Medical Plans Comparison Chart
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The Employee Assistance Program (EAP) covers five (5) visits of screening, short term counseling or referral services available per eligible employee or family member per plan year without charge, regardless of insurance plan enrollment. All requests for prior authorization for all mental health and/or substance abuse services and inquiries for EAP must be directed to ComPsych at 1-877-427-2327.
Annual Deductible
| Plan | Coverage |
|---|---|
| Traditional | $450 per person, $1250 per family maximum |
| PPO Plan In-Network | $350 per person maximum, $950 per family aggregate |
| PPO Plan Out-Of-Network | $600 per person, $1700 per family aggregate |
| High Deductible Plan | $2000 per person, $6000 per family aggregate |
Out of Pocket Maximum
As applicable, each policy year
| Plan | Coverage |
|---|---|
| Traditional | $4,300 per person, $8,600 per family maximum |
| PPO Plan In-Network | $3,250 per person maximum, $6,750 per family |
| PPO Plan Out-Of-Network | $6,500 per person, $13,500 per family |
| High Deductible Plan | $5,000 per person, $10,000 per family |
Physician Office Visit
| Plan | Coverage |
|---|---|
| Traditional | 80% of allowable charges after deductible |
| PPO Plan In-Network | Primary Care Visit to treat an injury or illness:
Specialist Visit:
|
| PPO Plan Out-Of-Network | 70% of allowable charges after deductible |
| High Deductible Plan | 70% of allowable charges after deductible |
Hospital Services Emergency Ambulance Transportation Outpatient Surgery
| Plan | Coverage |
|---|---|
| Traditional | 80% of allowable charges after deductible |
| PPO Plan In-Network | 85% of allowable charges after deductible |
| PPO Plan Out-Of-Network | 70% of allowable charges after deductible |
| High Deductible Plan | 70% of allowable charges after deductible |
Outpatient Psychotherapy Services
| Plan, | Coverage |
|---|---|
| Traditional | 80% of allowable charges after deductible |
| PPO Plan In-Network, | $20 copayment per visit |
| PPO Plan Out-Of-Network, | 70% of allowable charges after deductible |
| High Deductible Plan, | 70% of allowable charges after deductible |
Psychiatric Outpatient Facility, Inpatient and Other Professional Services
| Plan | Coverage |
|---|---|
| Traditional | 80% of allowable charges after deductible |
| PPO Plan In-Network | 85% of allowable charges after deductible |
| PPO Plan Out-Of-Network | 70% of allowable charges after deductible |
| High Deductible Plan | 70% of allowable charges after deductible |
Outpatient Rehabilitation Therapy Services
| Plan | Coverage | |
|---|---|---|
| Traditional | 80% of allowable charges after deductible. | Occupational and speech therapies are limited to 20 visits annual max. Physical therapy - 40 visits annual max. |
| PPO Plan In-Network | 85% of allowable charges after deductible. | Occupational and speech therapies are limited to 20 visits annual max. Physical therapy - 40 visits annual max. |
| PPO Plan Out-Of-Network | 70% of allowable charges after deductible. | Occupational and speech therapies are limited to 20 visits annual max. Physical therapy - 40 visits annual max. |
| High Deductible Plan | 70% of allowable charges after deductible. | Occupational and speech therapies are limited to 20 visits annual max. Physical therapy - 40 visits annual max. |
Wellness/Preventive Services
Traditional, PPO Plan In-Network, and High Deductible Plans
- All Affordable Care Act (ACC) listed preventative services will be covered 100% when in-network. No annual limits
- Services not specifically listed are subject to deductible and coinsurance.
PPO Out-Of-Network Plan
- 70% of allowable charges after deductible.
Telehealth/MDLive
| Plan | Coverage |
|---|---|
| Traditional | 80% |
| PPO Plan In-Network | $10 co-pay |
| PPO Plan Out-Of-Network | NA |
| High Deductible Plan | 70% |
Prescription Drugs
1st Tier – Generic
$10 co-pay for all plans
2nd Tier – Preferred Brand
$30 co-pay for all plans
3rd Tier – Non-Preferred Brand
$60 co-pay for all plans
4th Tier – Specialty Drugs
| Plan, | Coverage |
|---|---|
| Traditional, | $100 co-pay Out-of-Pocket Maximum on Prescription Drugs: $2-000 per person / $4,000 per family |
| PPO Plan In-Network, | $100 co-pay Out-of-Pocket Maximum on Prescription Drugs: $2,000 per person / $4,000 per family |
| PPO Plan Out-Of-Network, | $100 co-pay |
| High Deductible Plan, | $100 co-pay, Other than preventative, all pharmacy and medical services are subject to the deductible before any benefits are paid. High Deductible pharmacy benefit has a 30% copay after deductible. |