Small Business Plans, Inc.
Licensed Health Insurance Brokers
33 Walt Whitman Road, Suite 235B South Huntington, NY 11746
www.sbpbenefits.com
(800) 282 - 6603
Tier Single EE & Spouse EE&Children Family
Low-Cost Health Savings Account (HSA)Options
Oxford Health Plans
Freedom Plan - No referrals necessary
Out-of-Network : In - Network coverage only
4 tier
$234.36
$515.59
$433.57
$726.52
Rx Card : $15 Generic/ 50% Name Brand after health plan deductible
In-Network : $2,850 individual / $5,700 family deductible. 100% co-insurance after deductible.
Empire Blue Cross
No referrals necessary
HSA 6
Tier
Single
EE & Spouse
EE&Children
Family
4 tier
$248.32
$496.64
$446.98
$744.96
Rx Card: $10 Generic/ $30 Name Brand/ $50 Non-formulary after health plan deductible
In-Network : $3,000 individual / $6,000 family deductible. 80% / 20% of $10,000 co-insurance. 2X family co-insurance cap. Out-of-Network : $10,000 individual / $20,000 family deductible. 50% / 50% of $40,000 co-insurance. 2X family co-insurance cap.
Empire Blue Cross
No referrals necessary
HSA 7
Tier
Single
EE & Spouse
EE&Children
Family
4 tier
$219.31
$438.62
$394.76
$657.93
Rx Card: $10 Generic/ $30 Name Brand/ $50 Non-formulary after health plan deductible
In-Network : $5,000 individual / $10,000 family deductible. 100% co-insurance after deductible. Out-of-Network : $10,000 individual / $20,000 family deductible. 50% / 50% of $40,000 co-insurance. 2X family co-insurance cap.
HealthNet Outlook HSA 12NY
No referrals necessary
Tier
Single
EE & Spouse
EE&Children
Family
4 tier
$279.69
$622.89
$517.46
$832.61
Rx Card: $10 Generic/ $25 Name Brand/ $40 Non-formulary after health plan deductible
In-Network : $2,500 individual / $5,000 family deductible. 80% / 20% of $25,000 co-insurance. 2X family co-insurance cap. Out-of-Network : $3,500 individual / $7,000 family deductible. 60% / 40% of $20,000 co-insurance. 2X family co-insurance cap.
GHI EPO 3 HSA
No Referrals & national network access
Out-of-Network : In - network coverage only
Tier
Single
EE & Spouse
EE&Children
Family
4 tier 2 tier
$149.15 $149.15
$328.12
$283.37
$439.97 $380.32
In-Network: $5,6000 individual / $11,200 family deductible. 100% co-insurance after deductible.
RX - 100% after deductible
Aetna HSA MC OA 30-07
No referrals necessary
Tier
Single
EE & Spouse
EE&Children
Family
4 tier
$294.00
$679.00
$574.00
$888.00
Rx Card: $10 Generic/ $25 Name Brand/ $35 Non-formulary after health plan deductible
$2,250 individual / $4,500 family combined in/out of network deductible. 90% / 10% of $50,000 co-insurance in-network 70%/30% of $16,667 out-of-network co-insurance. $5,000/$10,000 combined in/out co-insurance out-of-pocket max. per year.
GHI EPO 4 HSA
No Referrals & national network access including Deductible & Rx copays
Tier
Single
EE & Spouse
EE&Children
Family
4 tier 2 tier
$177.15 $177.15
$389.73
$336.58
$522.59 $451.73
In-Network: $2,500 individual / $5,000 family deductible. 70% co-insurance after deductible until $4,750/$9,500 (family) out of pocket Rx Card: $0 Generic/ $20 Name Brand/ $40 Non-formulary after health plan deductible
All Plans are rated for Nassau and Suffolk counties (except Oxford which is rated for Suffolk only, call for other counties). Plans are for effective dates in April, May & June 2008. Eligible groups must have between 2-50 eligible employees. Please call Small Business Plans, Inc. for complete plan coverage's, exclusions and enrollment requirements.