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side-by-side comparison of both plans. - Sweet Briar College

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side-by-side comparison of both plans. - Sweet Briar College Powered By Docstoc
					          Sweet Briar College - Medical Plan Designs 1/1/11
                                                                                                                                                                        Plan 6 -
                                                                                                      Plan 4 - PPO                                               PPO High Deductible
          Deductible                                                                                  $500/$1,000                                         $1,500/$3,000 (aggregate deductible)
          Out-of-Pocket Maximum
          (includes medical copays and                                                    $3,000/$6,000 (deductible is included)                  $3,000/$6,000 (includes deductible and Rx) (aggregate)
          coinsurance)
          Lifetime Maximum                                                                              Unlimited                                                       Unlimited
          Inpatient Hospital (per
                                                                                                  20% after deductible                                            20% after deductible
          admission)
          Skilled Nursing (limited to 100
          day maximum per                                                                         20% after deductible                                            20% after deductible
          confinement)
          Home Health Care                                                                             No Charge                                                  20% after deductible
          Hospice                                                                                      No Charge                                                  20% after deductible
          Outpatient Surgery                                                                      20% after deductible                                            20% after deductible
          Professional Services
          (surgeon, radiologist,
                                                                                                  20% after deductible                                            20% after deductible
          pathologist, anesthesiologist,
          etc.)
          Second Surgical Opinion                                                   $20/$40 not subject to deductible                                             20% after deductible
          Diagnostic Lab/X-Ray (non                             Providers Office: Covered under office visit copay if performed same day
                                                                                                                                                                  20% after deductible
          complex)                                                                    Facility: 20% after deductible
          Complex Diagnostic - MRIs,
                                                                                                  20% after deductible                                            20% after deductible
          MRAs, CAT & PET Scans
          PCP Office Visit                                                                    $20 not subject to deductible                                       20% after deductible
          Specialist Office Visit                                                             $40 not subject to deductible                                       20% after deductible
          Preventive Care                                                                     0% not subject to deductible                                     0% not subject to deductible
          Immunizations/Well Baby                                                             0% not subject to deductible                                     0% not subject to deductible
          Care
          Allergy Testing                                                                   $20/$40 not subject to deductible                                     20% after deductible
                                                          No Charge (If services are billed with an office visit charge, the office visit copay
          Allergy Shots/Serum                                                                                                                                     20% after deductible
                                                                                              will apply)
          Shots and Therapeutic
                                                                                                  20% after deductible                                            20% after deductible
          Injections
                                                           Initial visit to confirm pregnancy: $40 copayment to OB or $20 copayment to
                                                                                                  PCP
                                                          A PCP/Specialist copay will be assessed for each visit to a provider that is not the 20% of the allowable change after the deductible is met for
          Maternity                                                                               OB                                                OB services; IP coverage at 20% after deductible

                                                                 Diagnostic testing and ultrasounds: $40 per visit for diagnostic testing;
          Emergency Room                                                                          20% after deductible                                            20% after deductible
          Urgent Care                                                                       $20/$40 not subject to deductible                                     20% after deductible


D:\Docstoc\Working\pdf\4af40ee6-33fd-4a51-bfd9-0c07d08e12a7.xlsxAnthem - PPO, 12/3/2011
          Sweet Briar College - Medical Plan Designs 1/1/11
                                                                                                                                                                Plan 6 -
                                                                                                   Plan 4 - PPO                                           PPO High Deductible
          Durable Medical Equipment
          (No Max; was $5,000)                                                                 20% after deductible                                       20% after deductible
          (Prosthetics covered with no
          Spinal Manipulation (30 visits
                                                                                          $40 not subject to deductible                                   20% after deductible
          per CY)
          Occupational, Physical and
          Speech Therapy (30 office visit
          limit per CY combined for OT                                                    $40 not subject to deductible                                   20% after deductible
          and PT; separate 30 visit limit
          per CY for speech)

          Mental & Nervous Disorders

             Inpatient (no limit)                                                              20% after deductible                                       20% after deductible
                                                                                          Office Visit: $20 (was $40)
             Outpatient (no limit)                                                                                                                        20% after deductible
                                                                       Outpatient Facility: 100% after deductible (was 20% after ded)
          Substance Abuse
            Inpatient (no limit)                                                               20% after deductible                                       20% after deductible
                                                                                          Office Visit: $20 (was $40)
             Outpatient (no limit)                                                                                                                        20% after deductible
                                                                       Outpatient Facility: 100% after deductible (was 20% after ded)
          Vision Exam (limited to 1
                                                                                          $15 not subject to deductible                               $15 not subject to deductible
          every 12 months)
                                                                                          $150/$300 ded on tiers 2 and 3
                                                                                               Retail: $10/$35/$55
                                                                                            Mail Order: $10/$70/$110
          Prescription Drug                                                                                                                               20% after deductible
                                                                                                  Current (2010)
                                                                                              Retail: $10/$30/$50
                                                                                            Mail Order: $10/$60/$100
          Out of Network
          Deductible (both In and OON)                                      $500/$1,000 (not combined with in-network deductible)                      $1,500/$3,000 (aggregate)
          Coinsurance                                                                               30%                                                          30%
          OOP Maximum                                                           $4,500/$9,000 (not combined with in-network)            $4,000/$8,000 (not combined with in-network) (aggregate)

          Disclaimer: The benefit booklet will govern the final claim payment process for the above benefits.




D:\Docstoc\Working\pdf\4af40ee6-33fd-4a51-bfd9-0c07d08e12a7.xlsxAnthem - PPO, 12/3/2011

				
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