|
Benefit Descriptions |
United HealthCare |
United HealthCare |
Blue Cross/Blue Shield |
Blue Cross/Blue Shield |
|
Type of Plan |
Preventative Plan |
Catastrophic Plan |
Preventative Plan |
Catastrophic Plan |
|
Dr. Visit Copays-Primary Care/Specialist: |
$10/$10 |
$20/$20 |
$50/$50 |
$50/$50 |
|
Annual Maximum Benefits |
$450/year |
$1,000/year |
N/A |
N/A |
|
Routine/Preventative Care Covered |
YES for specific tests |
YES for specific tests |
YES for specific tests |
YES for specific tests |
|
Hospital Inpatient Services: |
NO COVERAGE |
|
NO COVERAGE |
|
|
Deductible |
N/A |
$500/year |
N/A |
N/A |
|
Maximum Days/Year Covered |
N/A |
10 |
N/A |
N/A |
|
Maximum Benefits/Day: |
|
|
|
N/A |
|
In-Network |
N/A |
$2,000 |
N/A |
N/A |
|
Out-of-Network |
N/A |
$1,000 |
N/A |
N/A |
|
Hospital Outpatient Services: |
|
|
NO COVERAGE |
|
|
Preventative Care |
100% to $600 per year |
100% to $600 per year |
N/A |
80% |
|
Catastrophic Care |
NO COVERAGE |
80% to $400 per year |
N/A |
80% |
|
Durable Medical Equipment |
80% to $500/yr (in-network) |
80% to $500/yr (in-network) |
80% for surgical need only |
80% for surgical need only |
|
Diagnostic Services |
NO COVERAGE |
80% to $500/year |
Mammo/Osteo Tests only |
Mammo/Osteo Tests only |
|
Deductible (#/family): |
|
|
|
|
|
In-Network |
$0 |
$500 per person |
$0 |
$3,000 per person |
|
Out-of-Network |
$0 |
|
$0 |
|
|
Coinsurance % |
|
|
|
|
|
In-Network |
80% |
100% |
80% |
80% |
|
Out-of-Network |
? |
? |
? |
? |
|
Maximum Out-of-Pocket (Ind/Family) |
|
|
|
|
|
In-Network |
UNLIMITED |
UNLIMITED |
UNLIMITED |
UNLIMITED |
|
Out-of-Network |
UNLIMITED |
UNLIMITED |
UNLIMITED |
UNLIMITED |
|
Prescription Drugs: |
|
|
|
|
|
Rx Card (Generic/Brand/NonForm) |
$10 copay - Generics only |
$10 copay - Generics only |
BCBS pays $15/prescription |
BCBS pays $15/prescription |
|
Maximum Annual Rx Benefits |
$500 |
$500 |
N/A |
N/A |
|
Oral Contraceptives Included |
YES |
YES |
YES |
YES |
|
Mail Order Program |
NO |
NO |
NO |
NO |
|
Maternity Coverage |
NO |
NO |
NO |
NO |
|
Mental & Nervous (Behavioral Health): |
|
|
|
|
|
Inpatient |
NO COVERAGE |
$500 copay-Max 5 days |
$500/yr maximum benefit to $10,000 lifetime maximum |
$500/yr maximum benefit to $10,000 lifetime maximum |
|
Outpatient |
5 visits/yr w/$40 copay |
5 visits/yr w/$40 copay |
|
|
|
Alcohol & Substance Abuse |
|
|
|
|
|
Inpatient |
NO COVERAGE |
NO COVERAGE |
NO COVERAGE |
NO COVERAGE |
|
Outpatient |
NO COVERAGE |
NO COVERAGE |
NO COVERAGE |
NO COVERAGE |
|
Lifetime Maximum Benefit |
N/A |
N/A |
N/A |
N/A |
|
Pre-existing Clause |
6 prior/12 insured |
6 prior/12 insured |
6 prior/12 insured |
6 prior/12 insured |
|
Rate Guarantee Period |
12 months |
12 months |
12 months |
12 months |
|
Annual Maximum Benefits |
N/A |
N/A |
N/A |
$25,000 |
|
Lifetime Maximum Benefits/Person |
$500,000 |
$500,000 |
$500,000 |
$50,000 |
|
Premium Rates |
United HealthCare |
United HealthCare |
Blue Cross/Blue Shield |
Blue Cross/Blue Shield |
|
Preventative Plan |
Catastrophic Plan |
Preventative Plan |
Catastrophic Plan |
|
Age 0 - 18: Male |
$55.18 |
$143.52 |
Not Offered |
Not Offered |
|
Age 0 - 18: Female |
$55.18 |
$143.52 |
Not Offered |
Not Offered |
|
Age 19 - 29: Male |
$50.75 |
$132.01 |
$23.70 to $40.51 |
$57.91 to $89.90 |
|
Age 19 - 29: Female |
$83.55 |
$217.31 |
$23.70 to $40.51 |
$67.39 to $106.63 |
|
Age 30 - 39: Male |
$53.42 to $64.76 |
$138.96 to $168.45 |
$41.64 to $48.96 |
$92.41 to $116.26 |
|
Age 30 - 39: Female |
$87.94 to $89.41 |
$228.74 to $232.56 |
$41.64 to $48.96 |
$109.59 to $133.44 |
|
Age 40 - 49: Male |
$70.62 to $79.23 |
$183.69 to $206.07 |
$49.56 to $54.57 |
$119.66 to $162.32 |
|
Age 40 - 49: Female |
$88.48 to $90.47 |
$230.15 to $235.23 |
$49.56 to $54.57 |
$135.96 to $159.95 |
|
Age 50 - 59: Male |
$92.96 to $118.91 |
$241.78 to $309.28 |
$55.19 to $62.85 |
$168.82 to $253.10 |
|
Age 50 - 59: Female |
$97.86 to $119.39 |
$254.53 to $310.54 |
$55.19 to $62.85 |
$163.06 to $198.01 |
|
Age 60 - 64: Male |
$118.91 |
$309.28 |
$64.03 to $69.71 |
$265.69 to $232.30 |
|
Age 60 - 64: Female |
$119.29 |
$310.54 |
$64.03 to $69.71 |
$203.05 to $225.41 |
|
Age 65+: Male |
$118.91 |
$309.28 |
Not Offered |
Not Offered |
|
Age 65+: Female |
$119.39 |
$310.54 |
Not Offered |
Not Offered |