2016 Small Group Medical Network Plan Benefits Carrier
Network Limited Limited Limited Limited Limited Limited Limited Limited Full Full Full Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Full Full Full Full Full Full Full Full Full Full Full Full Full
Product HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO
Metal Tier Gold Gold Gold Gold Platinum Platinum Silver Silver Gold Gold Silver Bronze Bronze Bronze Gold Gold Gold Gold Gold Gold Platinum Platinum Silver Silver Bronze Bronze Gold Gold Silver Silver Gold Gold Gold Gold Silver Bronze Bronze Gold Gold Gold Silver Bronze Bronze
Plan Name Priority Select HMO 50/30%/6850 Priority Select HMO 500/20%/5000 Select HMO 50/30%/6850 Select HMO 500/20%/5000 Priority Select HMO 25/20%/5000 Select HMO 25/20%/5000 Priority Select HMO 1750/40%/6850 Select HMO 1750/40%/6850 HMO 500/20%/5000 HMO 50/30%/6850 HMO 1750/40%/6850 Select PPO 5000/30%/6850 Select PPO 6000/100%/6500 Select PPO 6000/35%/6600 Select PPO 1000/20%/4000 Select PPO 20/30%/5500 Select PPO 2000/20%/4000 Select PPO 2000/20%/4000 w/HRA Select PPO 35/20%/6200 Select PPO 500/20%/4500 Select PPO 20/10%/4000 Select PPO 200/10%/3000 Select PPO 1500/20%/6500 Select PPO 2000/35%/6850 Select PPO 4500/30%/6350 w/HSA Select PPO 6000/0%/6000 w/HSA Select PPO 2000/0%/2500 w/HSA RxC Select PPO 2000/0%/3000 w/HSA Select PPO 2000/0%/4600 w/HSA RxC Select PPO 2000/20%/4850 w/HAS PPO 20/30%/5500 PPO 500/20%/4500 PPO 1000/20%/4000 PPO 2000/20%/4000 PPO 2000/35%/6850 PPO 5000/30%/6850 PPO 6000/35%/6600 PPO 2000/20%/4000 w/HRA PPO 2000/0%/2500 w/HSA PPO 2000/0%/3000 w/HSA PPO 2000/20%/4600 w/HSA PPO 4500/30%/6350 w/HSA PPO 6000/0%/6000 w/HSA
Plan Ded. $0 $500 $0 $500 $0 $0 $1,750 $1,750 $500 $0 $2,000 $5,000 $6,000 $6,000 $1,000 $0 $2,000 $2,000 $0 $500 $0 $200 $1,500 $2,000 $4,500 $6,000 $2,000 $2,000 $2,000 $2,000 $0 $500 $1,000 $2,000 $2,000 $5,000 $6,000 $2,000 $2,000 $2,000 $2,000 $4,500 $6,000
OOP Max. $6,850 $5,000 $6,850 $5,000 $5,000 $5,000 $6,850 $6,850 $5,000 $6,850 $6,850 $6,850 $6,500 $6,600 $4,000 $5,500 $4,000 $4,000 $6,200 $4,500 $4,000 $3,000 $6,500 $6,850 $6,350 $6,000 $2,500 $3,000 $4,600 $4,850 $5,500 $4,500 $4,000 $4,000 $6,850 $6,850 $6,600 $4,000 $2,500 $3,000 $4,600 $6,350 $6,000
Office Visit $50/$100 $30/$60 $50/$100 $30/$60 $25/$50 $25/$50 $50/$75 $50/$75 $30 / $60 $50 / $100 $50 / $75 $30/$30⁺ $70/$90⁺ $70/$70⁺ $20/$40 $20/$40 $25/$50 20% $35/$55 $30/$60 $20/$40 $10/$30 $45/$70 $25/$45 30%/30% 0%/0% 0%/0% 0%/0% 20%/20% 20%/20% $20 / $40 $30 / $60 $20 / $40 $25 / $50 $25 / $45 $30/$30 ⁺ $70/$70 ⁺ 20% 0% 0% 20% 30% 0%
⁺ Deductible waived for first three (3) office visits * Rx deductible applies only to tiers 2 & 3
This is an overview for comparison purposes only. Please refer to carrier benefit summaries for full details.
Inpatient $750/day (max 4) 20% $750/day (max 4) 20% $250/day (max 5) $250/day (max 5) 40% 40% 20% $750/day (max 4) 40% $500/admit 0% after OOP 35% 20% 30% 20% 20% 20% 20% 10% 10% 20% 35% 30% 0% 0% 0% 0% 20% 30% 20% 20% 20% 35% $500/admit 35% 20% 0% 0% 20% 30% 0%
Rx $15/$50/$90 $15/$40/$80 $15/$50/$90 $15/$40/$80 $15/$40/$80 $15/$40/$80 $15/$40/$80 $15/$40/$80 $15/$40/$80 $15/$50/$90 $15/$40/$80 $15/$40/$80 0% after OOP $15/$50/$90 $15/$40/$80 $15/$40/$80 $10/$35/$70 20%/20%/20% $15/$50/$70 $15/$40/$80 $5/$15/$25 $10/$35/$70 $15/$55/$75 $15/$40/$80 30%/30%/30% 0%/0%/0% $15/$40/$80 20%/20%/20% 20%/20%/20% 20%/20%/20% $15/$40/$80 $15/$40/$80 $15/$40/$80 $10/$35/$70 $15/$40/$80 $15/$40/$80 $15/$50/$90 20%/20%/20% $15/$40/$80 0%/0%/0% 20%/20%/20% 30%/30%/30% 0%/0%/0%
Rx Ded. *$250 *$250 *$250 *$250 $0 $0 *$250 *$250 *$250 *$250 *$250 *$500 $500 *$250 *$250 *$250 $0 Plan ded $0 *$250 $0 $0 *$250 $0 Plan ded Plan ded Plan ded Plan ded Plan ded Plan ded *$250 *$250 *$250 $0 $0 *$500 *$250 Plan ded Plan ded Plan ded Plan ded Plan ded Plan ded
