2016 Small Group Medical Network Plan Benefits Carrier
Network Full Full Full Full Full Full Full Full Full Full Full Full Full
Product HMO HMO HMO HMO HMO HMO HMO HMO HMO PPO PPO PPO PPO
Metal Tier Bronze Gold Gold Gold Platinum Platinum Silver Silver Bronze Bronze Gold Platinum Silver
Plan Name 60 HMO 6000/70 80 HMO 0/35 80 HMO 500/30 80 HRA 2000/30 90 HMO 0/15 90 HMO 0/20 70 HMO 1000/50 Silver 70 HMO 1500/45 60 HSA 4500/40% 60 PPO 6000/70 80 PPO 0/35 90 PPO 0/20 70 PPO 1500/45
Plan Ded. $6,000 $0 $500 $2,000 $0 $0 $1,000 $1,500 $4,500 $6,000 $0 $0 $1,500
OOP Max. $6,500 $6,200 $6,250 $6,250 $2,500 $4,000 $6,500 $6,500 $6,500 $6,500 $6,200 $4,000 $6,500
Office Visit $70/$90⁺ $35/$35 $30/$30 $30/$30 $15/$15 $20/$40 $50/$50 $45/$70 40% $70/$90⁺ $35/$55 $20/$40 $45/$75
⁺ 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 0% $655/day (max 5) $600/day (max 5) 20% $250/admit $290/day (max 5) 30% 20% 40% 0% 20% 10% 20%
Rx 0%/0%/0% $15/$50/$50 $15/$50/$50 $15/$30 $5/$15/$15 $5/$15/$15 $25/$50/$50 $15/$55/$55 40%/40%/40% 0%/0%/0% $15/$50/$50 $5/$15 $15/$55/$55
Rx Ded. $500 $0 $0 $0 $0 $0 $0 *$250 Plan ded $500 $0 $0 *$250
