|
UHC Choice Plus
<br />Network - IWI HRA
<br />UHC Choice Plus
<br />Network - IW1 HSA
<br />UHC Core Network -
<br />IVZ HRA
<br />UHC Core Network -
<br />IW1 HSA
<br />Annual Deductible single/family $2,500/$5,000 $2,800/$5,600 $2,500/$7,500 $2,800/$5,000
<br />Co-Insurance %100%100%100%100%
<br />Annual Out-of-Pocket Max single/family $5,000/$10,000 $5,950/$11,900 $6,000/$18,000 $3,500/$7,000
<br />Office Visits and Urgent Care
<br />Preventive Care Office Visit Co-Pay $0 $0 $0 $0
<br />Regular Office Visit Co-Pay 100% after deductible 100% after deductible 100% after deductible 100% after deductible
<br />Specialist Visit Co-Pay 100% after deductible 100% after deductible 100% after deductible 100% after deductible
<br />Urgent Care Co-Pay 100% after deductible 100% after deductible 100% after deductible 100% after deductible
<br />Hospital Coverage
<br />Emergency Room Co-Pay 100% after deductible 100% after deductible 100% after deductible 100% after deductible
<br />Prescription Coverage
<br />Retail Generic/Brand/Non-Preferred 100% after deductible 100% after deductible 100% after deductible 100% after deductible
<br />Coverage Level Monthly Premium Monthly Premium Monthly Premium Monthly Premium
<br />Employee Only $821.66 $753.34 $805.22 $738.28
<br />Employee + Spouse $1,726.19 $1,582.67 $1,691.67 $1,551.02
<br />Employee + Children $1,644.05 $1,507.35 $1,611.16 $1,477.20
<br />Employee + Family $2,137.29 $1,959.58 $2,094.54 $1,920.40
<br />Percentage Change from HealthPartners Plans
<br />Medica Passport
<br />Network HRA Gold
<br />Medica Passport
<br />Network HSA Gold
<br />Medica Elect Network
<br />HRA Gold
<br />Medica Elect Network
<br />HSA Gold
<br />Annual Deductible single/family $2,500/$5,000 $2,800/$5,600 $2,500/$5,000 $2,800/$5,600
<br />Co-Insurance %90%100%90%100%
<br />Annual Out-of-Pocket Max single/family $2,500/$5,000 $2,800/$5,600 $2,500/$5,000 $2,800/$5,600
<br />Office Visits and Urgent Care
<br />Preventive Care Office Visit Co-Pay $0 $0 $0 $0
<br />Regular Office Visit Co-Pay 90% after deductible 100% after deductible 90% after deductible 100% after deductible
<br />Specialist Visit Co-Pay 90% after deductible 100% after deductible 90% after deductible 100% after deductible
<br />Urgent Care Co-Pay 90% after deductible 100% after deductible 90% after deductible 100% after deductible
<br />Hospital Coverage
<br />Emergency Room Co-Pay 90% after deductible 100% after deductible 90% after deductible 100% after deductible
<br />Prescription Coverage
<br />Retail Generic/Brand/Non-Preferred 90% after deductible 100% after deductible 90% after deductible 100% after deductible
<br />Coverage Level Monthly Premium Monthly Premium Monthly Premium Monthly Premium
<br />Employee Only $856.87 $785.63 $839.73 $769.92
<br />Employee + Spouse $1,800.17 $1,650.49 $1,764.17 $1,617.49
<br />Employee + Children $1,714.51 $1,571.95 $1,680.21 $1,540.51
<br />Employee + Family $2,228.88 $2,043.57 $2,184.31 $2,002.70
<br />Percentage Change from HealthPartners Plans
<br />PIC 2500 100 HRA -
<br />Complete Network
<br />PIC 3000 100 HSA -
<br />Complete Network
<br />PIC 2500 100 HRA -
<br />Horizon Network
<br />PIC 3000 100 HSA -
<br />Horizon Network
<br />Annual Deductible single/family $2,500/$5,000 $3,000/$6,000 $2,500/$5,000 $3,000/$6,000
<br />Co-Insurance %100%100%100%100%
<br />Annual Out-of-Pocket Max single/family $2,500/$5,000 $3,000/$6,000 $2,500/$5,000 $3,000/$6,000
<br />Office Visits and Urgent Care
<br />Preventive Care Office Visit Co-Pay $0 $0 $0 $0
<br />Regular Office Visit Co-Pay 100% after deductible 100% after deductible 100% after deductible 100% after deductible
<br />Specialist Visit Co-Pay 100% after deductible 100% after deductible 100% after deductible 100% after deductible
<br />Urgent Care Co-Pay 100% after deductible 100% after deductible 100% after deductible 100% after deductible
<br />Hospital Coverage
<br />Emergency Room Co-Pay 100% after deductible 100% after deductible 100% after deductible 100% after deductible
<br />Prescription Coverage
<br />Retail Generic/Brand/Non-Preferred 100% after deductible 100% after deductible 100% after deductible 100% after deductible
<br />Coverage Level Monthly Premium Monthly Premium Monthly Premium Monthly Premium
<br />Employee Only $868.61 $796.39 $851.24 $780.46
<br />Employee + Spouse $1,824.83 $1,673.10 $1,788.33 $1,639.65
<br />Employee + Children $1,737.99 $1,593.48 $1,703.23 $1,561.61
<br />Employee + Family $2,259.42 $2,071.56 $2,214.23 $2,030.13
<br />Percentage Change from HealthPartners Plans 11% Higher
<br />Benefit Details
<br />Alternate Medica Plans
<br />9.5% Higher
<br />CITY OF ORONO MEDICAL PLAN OPTION 3 - MEDICA
<br />CITY OF ORONO MEDICAL PLAN OPTION 4 - PREFERREDONE
<br />Benefit Details
<br />Alternate PreferredOne Plans
<br />Benefit Details
<br />Alternate United Healthcare Plans
<br />5% Higher
<br />CITY OF ORONO MEDICAL PLAN OPTION 2 - UNITED HEALTHCARE
<br />275
<br />275
|