2016 Small Group Medical Network Plan Benefits Carrier
Network Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Full Full Full Full Full Full Limited Full Full Full Full Full Full Full Full Full Full Full Full
Product HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO PPO
Metal Tier Gold Gold Gold Gold Gold Platinum Platinum Platinum Platinum Platinum Platinum Platinum Silver Silver Silver Platinum Gold Silver Platinum Gold Silver Bronze Platinum Platinum Gold Gold Gold Silver Silver Bronze Bronze Silver Bronze Bronze
Plan Name 80 HMO 0/35 Mirror Local Access+HMO 1700/30 OffEx Local Access+HMO 750/30 OffEx Trio ACO HMO 1700/30 OffEx Trio ACO HMO 750/30 OffEx 90 HMO 0/20 Mirror Local Access+HMO 0/20 OffEx Local Access+HMO 0/25 OffEx Local Access+HMO 0/30 OffEx Trio ACO HMO 0/25 OffEx Trio ACO HMO 0/20 OffEx Trio ACO HMO 0/30 OffEx 70 HMO 1500/45 Mirror Local Access+HMO 1700/55 Off Ex Trio ACO HMO 1700/55 OffEx Access+ HMO 0/25 Access+ HMO 1700/30 Access+ HMO 1700/55 90 HMO 0/20 Mirror 80 HMO 0/35 Mirror 70 HMO 1500/45 Mirror 60 PPO 6000/70 Network Mirror Full PPO 0/10 Full PPO 150/15 Full PPO 0/20 Full PPO 750/20 Full PPO 1000/35 Full PPO 1250/40 Full PPO 1700/40 Full PPO 3500/60 Full PPO 4500/45 Full PPO HSA 2000/20% Full PPO HSA 4500/30% Full PPO HSA 5500/40%
Plan Ded. $0 $1,700 $750 $1,700 $750 $0 $0 $0 $0 $0 $0 $0 $1,500 $1,700 $1,700 $0 $1,700 $1,700 $0 $0 $1,500 $6,000 $0 $150 $0 $750 $1,000 $1,250 $1,700 $3,500 $4,500 $2,600 $4,500 $5,500
OOP Max. $6,200 $5,000 $5,000 $5,000 $5,000 $4,000 $1,500 $2,500 $3,000 $2,500 $1,500 $3,000 $6,500 $6,500 $6,500 $2,500 $5,000 $6,500 $4,000 $6,200 $6,500 $6,500 $2,500 $3,000 $6,500 $6,500 $6,500 $6,500 $6,500 $6,500 $6,500 $4,400 $6,500 $6,500
Office Visit $35/$55 $30/$50 $30/$60 $30/$50 $30/$60 $20/$40 $20/$40 $25/$50 $30/$40 $25/$50 $20/$40 $30/$40 $45/$70 $55/$55 $55/$55 $25 / $50 $30 / $50 $55 / $55 $20 / $40 $35 / $55 $45 / $70 $70/$90⁺ $10 / $25 $15 / $30 $20 / $45 $20 / $35 $35 / $50 $40 / $50 $40 / $50 $60 / $70 $45 / $45 20% / 20% 30% / 30% 40% / 40%
⁺ 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 $600/day (max 5) 20% 20% 20% 20% $250/day (max 5) $500/admit $250/day (max 3) $500/day (max 4) $250/day (max 3) $500/admit $500/day (max 4) 20% 40% 40% $250/day (max 3) 20% 40% $150/day (max 5) $300/day (max 5) 20% 0% 10% 10% 30% 20% 20% 40% 30% 15% 30% 20% 30% 40%
Rx $15/$50/$70 $15/$30/$50 $15/$30/$50 $15/$30/$50 $15/$30/$50 $5/$15/$25 $5/$15/$25 $5/$15/$25 $5/$15/$25 $5/$15/$25 $5/$15/$25 $5/$15/$25 $15/$55/$75 $15/$55/$75 $15/$55/$75 $5/$15/$25 $15/$30/$50 $15/$55/$75 $5/$15/$25 $15/$50/$70 $15/$55/$75 0%/0%/0% $5/$30/$50 $5/$30/$50 $15/$40/$60 $10/$30/$50 $5/$30/$50 $15/$50/$75 $15/$50/$75 $15/$50/$75 $15/$50/$75 $15/$50/$75 $15/$50/$75 $15/$50/$75
Rx Ded. $0 *$300 $0 *$300 $0 $0 $0 $0 $0 $0 $0 $0 *$250 *$300 *$300 $0 $300 *$300 $0 $0 *$250 Plan ded $0 $0 $0 $200 $500 $250 $300 $225 $225 Plan ded Plan ded Plan ded
