Sample NYWIFT Health Insurance Plans TEIGIT
(ALL MONTHLY PREMIUM RATES VALID FROM 01/01/09 TO 12/31/09)
OXFORD Liberty Metro In-Network Primary Co-pay: $25 In-Network Specialist Co-pay: $40 Out of Network Deductible: single: $2,000/Family: $6,000 Out of Network Reimbursement: 70% Out of Network Maximum Out-of-Pocket: Single:$5,000 / family: $15,000 **There is no prescription drug coverage** Monthly Premium: $468.46 (Member), $1030.62 (Member/Spouse), $866.66 (Member/Child), $1452.24 (Full Family). OXFORD Freedom Metro In-Network Primary Co-pay: $15 In-Network Specialist Co-pay: $25 Out of Network Deductible: $1000 Out of Network Reimbursement: 70% Out of Network Maximum Out-of-Pocket: single: $4000 / family: $12,000 RX: $10/$25/$50. * There is $50 annual deductible on brand name drugs. Monthly Premium: $686.92 (Member), $1511.23 (Member/Spouse), $1270.81 (Member/Child), $2129.44 (Full Family). OXFORD Freedom Plan In-Network Primary Co-pay: $10 In-Network Specialist Co-pay: $10 Out of Network Deductible: single: $300 / family: $750 Out of Network Reimbursement: 70% Out of Network Maximum Out-of-Pocket: Single: $3,300 / family: $8,250 RX: $10/$25/$50. * There is no deductible on brand name drugs. Monthly Premium: $879.61 (Member), $1759.22 (Member/Spouse), $1671.26 (Member/Child), $2726.80 (Full Family). HSA-HD: $398.41 (Member), $876.50 (Member/Spouse), $737.05 (Member/Child), $1235.05 (Full Family) Exclusive Plan Metro EPO: $542.06 (Member), $1192.54 (Member/Spouse), $1002.82 (Member/Child), $1680.40 (Full Family)
ATLANTIS HEALTH PLAN (2009 - Prices Subject To Change) Health Maintenance Organization (HMO) Open Access – No Referrals Needed
Single: $340.07, Couple: $680.14, Parent/Child: $683.88, Family: $872.28 (In-network coverage only) $20 Doctor co-pay $20 Specialist co-pay $20 Diagnostic/Lab co-pay $50 ER/Out-patient co-pay; $50 Ambulance $500 Hospital/In-patient co-pay or $75 Out-patient co-pay Unlimited lifetime benefits Priority Generic Prescription Drug Coverage: 1. $0 Co-pay per generic prescription (no annual limit) 2. $25 Co-pay per authorized brand prescription ($250 deductible/$2000 limit per year) Point of Service Plan (POS) Open Access – No Referrals needed Single: $410.17; Couple: $820.34; Parent/Child: $824.85; Family: $1052.09 Option of In or Out-of-network coverage and treatment In-network office & specialist co-pay is $20, emergency room $50, $50 ambulance, hospital in-patient $500; no deductible or co-insurance if in-network $2000 (Individual)/ $4000 (couple/parent-child/family) deductibles if out-of-network 70/30 co-insurance split after deductible if out-of-network $5000 / $10,000 maximum out-of-pocket $1 million lifetime benefit out-of-network. Unlimited $ benefit in-network 0/30/50 Prescription Rider (no annual deductible or annual limit): 1. $0 co-pay per generic prescription 2. $30 co-pay per brand prescription 3. $50 co-pay per non-formulary prescription *All deductibles, co-insurance, maximum out-of-pocket based on usual and customary rate for treatment (UCR). NOTE: Any treatment performed at any Atlantis Medical Group office is always $ZERO co-pay and $ZERO deductible for ALL Atlantis Health Plan members, regardless of plan (e.g. general preventive care, basic sick visits, blood work, x-rays, sonograms, minor surgical procedures, OB/GYN, physical therapy). Visit: www.atlantismedicalgroup.com for further information. ATLANTIS REWARDS PROGRAM: $29.95 per month The Atlantis Rewards Program offers opportunities to greatly reduce expenses and improve quality of life in areas such as business, family, health and wellness (e.g. discounts in dental and vision care, clothing, groceries).
ATLANTIS HEALTH PLAN is a Sponsor of HEALTHY NEW YORK: Healthy New York is a program offered by the State of New York designed to assist individuals and small business owners in providing their employees and their employees' families with the health insurance they need and deserve. In addition,
uninsured individuals/families whose employers do not provide health insurance may also purchase comprehensive coverage directly through Atlantis via the Healthy NY program. Also, if your income is below certain maximums or you have lost your employment and employee benefits, you may qualify for health coverage and enjoy reduced health insurance premiums. For more information on Healthy New York, visit: http://www.ins.state.ny.us/website2/hny/english/hny.htm ATLANTIS DENTAL PLAN CapDent & CapDent Plus Dental Plans Fully-Insured Dental Plans by monthly premium. Comprehensive dental benefits offering Managed Care and Point-of Service options for Individuals and Groups that can be added to all Atlantis Health Plan options. CapDent DMO Managed Care Single: $13.25 Couple: $22.00 Family: $28.00 CapDent Plus POS Single: $22.00 Couple: $38.00 Family: $49.50______
WORKING TODAY/FREELANCER’S UNION Working Today's Freelancers Union has formed the Freelancers Insurance Company (FIC), a new, wholly-owned, for-profit subsidiary of the nonprofit membership organization. Freelancers Union, which arranges health insurance coverage for its eligible New York-based members and their dependents, will make plans from FIC available to those same members starting on January 1, 2009. All currently enrolled members of Freelancers Union, as well as members newly approved for health insurance coverage, will be able to select from five FIC plans for their 2009 coverage. FIC will offer five plans in 2009: three PPO plans and two high-deductible plans. All FIC plans will use the BlueCard PPO® provider network, which is the same network used by Empire BlueCross BlueShield. For more information, visit: http://www.freelancersunion.org/insurance/index.html