medical mutual (mmo) plans — COSE groups are able

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medical mutual (mmo) plans — COSE groups are able Powered By Docstoc
					                       cose benefit comparison (effective january 1, 2007)




 medical mutual (mmo) plans — COSE groups are able to offer any two standard plans and one HSA compatible plan, simultaneously.
                          250/500 Plan             500/1000 Plan            750/1500 Plan            1000/2000 Plan           SuPermed                 SuPermed                 SuPermed                 SuPermed                 SuPermed                 SuPermed                 SuPermed                SuPermed                 SuPermed                 HealtH SavingS accOunt (HSa)                                                                     HmO HealtH
                          **supermed               **supermed               **supermed               **supermed               PluS                     PluS                     PluS                     PluS                     PluS                     multiPle                 multiPle                multiPle                 PluS                     (plans include First Horizon msaver administration Feature)                                      OHiO****
                          plus                     plus                     plus                     plus                     1000/3000 Hra            2000/6000 Hra            3000/9000 Hra            2080/250 Plan            2080/500 Plan            OPtiOn 100               OPtiOn 90               OPtiOn 80                2000/4000                (plans Have embedded deductibles)
                          *supermed                *supermed                *supermed                *supermed                                                                                                                                             Plan                     Plan                    Plan                     (aGGreGate               supermed                 supermed                 supermed                 supermed
                          classic Gold             classic Gold             classic Gold             classic Gold                                                                                                                                                                                                                    deductible)              plus                     plus                     plus                     plus
                                                                                                                                                                                                                                                                                                                                                              Hsa 2500/100             Hsa 3000/100             Hsa 4000/100             Hsa 5000/100
           annual $250 single                      $500 single              $750 single              $1,000 single            network:                 network:                 network:                 network:                 network:                 network: none            network: none           network:                 $2,000 single            network:                 network:                 network:                 network:              none
        deductible $500 family                     $1,000 family            $1,500 family            $2,000 family            $1,000 single            $2,000 single            $3,000 single            $250 single              $500 single              non-network:             non-network:            $100 single              $4,000 family            $2,500 single            $3,000 single            $4,000 single            $5,000 single
                                                                                                                              $3,000 family            $6,000 family            $9,000 family            $500 family              $1,000 family            $250 single              $250 single             $200 family                                       $5,000 family            $6,000 family            $8,000 family            $10,000 family
                                                                                                                              non-network:             non-network:             non-network:             non-network:             non-network:             $500 family              $500 family             non-network:                                      non-network:             non-network:             non-network:             non-network:
                                                                                                                              $2,000 single            $4,000 single            $6,000 single            $500 single              $1,000 single                                                             $250 single                                       $3,000 single            $3,500 single            $4,500 single            $5,500 single
                                                                                                                              $6,000 family            $12,000 family           $18,000 family           $1,000 family            $2,000 family                                                             $500 family                                       $6,000 family            $7,000 family            $9,000 family            $11,000 family
     coinsurance plus: network: 80% non-network: 64%                                                                          network: 100%                                                              network: 80%                                      network: 100%            network: 90%            network: 80%             network: 100%            network: 100%                                                                                    none
                          classic Gold: network: 90% non-network: 80%                                                         non-network: 80% for most services                                         non-network: 60% for most                         non-network:             non-network:            non-network:             non-network:             non-network: 60%
                                                                                                                                                                                                         services                                          70%                      70%                     60%                      80%
    out-oF-pocket plus:                                                     plus:                                             network: none            network: none            network: none            network:                 network:                 network: none            network:                                         network: none            network: none            network: none            network: none            network: none         none
        maximum network: $1,250 single; $2,500                              network: $1,500 single; $3,000                    non-network:             non-network:             non-network:             $2,000 single            $2,500 single            non-network:             $1,250 single                                    non-network:             non-network:             non-network:             non-network:             non-network:
            (excluding    family                                            family                                            $4,000 single            $8,000 single            $12,000 single           $4,000 family            $5,000 family            $1,500 single            $2,500 family                                    $1,500 single            $4,500 single            $4,000 single            $3,000 single            unlimited
           deductible)    non-network:                                      non-network:                                      $12,000 family           $24,000 family           $36,000 family           non-network:             non-network:             $3,000 family            non-network:                                     $3,000 family            $9,000 family            $8,000 family            $6,000 family
                          $2,500 single; $5,000 family                      $2,500 single; $5,000 family                                                                                                 $4,000 single            $5,000 single                                     $3,000 single
                          classic Gold:                                     classic Gold:                                                                                                                $8,000 family            $10,000 family                                    $6,000 family
                          $1,250 single; $2,500 family                      $1,500 single; $3,000 family
      oFFice visits 100% after $15 copayment                                100% after $20 copayment                          100% after $20 copayment                                                   100% after $20 copayment                          100% after               100% after              100% after               100% after               network: 100% after deductible                                                                   100% after $15
                                                                                                                                                                                                                                                           $15 copayment            $20 copayment           $20 copayment            deductible               non-network: 60% after deductible                                                                copayment
       laboratory plus: 80% after deductible                                                                                  100% after deductible                                                      80% after deductible                              100%                     100%                    100%                     100% after               network: 100% after deductible                                                                   100%
              x-ray, classic Gold: 90% after deductible                                                                                                                                                                                                                                                                              deductible               non-network: 60% after deductible
        diaGnostic
           services
      Well baby & plus: $15 copayment, then 100% for                        plus: $20 copayment, then 100% for                $20 copayment, then 100% for exam, 80% for services not provided in doctor’s office or by an                                 100% after $15           100% after $20          100% after $20           100% after               network: 100% not subject to deductible                                                          100% after $15
       cHild care exam, 80% after deductible for all                        exam, 80% after deductible for all                independent lab                                                                                                              copayment                copayment               copayment                deductible               non-network: 60% after deductible                                                                copayment
                          other services                                    other services
                          classic Gold: 90% after deductible                classic Gold: 90% after deductible
          inpatient plus: 80% after deductible                                                                                100% after deductible                                                      80% after deductible                              100% after $100          90%                     80% after                100% after               network: 100% after deductible                                                                   100% after $100
           Hospital classic Gold: 90% after deductible                                                                                                                                                                                                     copayment per                                    deductible               deductible               non-network: 60% after deductible                                                                deductible per
              care                                                                                                                                                                                                                                         admission                                                                                                                                                                                           admission
          inpatient plus: 80% after deductible                                                                                benefits are the same as for any other condition                           benefits are the same as for any                  100% after $100          90%                     80% after                100% after               network: 100% after deductible                                                                   100% after $100
         maternity classic Gold: 90% after deductible                                                                                                                                                    other condition                                   copayment per                                    deductible               deductible               non-network: 60% after deductible                                                                deductible per
              care                                                                                                                                                                                                                                         admission                                                                                                                                                                                           admission
    emerGency plus: 80% after deductible                                                                                      100% after $100 copayment                                                  80% after $100 copayment                          100% after               100% after              100% after               100% after               100% after deductible                                                                            100% after $75
 room coveraGe classic Gold: 90% after deductible                                                                                                                                                                                                          $75 copayment            $75 copayment           $100 copayment           deductible                                                                                                                copayment
                                                                                                                                                                                                                                                           (copayment               (emergency)             (emergency)                                                                                                                                        (copayment
                                                                                                                                                                                                                                                           waived if                90% after $75           80% after $100                                                                                                                                     waived if
                                                                                                                                                                                                                                                           admitted)                copayment               copayment                                                                                                                                          admitted)
                                                                                                                                                                                                                                                                                    (non-emergency)         (non-emergency)
                                                                                                                                                                                                                                                                                    (copayment              (copayment
                                                                                                                                                                                                                                                                                    waived if               waived if
                                                                                                                                                                                                                                                                                    admitted)               admitted)
         inpatient plus: 80% after deductible                                                                                 100% after deductible                                                      80% after deductible                              100% (maximum            90% (maximum            80% after                100% after               network: 100% after deductible                                                                   100% after $100
           mental classic Gold: 90% after deductible                                                                          (maximum 30 days/benefit period)                                           (maximum 30 days/benefit period)                  30 days/benefit          30 days/benefit         deductible               deductible               non-network: 60% after deductible                                                                deductible per
          HealtH & (maximum 45 days/benefit period)                                                                                                                                                                                                        period)                  period)                 (maximum 30              (maximum 45              (combined maximum 30 days/benefit period)                                                        admission
        substance                                                                                                                                                                                                                                                                                           days/benefit             days/benefit
            abuse                                                                                                                                                                                                                                                                                           period)                  period)
        treatment

        outpatient 50% after deductible (maximum 30 visits/benefit period)                                                    100% after $20 copayment                                                   80% after $20 copayment                           100% after $15           90% after $20           80% after $20            50% after                network: 100% after deductible                                                                   100% after
           mental                                                                                                             (maximum 20 visits/benefit period)                                         (maximum 20 visits/benefit period)                copayment                copayment               copayment                deductible               non-network: 60% after deductible                                                                $15 copayment
          HealtH &                                                                                                                                                                                                                                                                                                                   (maximum 30              (combined maximum 20 days/benefit period)                                                        (maximum 20
        substance                                                                                                                                                                                                                                          (combined                (combined               (combined                days/benefit                                                                                                              visits per benefit
            abuse                                                                                                                                                                                                                                          maximum 20               maximum 20              maximum 20               period)                                                                                                                   period)
        treatment                                                                                                                                                                                                                                          visits per benefit       visits per benefit      visits per benefit
                                                                                                                                                                                                                                                           period)                  period)                 period)
     prescription 80% after deductible (major medical prescription) or                               80% after                $10/$20/$40 retail                                                                                                           $10/$20/$40 retail                                                        100% after               100% after deductible                                                                            $25/$50/$100
           druGs $10/$20/$40 retail $25/$50/$100 mail order prescription                             deductible               $30/$60/$120 mail order                                                                                                      $25/$50/$100 mail order prescription drug copay card***                   deductible                                                                                                                mail order
                 (Oral    drug copay card ***                                                        (major medical                                                                                                                                                                                                                                                                                                                                            prescription drug
       Contraceptives                                                                                prescription                                                                                                                                                                                                                                                                                                                                              copay card ***
        & Mail Order                                                                                 coverage only)
            included)
NOTE: This comparison chart is a general overview of benefits for COSE-sponsored plans. This is not a certificate of coverage.
*You may receive services from any hospital or physician network. **You must receive services from a SuperMed hospital and a SuperMed Plus physician to receive maximum benefits. *** Plans that include a prescription drug copay card also include the SuperScript program. See your plan summary highlight sheets for details on this program. **** This plan utilizes the HMO Health Ohio network and requires the selection of a Primary Care Provider.

				
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