Get documents about "3 Catskill health benefit fact sheet 2006
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CATSKILL CENTRAL SCHOOL DISTRICT
BENEFIT COMPARISON
TRADITIONAL BLUE PPO TRADITIONAL BLUE POS GHI HMO CDPHP
In-Network Out-of-Network In-Network Out-of-Network
TYPE OF PLAN A Preferred Provider Organization (PPO). Coverage varies A Point-of-Service Plan (POS). Coverage varies based on whether A Health Maintenance Organization A Health Maintenance Organization
based on whether services are provided by an in-network or services are provided by an in-network or out-of-network provider. (HMO) with no coverage for non- (HMO) with no coverage for non-
out-of-network provider. No Primary Care Physician, and no Primary Care Physician and specialist referrals required. Prior approval participating providers, except in participating providers, except in
specialist referrals required. Prior approval required for some required for some benefits. medical emergency or as authorized by medical emergency or as authorized by
benefits. Primary Care Physician, with specialist Primary Care Physician, with specialist
referral required referral required
ANNUAL DEDUCTIBLE None $250 individual, $500 family None $100 individual, $300 family None None
CO-INSURANCE None 20% coinsurance based on None 20% coinsurance based on schedule of None None
schedule of allowances allowances
OUT-OF-POCKET LIMIT None Coinsurance waived after None Coinsurance waived after member has None None
member has spent $2,500 spent $2,500 ind/$5,000 family in a
ind/$5,000 family in a calendar calendar year, excluding payments in
year, excluding payments in excess of the Schedule of Allowances.
excess of the Schedule of
Allowances.
MAXIMUM LIFETIME None No lifetime maximum; $250,000 None No lifetime maximum; $250,000 annual None None
PAYMENTS annual maximum per individual maximum per individual
DEPENDENT Dependents to age 19 - Full-Time Students to age 25 Dependents to age 19 - Full-Time Students to age 25 Dependents to age 19 - Full-Time Dependents to age 19 - Full-Time
COVERAGE Students to age 25 Students to age 25
WAITING PERIOD None None None None
HOSPITAL SERVICES
Inpatient Covered in full Deductible and 80% of fee Covered in full Deductible and 80% of fee schedule Covered in full up to 365 days per Covered in full
schedule hospital admission
Outpatient Covered in full Deductible and 80% of fee Covered in full Deductible and 80% of fee schedule Covered in full $10 copay
schedule
Emergency Room $35 copay (waived if admitted) Covered in full $35 copay $50 copay
MENTAL HEALTH
In-patient Covered in full, up to 30 Deductible and 80% of fee Covered in full, up to 30 days Deductible and 80% of fee schedule, up Covered in full up to 30 days. 20% coinsurance, up to 30 days per
days per calendar year schedule, up to 30 days per per calendar year (aggregate) to 30 days per calendar year (aggregate) calendar year
(aggregate) calendar year (aggregate)
Out-patient Up to 20 annual visits; Deductible and 80% of fee Up to 20 annual visits; Deductible and 80% of fee schedule, 20 Up to 20 annual visits; 1-5 visits $10 Up to 20 annual visits; 1-4 visits $10
1-10 visits: $10 copay; schedule, 20 visits annually 1-10 visits: $10 copay; visits annually (aggregate) copay, 6-20 visits $25 copay copay, 5-20 visits $15 copay
11-20 visits: (aggregate) 11-20 visits: $25
$25 copay copay
SUBSTANCE ABUSE
In-patient Covered in full, up to 30 30 days hospital for medically Covered in full, up to 30 days 30 days hospital for medically necessary Covered in full, up to 30 days per Covered in full
days hospital for medically necessary detoxification, hospital for medically detoxification, reimbursed at 80% of fee calendar year
necessary detoxification. reimbursed at 80% of fee necessary detoxification. schedule after deductible.
schedule after deductible.
Rose and Kiernan, Employee Benefits Management Group
66098e1e-94c7-45fa-8715-957430f13690.xls 8/23/2012 1
CATSKILL CENTRAL SCHOOL DISTRICT
BENEFIT COMPARISON
TRADITIONAL BLUE PPO TRADITIONAL BLUE POS GHI HMO CDPHP
In-Network Out-of-Network In-Network Out-of-Network
Out-patient $10 copay per visit, 60-visit Deductible and 80% of fee $10 copay per visit, 60-visit Deductible and 80% of fee schedule, 60- Covered in full up to 60 visits $10 copay, 60 visits per calendar year
maximum (aggregate) schedule, 60-visit maximum maximum (aggregate) visit maximum (aggregate)
(aggregate)
PHYSICIAN SERVICES
Office Visits $10 copay per visit Deductible and 80% of fee $10 copay per visit Deductible and 80% of fee schedule $10 copay $10 copay
schedule
Hospital Visits Covered in full Deductible and 80% of fee Covered in full Deductible and 80% of fee schedule Covered in full. Covered in full.
schedule
Surgery Covered in full Deductible and 80% of fee $10 copay Deductible and 80% of fee schedule Covered in full. Covered in full.
schedule
Second Surgical $10 copay Deductible and 80% of fee $10 copay Deductible and 80% of fee schedule Covered in full. $10 copay
Opinion schedule
Annual Routine Physical $10 copay Not covered $10 copay Not covered $10 copay Covered in full.
OTHER SERVICES
HOME HEALTH CARE $10 copay per visit, 100-visit Deductible and 80% of fee $10 copay per visit, 100-visit Deductible and 80% of fee schedule, Covered in full, 40 visits per calendar Covered in full, unlimited visits per
maximum (aggregate) schedule, 100-visit maximum maximum (aggregate) 100-visit maximum (aggregate) year. calendar year.
(aggregate)
HOSPICE Covered in full up to 210 Deductible and 80% of fee Covered in full up to 210 Deductible and 80% of fee schedule up Covered in full up to 210 days. Covered in full up to 210 days.
days. schedule up to 210 days. days. to 210 days.
WELL BABY CARE & Covered in full through age Through age 19, deductible and Covered in full through age Through age 19, deductible and 80% of Covered in full Covered in full
IMMUNIZATIONS 19 80% of fee schedule 19 fee schedule
LAB & X-RAY Covered in full Deductible and 80% of fee Covered in full Deductible and 80% of fee schedule Lab covered in full. $10 copay for x-rays $10 copay
schedule
AMBULANCE Covered in full Deductible and 80% of fee Covered in full Covered in full Covered in full $50 copay
schedule
DURABLE MEDICAL Covered in full Deductible and 50% of lesser of Covered in full Deductible and 50% of fee schedule $1,500 annual maximum, 20% 20% coinsurance
EQUIPMENT charges or fee schedule coinsurance
PHYSICAL, SPEECH $10 copay; 60-visit Deductible and 80% of fee $10 copay; 30-visit maximum Deductible and 80% of fee schedule, 30- $10 copay, 30 visits within 60 days. $10 copay, up to 120 day treatment
AND OCCUPATIONAL maximum (aggregate) schedule, 60-visit maximum (aggregate) physical therapy visit maximum (aggregate) physical period for physical and occupational
THERAPY (aggregate) and 30 visits (aggregate) therapy and 30 visits (aggregate) therapy.
occupational and speech occupational and speech therapy
therapy
Rose and Kiernan, Employee Benefits Management Group
66098e1e-94c7-45fa-8715-957430f13690.xls 8/23/2012 2
CATSKILL CENTRAL SCHOOL DISTRICT
BENEFIT COMPARISON
TRADITIONAL BLUE PPO TRADITIONAL BLUE POS GHI HMO CDPHP
In-Network Out-of-Network In-Network Out-of-Network
PRESCRIPTION DRUG Administered by ESI, $5 Covered at retail upto the $5 Generic/$10 Brand Not covered $3 Generic/$6 Preferred Brand/$20 $5 Generic/$25 Brand Formulary/$40
Generic/Brand retail and allowable amount less the Copay, $0 Copay Mail Order Non-Preferred Brand, 2 copays per 90 Brand Non Formulary managed plan, 2
mail order member's copay. day supply mail order, all maintenance copays per 90 day supply mail order
drugs through mail only.
VISION CARE $10 copay; one exam Not covered $10 copay, one exam every Not covered Exam only, $10 copay - annual Not covered
annually for children 14 & two years
under; one exam every two
years regardless of age
WEBSITES
www.bsneny.com www.bsneny.com www.ghi.com www.cdphp.com
PLEASE NOTE:
This summary of benefits contains general information only. It is subject to the conditions, limitations and exclusions contained in the appropriate certificate of insurance.
For more detailed information refer to the corresponding certificate or policy.
Rose and Kiernan, Employee Benefits Management Group
66098e1e-94c7-45fa-8715-957430f13690.xls 8/23/2012 3
