Question: How much would an insured pay in premiums for Plan DEF in one year? $ How much would an insured pay in premiums for Plan

 

 How much would an insured pay in premiums for Plan DEF in one year? $

 How much would an insured pay in premiums for Plan JKL in one year for family coverage? $

 

Which plan has thehighest PCP copaymentfor office visits?

 

Which plan has thelowest non zero PCP copaymentfor office visits? 

                                                                                                                                                                                                        

Note: The Plan Year for all Plans is Jan 1 - Dec 31.

PLANS



ABC

DEF

GHI

JKL

MNO

PQR



Plan Type

PPO

HMO

POS

PPO

HMO

PPO



Category

Group

Individual

Group

Group

Group

Individual



% Premium Paid by Employer

100

N/A

80

50

90

N/A



Annual Single Premium

$ 3,341.10

N/A

$ 5,200.20

$ 5,608.52

$ 4,782.95

$ 6,680.35



Annual Family Premium

N/A

$ 7,151.05

$ 10,451.48

$ 12,000.00

N/A

$ 14,024.00



Stop Gap?

YES

NO

YES

NO

NO

YES



Annual Deductible

$ 1,300.00

$ -

$ 1,400.00

$ 1,500.00

$ 400.00

$ 2,500.00



Deductible Counts Toward Stop Gap?

NO

N/A

YES

N/A

N/A

YES



Copayments Count Toward Stop Gap?

YES

N/A

YES*

N/A

N/A

YES*



Copayment (PCP/Specialist/ED)

$55/$80/$375

$0/$0/$400

$35/$60/$500

$50/$75/$450

$0/$0/$425

$40/$65/$500



Coinsurance - Hospital

25%

15%

40%

35%

5%

33%



Coinsurance - Laboratory

33%

0%

35%

45%

20%

55%



Maximum Out-of-Pocket

$ 4,000.00

N/A

$ 4,500.00

N/A

N/A

$ 3,750.00



Out of Network Coverage?

YES

NO

YES

NO

NO

YES



Prescription Drug Benefit

YES

YES

YES

YES

YES

YES



Prescription Drug Co-Payments









Tier 1

$ 20.00

$ 10.00

$ 25.00

$ 15.00

$ 10.00

$ 20.00



Tier 2

$ 45.50

$ 20.00

$ 35.50

$ 30.00

$ 16.00

$ 28.50



Tier 3

$ 75.00

$ 50.00

$ 85.00

$ 75.00

$ 40.00

$ 100.00



Tier 4

$ 125.00

$ 75.00

$ 140.00

$ 130.00

$ 55.00

$ 150.00



* Excluding ED Copayments









 


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