A Plus Benefits Inc. Employee Medical Plan Comparison

A Plus Benefits Inc. Employee Medical Plan Comparison

$1,000
$3,000
After Rx Deductible
Generic
50%
Preferred
50%
Non-Preferred
50%
Specialty
Not Covered
Rx Deductible
Per person
Per family
No benefit
Generic
Preferred
Non-Preferred
Specialty
$5
25%
50%
Not Covered
No benefit
20% after deductible
Generic
Preferred
Non-Preferred
Specialty
$5
25%
50%
Not Covered
No benefit
20% after deductible
20% after deductible, up to
20 visits per year
20% after deductible, up to
30 days per year
Covered 100%
20% after deductible
$100 co-pay, then 20%
$35 co-pay
$1,000
$3,000
$5,500
$11,000
Covered 100%
$30 co-pay
$25 co-pay
Individual
Family
Individual
Family
Network Providers
Select
$4,000
$8,000
$500
$1,500
Generic
Preferred
Non-Preferred
Specialty
$5
25%
50%
Not Covered
No benefit
20% after deductible
20% after deductible, up to
20 visits per year
20% after deductible, up to
30 days per year
Covered 100%
20% after deductible
$100 co-pay
$35 co-pay
Covered 100%
$25 co-pay
$20 co-pay
Individual
Family
Individual
Family
Network Providers
Preferred
$3,500
$7,000
$250
$750
Generic
Preferred
Non-Preferred
Specialty
$12,000
$6,000
$3,000
$1,500
No benefit
Choice: 30% after deductible
allowed amount up to 15 visits
per year
See above, up to
20 visits per year
See above, up to
30 days per year
of the allowed amount.
Essential: 100%
Value: 50%
Select: 50%
Preferred: 50%
Choice: 30%
After out of network deductible
Unlimited
Essential No Benefits
$4,000
Value
$2,000
Select
$1,000
Preferred
$500
Choice
Non-Network Providers
All Plan Options
A PLUS BENEFITS
Covered Services: This medical plan provides benefits for covered medical services only. Please read the Covered Medical Expenses portion of the plan booklet carefully.
Excluded Services: No benefit will be paid for services that are specifically listed as not covered by this plan. Please read the Plan Exclusions section of the plan booklet carefully.
These benefits are illustrated in summary form only. They should not be construed as complete in and of themselves. They are only for comparison and, in the case of discrepancy, the plan documents apply. Please refer to the Master Plan Description
booklet for a complete description of benefits, limitations, and exclusions.
$5
25%
50%
Not Covered
10% after deductible, up to
15 visits per year
10% after deductible
10% after deductible, up to
20 visits per year
10% after deductible, up to
30 days per year
Covered 100%
10% after deductible
$75 co-pay
$25 co-pay
Covered 100%
$20 co-pay
$15 co-pay
Individual
Family
Individual
Family
Network Providers
Choice
Preauthorization may be required for some services. Please see the Preauthorization Requirements in the plan booklet. Preauthorization does not guarantee benefits.
If the total charges for all services associated with an office visit exceed $750, it will be billed as outpatient services.
The doctor network is the EMI Health Care Plus Network in Utah and Cigna PPO outside of Utah. Visit www.emihealth.com to find network doctors.
If generic is available, preferred drugs will
have a 50% co-pay.
Retail Prescription Drugs
Chiropractic Services
30% after deductible
Outpatient Rehab Therapy
Durable Medical Equipment
20% after deductible, up to
20 visits per year
30% after deductible, up to
20 visits per year
Skilled Nursing Facility
Covered 100%
20% after deductible, up to
30 days per year
30% after deductible, up to
30 days per year
Outpatient X-Ray & Lab
Inpatient Mental Health
Chemical Dependency
20% after deductible
$150 co-pay, then 20%
Emergency Room Services
Maternity Care
Outpatient MRI, CAT
Outpatient Surgery
Outpatient Hospital Services
Inpatient Hospital Services
$50 co-pay
30% after deductible
$2,000
$6,000
$6,850
$13,700
Covered 100%
$35 co-pay
$30 co-pay
Individual
Family
Individual
Family
Urgent Care & After Hours
Covered 100%
30% after deductible
Preventative Care
30% after deductible
Office Visits - Specialist
$6,850
$13,700
Individual
Family
Annual Out-of-Pocket Max
Office Visits - Primary Care
$3,500
$10,500
Network Providers
Network Providers
Individual
Family
Value
Essential
A Plus Benefits Inc. Employee Medical Plan Comparison
Annual Deductible
Benefit limits listed are per
person per calendar year.
unlimited
unlimited
$2,500
$5,000
Not Covered
Not Covered
$6,350
$12,700
$3,000
$6,000
Generic
Preferred
Non-Preferred
Specialty
Not Covered
20%
30%
50%
20% after deductible, up to
20 visits per year
20% after deductible, up to
30 days per year
20% after deductible
Covered 100%
20% after deductible
Individual
Family
Individual
Family
Network Providers
Not Covered
50% after deductible on allowed
amount, up to 20 visits per year
50% after deductible on allowed
amount, up to 30 days per year
50% after deductible on
allowed amount
Not covered
50% after deductible on allowed
amount
Individual
Family
$4,000
$8,000
unlimited
unlimited
Non-Network
Providers
Individual
Family
MedSave 2
A PLUS BENEFITS
Covered Services: This medical plan provides benefits for covered medical services only. Please read the Covered Medical Expenses portion of the plan booklet carefully.
Excluded Services: No benefit will be paid for services that are specifically listed as not covered by this plan. Please read the Plan Exclusions section of the plan booklet carefully.
These benefits are illustrated in summary form only. They should not be construed as complete in and of themselves. They are only for comparison and, in the case of discrepancy, the plan documents apply. Please refer to the Master Plan Description
booklet for a complete description of benefits, limitations, and exclusions.
The doctor network is the EMI Health Care Plus Network in Utah and Cigna PPO outside of Utah. Visit www.emihealth.com to find network doctors.
Preauthorization may be required for some services. Please see the Preauthorization Requirements in the plan booklet. Preauthorization does not guarantee benefits.
If a employee is enrolled on MedSave 1 single coverage, the individual deductible must be met before benefits are payable. However, if the employee is enrolled in two party or family coverage, the individual
deductible does not apply. In this case, the full family deductible must be met, either by one participant or collectively by all participants in the family before any benefits are payable.
Listed percentages are after deductible amounts covered after the
deductible has been met.
Generic
Preferred
Non-Preferred
Specialty
50% after deductible on allowed
amount, up to 20 visits per year
20% after deductible, up to
20 visits per year
Outpatient Rehab Therapy
Retail Prescription Drugs
50% after deductible on allowed
amount, up to 30 days per year
50% after deductible on
allowed amount
Not covered
50% after deductible on allowed
amount
Individual
Family
Individual
Family
Non-Network
Providers
20% after deductible, up to
30 days per year
20% after deductible
Covered 100%
20%
30%
50%
$6,850
$6,850
Individual
Family
20% after deductible
$1,500
$3,000
Single
2-Party/Family
Network Providers
MedSave 1
Skilled Nursing Facility
Durable Medical Equipment
Chemical Dependency
Outpatient Mental Health
Inpatient Mental Health
All Other Covered Services
Hospital or Other Facility
Emergency Room
Outpatient Diagnostic Testing
Preventative Care
Office Visits - Specialist
Office Visits - Primary Care
Annual Deductible
(Please note: On the Med Save 1 plan if an employee is
enrolled in two party or family coverage, the individual
deductible does not apply. See details below.)
Annual Out-of-Pocket Maximum
MedSave 1 and 2 are Health Savings Account (HSA) qualifying
High Deductible Health Plans please refer to the Benefits Spending
Account section for more information on Health Savings Accounts.
High-Deductible Medical Plan Comparison