2016 Small Group Medical Network Plan Benefits Carrier
Network Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited
Product HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO
Metal Tier Bronze Gold Gold Platinum Platinum Silver Silver Bronze Gold Gold Platinum Platinum Silver Silver Bronze Silver Bronze Silver Bronze Silver Bronze Gold Gold Platinum Platinum Silver Silver Gold Gold Gold Gold Gold Gold Platinum Platinum Platinum Platinum Platinum Platinum Platinum
Plan Name Mirrored Performance 6000/70/1000% Mirrored Performance 0/35/20% Mirrored Performance 0/35/600 Mirrored Performance 0/20/10% Mirrored Performance 0/20/250 Mirrored Performance 1500/45/20% A Mirrored Performance 1500/45/20% B Mirrored Premier 6000/70/100% Mirrored Premier 0/35/20% Mirrored Premier 0/35/600 Mirrored Premier 0/20/10% Mirrored Premier 0/20/250 Mirrored Premier 1500/45/20% A Mirrored Premier 1500/45/20% B Mirrored Performance HSA 4500/40%/40% Mirrored Performance HSA 2000/20%/20% Mirrored Premier HSA 4500/40%/40% Mirrored Premier HSA 2000/20%/20% Mirrored Value HSA 4500/40%/40% Mirrored Value HSA 2000/20%/20% Mirrored Value 6000/70/100% Mirrored Value 0/35/20% Mirrored Value 0/35/600 Mirrored Value 0/20/10% Mirrored Value 0/20/250 Mirrored Value 1500/45/20% A Mirrored Value 1500/45/20% B Performance 0/30/1000 A Performance 0/30/1000 B Performance 0/40/1000 Performance 1000/30/30% Performance 0/30/30% Performance 0/40/40% Performance 0/10/200 Performance 0/15/250 Performance 0/20/1000 A Performance 0/20/1000 B Performance 0/20/250 Performance 0/20/300 Performance 0/20/500 A
Plan Ded. $6,000 $0 $0 $0 $0 $1,500 $1,500 $6,000 $0 $0 $0 $0 $1,500 $1,500 $4,500 $2,000 $4,500 $2,000 $4,500 $2,000 $6,000 $0 $0 $0 $0 $1,500 $1,500 $0 $0 $0 $1,000 $0 $0 $0 $0 $0 $0 $0 $0 $0
OOP Max. $6,500 $6,200 $6,200 $4,000 $4,000 $6,500 $6,500 $6,500 $6,200 $6,200 $4,000 $4,000 $6,500 $6,500 $6,500 $6,250 $6,500 $6,250 $6,500 $6,250 $6,500 $6,200 $6,200 $4,000 $4,000 $6,500 $6,500 $6,250 $5,000 $5,000 $3,400 $4,500 $4,500 $3,000 $2,900 $2,000 $3,000 $2,500 $3,000 $2,000
Office Visit $70/$90⁺ $35/$55 $35/$55 $20/$40 $20/$40 $45/$70 $45/$70 $60/$70 $35/$35 $35/$55 $20/$40 $20/$40 $45/$70 $45/$70 40%/40% 20%/20% 40%/40% 20%/20% 40%/40% 20%/20% $60/$70 $35/$35 $35/$55 $20/$40 $20/$40 $45/$70 $45/$70 $30/$70 $30/$60 $40/$60 $30/$30 $30/$30 $40/$40 $10/$20 $15/$15 $20/$40 $20/$30 $20/$40 $20/$30 $20/$30
This is an overview for comparison purposes only. Please refer to carrier benefit summaries for full details.
Inpatient 0% after OOP 20% $600/day (max 5) 10% $250/day (max 5) 20% 20% 0% after OOP 20% $600/day (max 5) 10% $250/day (max 5) 20% 20% 40% 20% 40% 20% 40% $0 0% after OOP $0 $600/day (max 5) $0 $250/day (max 5) $0 20% $1,000/admit $1,000/day $1,000/day $0 30% 40% $200/day (max 3) $250/day (max 3) $1,000 $1,000/admit $250/admit $300/day (max 3) $500/day (max 3)
Rx 0%/0%/0% ͌ $15/$50/$70 $15/$50/$70 $5/$15/$25 $5/$15/$25 $15/$55/$75 $15/$55/$75 0%/0%/0% ͌ $15/$50/$70 $15/$50/$70 $5/$15/$25 $5/$15/$25 $15/$55/$75 $15/$55/$75 40%/40%/40% 20%/20%/20% 40%/40%/40% 20%/20%/20% 40%/40%/40% 20%/20%/20% 0%/0%/0% ͌ $15/$50/$70 $15/$50/$70 $5/$15/$25 $5/$15/$25 $15/$55/$75 $15/$55/$75 $19/$35/$70 $19/$35/$70 $19/$35/$70 $19/$35/$70 $15/$50/$70 $19/$35/$70 $15/$35/$50 $15/$35/$50 $15/$35/$50 $15/$35/$50 $10/$25/$50 $19/$35/$70 $19/$35/$70
Rx Ded. $500 $0 $0 $0 $0 *$250 *$250 $500 $0 $0 $0 $0 *$250 *$250 Plan ded Plan ded Plan ded Plan ded Plan ded Plan ded $500 $0 $0 $0 $0 *$250 *$250 $0 $0 *$150 *$150 $0 $0 $0 $0 $0 $0 $0 $0 $0
2016 Small Group Medical Network Plan Benefits Carrier
Network Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited Limited 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
Product HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO
Metal Tier Platinum Silver Gold Gold Gold Gold Gold Gold Platinum Platinum Platinum Platinum Platinum Platinum Silver Platinum Platinum Gold Gold Gold Gold Gold Gold Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Silver Bronze Silver Bronze Gold Gold Platinum Platinum Silver
Plan Name Performance 0/20/500 B Performance 1750/40/40% Premier 0/30/30% Premier 0/40/40% Premier 0/30/1000 A Premier 0/30/1000 B Premier 0/40/1000 Premier 1000/30/30% Premier 0/10/200 Premier 0/15/250 Premier 0/20/250 Premier 0/20/300 Premier 0/20/1000 A Premier 0/20/1000 B Premier 1750/40/40% Premier 0/20/500 A Premier 0/20/500 B Value 0/30/1000 A Value 0/30/1000 B Value 0/30/30% Value 0/40/1000 Value 0/40/40% Value 1000/30/30% Value 0/10/200 Value 0/15/250 Value 0/20/1000 A Value 0/20/1000 B Value 0/20/250 Value 0/20/300 Value 0/20/500 A Value 0/20/500 B Value 1750/40/40% Mirrored Choice HSA 4500/40%/40% Mirrored Choice HSA 2000/20%/20% Mirrored Choice 6000/70/100% Mirrored Choice 0/35/20% Mirrored Choice 0/35/600 Mirrored Choice 0/20/10% Mirrored Choice 0/20/250 Mirrored Choice 1500/45/20% A
Plan Ded. $0 $1,750 $0 $0 $0 $0 $0 $1,000 $0 $0 $0 $0 $0 $0 $1,750 $0 $0 $0 $0 $0 $0 $0 $1,000 $0 $0 $0 $0 $0 $0 $0 $0 $1,750 $4,500 $2,000 $6,000 $0 $0 $0 $0 $1,500
OOP Max. $3,000 $5,750 $4,500 $4,500 $6,250 $5,000 $5,000 $3,400 $3,000 $2,900 $2,500 $3,000 $2,000 $5,000 $5,750 $2,000 $3,000 $6,250 $5,000 $4,500 $5,000 $4,500 $3,400 $3,000 $2,900 $2,000 $3,000 $2,500 $3,000 $2,000 $3,000 $5,750 $6,500 $6,250 $6,500 $6,200 $6,200 $4,000 $4,000 $6,500
Office Visit $20/$30 $40/$40 $30/$30 $40/$40 $30/$70 $30/$60 $40/$60 $30/$30 $10/$20 $15/$15 $20/$40 $20/$30 $20/$40 $30/$60 $40/$40 $20/$30 $20/$30 $30/$70 $30/$60 $30/$30 $40/$60 $40/$40 $30/$30 $10/$20 $15/$15 $20/$40 $20/$30 $20/$40 $20/$30 $20/$30 $20/$30 $40/$40 40%/40% 20%/20% $70/$90⁺ $35/$35 $35/$55 $20/$40 $20/$40 $45/$70
This is an overview for comparison purposes only. Please refer to carrier benefit summaries for full details.
Inpatient $500/admit 40% 30% 40% $1,000/admit $1,000/day $1,000/day $0 $200/day (max 3) $250/day (max 3) $250/admit $300/day (max 3) $1,000 $1,000/day 40% $500/day (max 3) $500/admit $1,000/admit $1,000/day 30% $1,000/day 40% 30% $200/day (max 3) $250/day (max 3) 100000% $1,000/admit $250/day $300/day (max 3) $500/day (max 3) $500/admit 40% $0 20% 0% after OOP 20% $600/day (max 5) 10% $250/day (max 5) 20%
Rx $10/$25/$50 $19/$35/$70 $15/$50/$70 $19/$35/$70 $19/$35/$70 $19/$35/$70 $19/$35/$70 $19/$35/$70 $15/$35/$50 $15/$35/$50 $10/$25/$50 $19/$35/$70 $15/$35/$50 $19/$35/$70 $19/$35/$70 $19/$35/$70 $10/$25/$50 $19/$35/$70 $19/$35/$70 $15/$50/$70 $19/$35/$70 $19/$35/$70 $19/$35/$70 $15/$35/$50 $15/$35/$50 $15/$35/$50 $15/$35/$50 $10/$25/$50 $19/$35/$70 $19/$35/$70 $10/$25/$50 $19/$35/$70 40%/40%/40% 20%/20%/20% 0%/0%/0% ͌ $15/$50/$70 $15/$50/$70 $5/$15/$25 $5/$15/$25 $15/$55/$75
Rx Ded. $0 *$150 $0 $0 $0 *$150 *$150 *$150 $0 $0 $0 $0 $0 *$150 *$150 $0 $0 $0 $0 $0 *$150 $0 *$150 $0 $0 $0 $0 $0 $0 $0 $0 *$500 Plan ded Plan ded $500 $0 $0 $0 $0 *$250
2016 Small Group Medical Network Plan Benefits
Sharp (continued)
Carrier
Network Full Full Full 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 HMO HMO HMO HMO HMO
Metal Tier Silver Gold Gold Gold Gold Gold Gold Platinum Platinum Platinum Platinum Platinum Platinum Platinum Platinum Silver
Plan Name Mirrored Choice 1500/45/20% B Choice 0/30/1000 A Choice 0/30/1000 B Choice 0/30/30% Choice 0/40/1000 Choice 0/40/40% Choice 1000/30/30% Choice 0/10/200 Choice 0/15/250 Choice 0/20/1000 A Choice 0/20/1000 B Choice 0/20/250 Choice 0/20/300 Choice 0/20/500 A Choice 0/20/500 B Choice 1750/40/40%
⁺ Deductible waived for first three (3) office visits ͌ up to $500 max/script
Plan Ded. $1,500 $0 $0 $0 $0 $0 $1,000 $0 $0 $0 $0 $0 $0 $0 $0 $1,750
OOP Max. $6,500 $6,250 $5,000 $4,500 $5,000 $4,500 $3,400 $3,000 $2,900 $2,000 $3,000 $2,500 $3,000 $2,000 $3,000 $5,750
Office Visit $45/$70 $30/$70 $30/$60 $30/$30 $40/$60 $40/$40 $30/$30 $10/$20 $15/$15 $20/$40 $20/$30 $20/$20 $20/$30 $20/$30 $20/$30 $40/$40
* 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 20% $1,000/admit $1,000/day 30% $1,000/day 40% 30% $200/day (max 3) $250/day (max 3) 100000% $1,000/admit $250/admit $300/day (max 3) $500/day (max 3) $500/admit 40%
Rx $15/$55/$75 $19/$35/$70 $19/$35/$70 $15/$50/$70 $19/$35/$70 $19/$35/$70 $19/$35/$70 $15/$35/$50 $15/$35/$50 $15/$35/$50 $15/$35/$50 $10/$25/$50 $19/$35/$70 $19/$35/$70 $10/$25/$50 $19/$35/$70
Rx Ded. *$250 $0 $0 $0 *$150 $0 *$150 $0 $0 $0 $0 $0 $0 $0 $0 *$500
