Millsaps College 2018 Medical Plan Summary Network Ind. Deductible Network Fam. Deductible Network Out of Pocket Max Ind Network Out of Pocket Max Fam Network OOP includes Coinsurance Network Outpatient Surgery/Anesth/Facility
Diagnostic Services Allergy Injections / Testing Physician’s Office Copays Physician’s Office Other Svcs Wellness - Other as required by ACA Home Health Hospice
Chiropractic Care RX Drugs Category 1 / Cat 2 / Cat 3 / Cat 4 / DSP Mailorder Maintenance Drugs
PPO Plan
HD Plan
$1,000 combined $3,000 combined
$2,000 combined $6,000 combined
$2,500 net / $5,000 non $7,500 net /$15,000 non Ded/Coins/Copays
$4,000 net / $7,000 non $12,000 net / $21,000 non Ded/Coins/Copays
80% net / 60% non
80% net / 60% non
Ded, coinsurance
Ded, coinsurance
Coins, ded waived in doctor's office. Free standing diagnostic facility remains subject to deductible & coins. Coinsurane, ded waived in office
Ded, coinsurance Ded, coinsurance
$25 PCP / $40 specialist You pay 20%, ded waived 100% Ded, coins, 100 visits 100% ded waived
$25 PCP / $40 specialist Ded, coinsurance 100% Ded, coinsurance 100% after ded
$40 copay, 20%, 26 visits/yr
Ded, coinsurance
$15 / $30 / $60 / $100
$15 / $30 / $60 / $100
2 x retail copays
2 x retail copays
