deductible for brand drugs) not covered Routine exam & fitting, $ copay for each hearing aid annual eye exam Fitness $15 $20 Silver Sneakers

2 Reading & PSU/St. Joseph Advantra SilverPlus HMO Aetna Medicare Silver HMO Premiums/month $36 $56 Max Out of Pocket, In $6,700 $6,700 Primary Care Dr. Visits $10 $5 Specialist Office Visit $45 $35 Urgent Care $50 $50 Mental Health, Subst Abuse $195 per day (Days 1-7) $195 per day (Days 1-9) Out-patient Surgery Surgi- $320/$370 $ Center/Hospital Ambulance $290 $295 Emergency Care $80 $80 /Tests $15/15 $10/20 X-Rays $30 $25 High Tech Imaging $265 $265 Diabetic Supplies $0-20% 0-20% Durable Medical Equipment 20% 20% PT/OT/Cardiac Rehab $35 $35 Prescription Drugs Yes ($95 deductible) Yes Preferred Pharmacies Oral exam & cleaning (2/yr); 1-4 bite wing xray/yr CVS,Kmart, Wal-Mart, Weis $500 for preventive dental/yr Routine exam $0 Free exam $300 total per year for aids 1 annual eye exam Free Exam, $125 towards eyewear each year. Free Exam, $125 towards eyewear each year. Fitness SilverSneakers SilverSneakers Over The Counter Items $15 per month

3 Reading & PSU/St. Joseph Advantra SilverPlus PPO AdvantraOne PPO Advantra Silver PPO Premiums/month $86 $19 $0 Plan pays $63 towards Part B Max Out of Pocket, In $6,700 $6,700 $6,700 Primary Care Dr. Visits $5 $35 $10 Specialist Office Visit $30 $50 $35 Urgent Care $50 $60 $50 Mental Health, Subst Abuse $400 per hospital stay $360 per day $185 per day (Days 1-9) Out-patient Surgery Surgi- $275/325 20% $300/350 Center/Hospital Ambulance $225 $325 $275 Emergency Care $80 $80 $80 & Tests $5/10 $50 $5/20 X-Rays $25 $60 $25 High Tech Imaging $315 20% $265 Diabetic Supplies $0-20% $0-20% $0-20% Durable Medical Equipment 20% 20% 20% PT/OT/Cardiac Rehab $35 $40 $40 Prescription Drugs Yes Yes ($400 deductible Yes Preferred Pharmacies Can use any provider & get reimbursed 1 Routine exam $150 towards preventive dental (1) dental exams& cleanings; (1) x-ray Not Covered Not Covered $0 $0 $0 1 annual eye exam $125 towards eyewear every year $0 $0 Fitness SilverSneakers SilverSneakers SilverSneakers

4 Reading & PSU/St. Joseph Aetna Medicare Gold PPO Aetna Medicare Premier Plan PPO Premiums/month $156 $126 Max Out of Pocket, In $4,500 $6,700 Primary Care Dr. Visits $5 $10 Specialist Office Visit $25 $40 Urgent Care $50 $50 $195 per day Mental Health, Subst Abuse $300 per hospital stay (Days 1-8) Out-patient Surgery Surgi- $ $ Center/Hospital Ambulance $195 $300 Emergency Care $80 $80 /Tests $0 $0/25 X-Rays $15 $30 High Tech Imaging $200 $240 Diabetic Supplies 0-20% 0-20% Durable Medical Equipment 20% 20% PT/OT/Cardiac Rehab $15 $35 Prescription Drugs Yes Yes Preferred Pharmacies Routine exam Kmart, Sams, Walgreens, Wal-Mart, Weis $150 towards preventive dental (1) dental exams& cleanings; (1) x-ray Free exam $500 total per year for aids $500 towards preventive dental (2) annual exams& cleanings Free exam $300 total per year for aids 1 annual eye exam $150 towards eyewear every year $125 towards eyewear every year Fitness SilverSneakers SilverSneakers

5 Reading & PSU/St. Joseph BlueJourney Premier HMO BlueJourney Value HMO BlueJourney Essential HMO Premiums/month $148 $48 $0 Max Out of Pocket, In- $3,400 $3,400 $6,700 Primary Care Dr. Visits $10 $10 $5 Specialist Office Visit $20 $25 $30 Urgent Care $30 $35 $40 Mental Health, Subst Abuse $65 per day $100 per day $150 per day (Days 1-8) Out-patient Surgery $100/200 $200/300 $225/325 surgi center/hospital Ambulance $100 $150 $200 Emergency Care $100 $100 $80 $20/day (Days 6-20); $20/day (Days 6-20); $167 per day $160 per day (Days 21- $167 per day (Days ) 100) $15 $15 $15 X-Rays $25 $25 $50 Diagnostic Radiology $75 $100 $250 Diabetic Supplies $0 $0 $0 Durable Medical Equipment 20% 20% 20% PT/OT/Cardiac Rehab $20 $25 $30 Prescription Drugs Yes Yes Yes Preferred Pharmacies: 1 annual exam, cleaning and bitewin xrays (2); $1500 max/yr Routine exam & fitting, $800 for hearing aids every 3 yrs 1 annual eye exam; 1 std pr of lenses & $40 towards frames or contacts per 2 yrs CVS, Giant, Sams, Wal-Mart, Weis, W Reading $10 co-pay $10 co-pay $10 co-pay $20 co-pay each for exam & fitting $25 co-pay each for exam & fitting $30 co-pay each for exam & fitting $20 $20 $20 Fitness Silver & Fit Silver & Fit Silver & Fit Over The Counter Items $15 per month $15 per month $25 per month

6 Reading & PSU/St. Joseph BlueJourney Prime PPO BlueJourney Classic PPO Premiums/month $169 $62 Max Out of Pocket, In- $3,400 $6,700 Primary Care Dr. Visits $10 $10 Specialist Office Visit $25 $35 Urgent Care $35 $45 $100 per day $200 per day Mental Health, Subst Abuse (Days 1-7) Out-patient Surgery surgi center/hospital $100/200 $200/300 Ambulance $125 $150 Emergency Care $100 $80 $150 per day $167 per day $15 $15 X-Rays $20 $25 Diagnostic Radiology $100 $150 Diabetic Supplies $0 $0 Durable Medical Equipment 20% 20% PT/OT/Cardiac Rehab $25 $35 Prescription Drugs Yes Yes Preferred Pharmacies: 1 annual exam, cleaning and bitewin xrays (2); Routine exam & fitting, $800 for hearing aids every 3 yrs 1 annual eye exam; $40 towards frames or contacts; $48 for lenses every 2 yrs CVS, Giant, Sams, Wal-Mart, Weis, W Reading $10 co-pay $10 co-pay $25 co-pay each for exam & fitting $35 co-pay each for exam & fitting $20 $20 Fitness Silver & Fit Silver & Fit Over The Counter Items $15 per month $15 per month

7 PSU/St. Joseph Community Blue Medicare HMO Community Blue Medicare PPO Premiums/month $0 $23 Max Out of Pocket, In- $6,700 $6,700 Primary Care Dr. Visits $0 $0 Specialist Office Visit $50 $40 Urgent Care $50 $50 Mental Health, Subst Abuse $295 per day $295 per day Out-patient Surgery $300-$350 $300-$350 Ambulance $350 $350 Emergency Care $80 $80 (Days 21-62) $0-30 $0-30 X-Rays $50 $50 High Tech Imaging $270 $270 Diabetic Supplies $0-20% $0-20% Durable Medical Equipment 20% 20% PT/OT/Cardiac Rehab $40 $40 Prescription Drugs Yes Yes Preferred Pharmacies: Esterbrook, Giant, K-Mart, Rite-Aid, Wal-Mart, Walgreens, W. Rdng $ 40 (1) Routine exam annual eye exam $30 for (1) cleaning & exam $25 for (1) x-ray $ for each hearing aid every year Std eyeglass lenses & frames or contacts covered in $30 for (1) cleaning & exam $25 for (1) x-ray $ for each hearing aid every year Std eyeglass lenses & frames or contacts covered in Fitness Silver Sneakers Silver Sneakers Transportation $10 CoPay (24) 1-way trips $10 CoPay (24) 1-way trips

8 Reading & PSU/St. Joseph Freedom Blue Deluxe PPO Freedom Blue Standard PPO Freedom Blue ValueRx PPO Premiums/month $ $ $73.00 Max Out of Pocket, In $6,700 $6,700 $6,700 Primary Care Dr. Visits $5 $10 $10 Specialist Office Visit $30 $35 $40 Urgent Care $50 $50 $50 $250 per day Mental Health, Subst Abuse $250 per hospital stay $500 per hospital stay (Days 1-6) Out-patient Surgery $ $ $ Ambulance $150 $175 $200 Emergency Care $80 $80 $80 $0-10 $0-15 $0-20 X-Rays $10 $20 $40 High Tech Imaging $100 $125 $200 Diabetic Supplies $0-20% $0-20% $0-20% Durable Medical Equipment 20% 20% 20% PT/OT/Cardiac Rehab $30 $35 $40 Prescription Drugs Yes Yes Yes Preferred Pharmacies: Esterbrook, Giant, K-Mart, Rite-Aid, Wal-Mart, Walgreens, W. Rdng 1 Routine $30 per year 1 annual eye exam $20 for (2) cleaning & exam $20 for (1) x-ray Standard eyeglass lenses & frames or contacts covered in full $30 for (2) cleaning & exam $25 for (1) x-ray Standard eyeglass lenses & frames or contacts covered in full $30 for (2) cleaning & exam $25 for (1) x-ray Standard eyeglass lenses & frames or contacts covered in full Fitness Silver Sneakers Silver Sneakers Silver Sneakers Transportation $ for each hearing aid every year $10 CoPay (24) 1-way trips $ for each hearing aid every year $10 CoPay (24) 1-way trips $ for each hearing aid every year $10 CoPay (24) 1-way trips

9 Reading/PSU-St.Joseph Geisinger Gold Classic Advantage Rx HMO Geisinger Gold Classic Complete HMO Geisinger Gold Essential Rx HMO Premiums/month $149 $38 $0 Max Out of Pocket, In $3,400 $4,900 $6,700 Primary Care Dr. Visits $0 $5 $10 Specialist Office Visit $20 $35 $40 Urgent Care $20 $35 $40 $150 per day $175 per day $200 per day Mental Health, Subst Abuse Out-patient Surgery $200 $245 $350 Ambulance $100 $200 $200 Emergency Care $100 $80 $80 $160 per day (Days 21-42) $160 per day (Days 21-57) $160 per day (Days 21-62) $5 $5 $5 X-Rays $25 $30 $30 High Tech Imaging $150 $225 $225 Diabetic Supplies $0-20% coinsurance $0-20% coinsurance $0-20% coinsurance Durable Medical Equipment 20% 20% 20% PT/OT/Cardiac Rehab $20/20/0 $35/35/0 $40/40/0 Prescription Drugs Yes Yes Yes Preferred Pharmacies: NA Preventive Dental Routine exam & fitting 1 annual routine eye exam unlimited for preventive services $500 max/yrcomprehensive $20 copay $800 towards hearing aids/ 3 yrs $20 copay for exam $200 towards eyewear/yr $500 max/yr for preventive & comprehensive $20 copay $500 towards hearing aids/ yr $20 copay for exam $100 towards eyewear/yr Fitness $90 every 3 months $90 every 3 months

10 Reading/PSU-St.Joseph Geisinger Gold Preferred Advantage Rx PPO Geisinger Gold Preferred Complete Rx PPO Premiums/month $77 $0 Max Out of Pocket, In $5,900 $6,700 Primary Care Dr. Visits $5 $10 Specialist Office Visit $25 $40 Urgent Care $25 $40 $175 per day $200 per day Mental Health, Subst Abuse Out-patient Surgery $225 $350 Ambulance $200 $275 Emergency Care $80 $80 $160 per day (Days 21-57) $160 per day (Days 21-62) $15 $30 X-Rays $25 $40 High Tech Imaging $200 $275 Diabetic Supplies $0-20% coinsurance $0-20% coinsurance Durable Medical Equipment 20% 20% PT/OT/Cardiac Rehab $25/25/0 $40/40/0 Prescription Drugs Yes Yes Preferred Pharmacies: NA Optional Health $38/month $38/month Vision 1 routine exam and $100 towards eyewear per year Dental $500 per year for up to (2) cleanings & exams; (1) x-ray Hearing $20 towards 1 diagnostic exam and $500 towards hearing aids per year Fitness You get $90 every 3 months towards gym membership $0 copay $20 copay $0 copay $0 copay $20 copay $20 copay included included

11 PSU/St. Joseph Humana GoldPlus HMO H Humana GoldPlus HMO H HumanaGold Choice PFFS H Premiums/month $0 $0 $63 Plan pays $40 towards Part B Medical Deductible $0 $183 $0 Max Out of Pocket, In $6,700 $6,700 $6,700 Primary Care Dr. Visits $10 20% $15 Specialist Office Visit $45 20% $45 Urgent Care $ % $15-45 Inpatient hospital Stays $295 per day (Days 1-6) $600 per day (Days 1-3) $295 per day (Days 1-6) Out-patient Surgery $245/295 20% $245/295 surgi-center/hospital Ambulance $265 20% $250 Emergency Care $80 $80 $80 $0-105 $0-20% coinsurance $0-105 X-Rays $ % $ High Tech Imaging $ % $ Diabetic Supplies $0-20% coinsurance $0-20% coinsurance $0-20% coinsurance Durable Medical Equipment 20% 15% 20% PT/OT/Cardiac Rehab $ % $15-40 Prescription Drugs Yes Yes ($300 deductible for brand) Yes ($360 deductible for brand) Preferred Pharmacies: Preventive Dental (1) exam, cleaning & x-ray All EXCEPT FOR: Esterbrooks, W. Reading $0 Free routine exam & fitting $499 copay for 1 hearing aid/ear/yr 1 annual eye exam; $200 towards fames & Lenses OTC Items $60 every 3 mths Fitness Silver Sneakers Silver Sneakers Silver Sneakers Optional Dental $25.20/month $25.20/month $22.10/month $1500 max benefit per $1500 max benefit per $2000 max benefit for year for Preventive & Comprehensive year for Preventive & Comprehensive preventive & comprehensive services per year Optional Vision $40 towards 1 routine exam and $375 towards eyewear per year $15.30/month $15.30/month

12 PSU/St. Joseph Humana Choice PPO H Humana Choice PPO R Humana Choice PPO H Premiums/month $117 $95 $37 Max Out of Pocket, In $6,700 $6,700 $6,700 Primary Care Dr. Visits $5 $15 $15 Specialist Office Visit $30 $45 $45 Urgent Care $35 $35 $35 $350 per day $350 per day Mental Health, Subst Abuse $350 per stay Out-patient Surgery $150/250 $300/350 $300/350 surgi-center/hospital Ambulance $265 $265 $265 Emergency Care $80 $80 $80 /Tests $0-90 $0-105 $0-105 X-Rays $5-90 $ $ Diagnostic Radiology $ $ $ Diabetic Supplies $0-20% coinsurance $0-20% coinsurance $0-20% coinsurance Durable Medical Equipment 20% 20% 20% PT/OT/Cardiac Rehab $10-40 $15-40 $15-40 Prescription Drugs No Deductible $315 deductible for brand names Preferred Pharmacies: All EXCEPT FOR: Esterbrooks, W. Reading Preventive Dental (1) exam, cleaning & x-ray free Routine exam & fitting No Deductible $0 not covered $0 $0 not covered $0 $40 towards 1 annual eye exam; $100 towards fames & Lenses Fitness Silver Sneakers Silver Sneakers Silver Sneakers Optional Dental Optional Vision $399 copay for 1 hearing aid/ear/yr not covered $499 copay for 1 hearing aid/ear/yr $22.10/month $2000 max benefit for preventive & comprehensive services per year $15.30/month $40 towards 1 routine exam and $375 towards eyewear per year $19.60/month $1500 max benefit per year for Preventive & Comprehensive

13 Reading Health UPMC for Life PPO Rx Enhanced UPMC for Life HMO Rx UPMC for Life HMO Premier Rx Premiums/month $135 $81 $0 Max Out of Pocket, In- $6,700 $3,400 $6,000 In- Deductible $0 $0 $0 Primary Care Dr. Visits $5 $5 $0 Specialist Office Visit $40 $30 $45 Urgent Care $50 $50 $50 Mental Health, Subst Abuse $250 per admission $350 per admission $200/dy for dys1-5 Out-patient Surgery $250 $250 $250 Ambulance $100 $200 $300 Emergency Care $80 $100 $80 $160 per day (Days ) $20 per day (Days 1-20); $80 per day (Days ) $160 per day (Days ) $0-5 $0-5 $0-10 X-Rays $20 $40 $30 High Tech Imaging $100 $200 $250 Diabetic Supplies 20% 20% 20% Durable Medical Equipment 20% 20% 20% PT/OT/Cardiac Rehab $40 $30 $40 Prescription Drugs Yes Yes Yes Preferred Pharmacies: (2) exams & cleaning and (1) x- ray Routine exam annual eye exam Esterbrook, Giant, Kmart, Rite Aid, Walgreens, WalMart, W Reading $15 co-pay for exam $15 co-pay for x-ray $15 co-pay for exam $15 co-pay for x-ray $15 co-pay for exam $15 co-pay for x-ray not covered not covered not covered $200 towards exam and eyewear every year $175 towards exam and eyewear every 2 yrs $100 towards exam and eyewear every 2 yrs evisits/ederm $5/$38 $5/$38 $10/$38 Fitness Silver&Fit Silver&Fit Silver&Fit

14 PSU/St. Joseph VIBRA Enhanced PPO VIBRA Essential PPO Premiums/month $55.00 $0 Max Out of Pocket, In- $4,800 $5,900 Primary Care Dr. Visits $5 $5 Specialist Office Visit $35 $40 Urgent Care $50 $50 $195 per day $210 per day Mental Health, Subst Abuse (Days 1-8) (Days 1-8) Out-patient Surgery $ $ Surgi-Center/Hospital Ambulance $150 $225 Emergency Care $80 $80 $165 per day (Days ) $15 $15-$25 X-Rays $30 $35 High Tech Imaging $225 $275 Diabetic Supplies 20% 20% Durable Medical Equipment 20% 20% PT/OT/Cardiac Rehab $40/40/15 $40/40/10 Prescription Drugs Yes Yes Preferred Pharmacies: (2) exams, cleanings & xrays Routine exam & fitting $300/ 3years allowance for hearing aids annual eye exam & eyewear every 2 yrs Esterbrook, Giant, Rite Aid, Sams, Walgreens, WalMart, W Reading $20 per exam $30 per xray not covered $35 $40 $20 per exam $40 frame allowance up to $58 Lens allowance every 2 yrs $20 per exam $40 frame allowance up to $58 Lens allowance every 2 yrs Fitness $90 every 3 months not covered Transportation $30 allowance per trip 12 round trips/yr not covered Optional Dental $28/month $33.30/month Dental No (2) cleanings, exams & (2) cleanings, exams & deductible; no Max for Diagnostic or Preventive x-rays per year. $20 per exam; $10-30 per x-ray x-rays per year. $20 per exam; $10-30 per x-ray Dental $1000 Maximum for Other Services 20-50% coinsurance for other treatment 20-50% coinsurance for other treatment