WNY Plan Comparisons_3rdQTR_ 2005.doc

							                   $0 Copay for Kids: Benefits listed below with the “X” means that there is no copay for your dependents who are 18 and under!

           Benefits                                          Univera Solutions B                                          Simply Univera


                                     Healthy Choices                          Family First

Office Visit Copay (PCP)                    $20                                  $25 X                                          $30
                                    (well child visits: X)                (well child visits: X)
Office Visit Copay (Specialist)             $40                                   $40                                           $50
OB/GYN Office Visit                         $20                                    $25 X                                       $30 X
Inpatient Hospitalization                   $500                                   $500                                        $500
Emergency Room &                        $100/$100                             $100/$100                                      $100/$100
Ambulance
Outpatient Surgery                          $75                                    $75                                          $75
Outpatient X-Ray                            $20                                    $25 X                                       $30 X

Routine Annual Eye Exam                     $40                                    $40 X                                       $50 X
Durable Medical Equipment &             50% up to                          50% up to                                         50% up to
Prosthetics                            $1,000/ year                      $1,000/ year                                       $1,000/ year
Prescription Rider                      $10/30/50               $10/30/50       ($0 copay for                               $7/$50/$100
                                                                      generics for kids)
Out of Network Option                 $20 copay, 25% coinsurance up to $3,500 single/ $7,000                               Not included
(Univera Access)                                        family max./ year.
Special Features                  $250 annual „„lifestyle benefit” and Member rewards discounts                     Member rewards discounts
Single (non- sole props)                                          $1,035.09                                                   $884.01
Family (non sole- props)                                          $2,879.31                                                  $2,387.43

Sole Proprietor                                   $1,190.37 single/ $,3311.25 family                             $1,016.67 single/ $2,745.72 family


For complete terms, conditions, limitations and exclusions, refer to your subscriber agreement and/or Univera Access contract. This summary describes in general outline
only the main features of coverage provided by Univera Healthcare. If there are any inadvertent discrepancies between this summary and the contract, the contract shall
prevail.

*Pending NYSID approval
Prices do not include Chamber fees and are subject to change as they are pending New York State approval.