For Federal Civilian Employees

The 2000 Guide to Federal Employees Health Benefits Plans For Federal Civilian Employees Be sure to visit our web site at www.opm.gov/insure United States Office of Personnel Management Retirement and Insurance Service RI 70-1 Revised November 1999 Our Commitment to Our Customers T he U.S. Office of Personnel Management (OPM) administers the Federal Employees Health Benefits (FEHB) Program, the largest employer-sponsored health insurance program in the world. We interpret the health insurance laws and write regulations for the FEHB Program. We give advice and help to agencies and retirement systems so they can process your enrollment changes and deduct your premium. We also contract with and monitor your plan — and all the other health plans — that pay claims or provide care to covered members. This is our commitment to you: l Your choice of health benefits plans will compare favorably for value and selection with the private sector. l When you use the FEHB Guide and plan benefit brochures, you will find they are clear, factual and give you the information you need. l When you change plans or options, your new plan will issue your identification card within 15 calendar days after it gets your enrollment form from your agency or retirement system. needed, it should pay within 60 calendar days. l Your fee-for-service plan should pay your claims within 20 work days; if more information is l If you ask us to review a claim dispute with your plan, our decision will be fair and easy to understand, and we will send it to you within 60 calendar days. If you need to do more before we can review a claim dispute, we will tell you within 14 work days what you still need to do. get your letter. If we need time to give you a complete response, we will let you know. l When you write to us about other matters, we will respond within 30 calendar days after we Better Information Better Choices Better Health Table of Contents Page FEHB and You . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Program Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Patients’ Bill of Rights and Responsibilities . . . . . . . . . . . . . . . . . 6 Your Links to Information 2000 FEHB Web Site -- www.opm.gov/insure . . . . . . . . . . . . . . . . . . . . . . . . 7 Employee Express . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 We’re Y2K OK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Quality Indicators Satisfaction Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Accreditation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 A Word About Medicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Census 2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Plan Comparisions Nationwide Fee-for-Service Plans Open to All . . . . . . . . . . . . . . . . . . . . . . . . 13 Nationwide Fee-for-Service Plans Open Only to Specific Groups . . . . . . . . . . . . . 17 Health Maintenance Organization Plans and Plans Offering a Point of Service Product . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Things to Remember l A number of plans withdrew from the FEHB Program. Make sure your plan will be offered in 2000 l Be aware of benefit changes for 2000 l Check the premium for 2000 The information in the 2000 Guide to Federal Employees Health Benefits (FEHB) Plans gives you an overview of the FEHB Program and its participating plans. Do not make any final decisions about health plans without first reading the plans’ brochures. i FEHB and You T he Federal Employees Health Benefits (FEHB) Program can help you meet your health care needs. Federal employees, retirees and their survivors enjoy the widest selection of health plans in the country. You can choose from among Fee-for-Service (FFS) plans, regardless of where you live (see page 13), or Plans offering a Point of Service (POS) product and Health Maintenance Organizations (HMO), if you live (or sometimes if you work) within the area serviced by the plan (see page 21). You are fortunate to be able to choose from among many different health plans competing for your business. Use this Guide to compare the costs, benefits, and features of different plans. We combined the HMO and POS plans in a single section. We also now show comparative benefit information for all plans. The benefit categories we list were chosen based on enrollee requests, differences among plans, and simplicity. However, we urge you to consider the total benefit package, in addition to service and cost, when choosing a health plan. Some FFS plans are open to all enrollees, but some require that you join the organization that sponsors the plan. Some plans limit enrollment to certain employee groups. Membership requirements and/or limitations also apply to any POS product the FFS plan may be offering. Managed care is an important part of the FEHB Program. You will find managed care features in all the plans described in this Guide. Common features of managed care are pre-approval of hospital stays, the use of primary care providers as “gatekeepers” to coordinate your medical care, and networks of physicians and other providers. The plan brochures tell you what services and supplies are covered and the level of coverage. Look over the brochures carefully, especially the Changes page of your current plan to see how benefits have changed from last year. The brochures reflect the efforts of OPM and health plan representatives to eliminate jargon and use plain language. We also formatted the brochures to ensure they are all organized alike. You can get brochures from the health plans or your human resource office. They are also available on our web site at www.opm.gov/insure. When it comes to your health care, the best surprise is no surprise. 1 FEHB and You Choosing a plan Cost — certainly the premium you pay is an important consideration, but there are some other things you should consider. When thinking about premiums, what can you afford biweekly or monthly? Should you enroll in a High Option – and pay High Option premiums – if a Standard Option would do? If you need to go to the hospital, how much will you have to pay? Do you know how much you will pay for an emergency room visit? If you have children, what will it cost you for a well-child care visit? Do you have to pay a deductible for the services you might use? Your share of medical expenses is either a coinsurance (a percentage of the bill) or a copayment (a fixed dollar amount). Which option do you prefer and what does the plan require? Does the plan limit the dollar amount it will pay for certain services? tor to act as your primary care physician, or PCP, who refers you to specialists. If you don’t use a plan doctor, the plan usually will not pay for the services, unless it is an emergency. A plan offering a Point of Service (POS) product also has rules about what benefits are covered and doctor choice and access to specialists, but you can choose any doctor you like and see specialists without referrals if you agree to pay more. If you are willing to pay a little more in total costs for the widest choice of doctors, a Fee-for-Service (FFS) plan might be for you. FFS plans let you choose your own doctor and allow you to see specialists without a referral. Most FFS plans have Preferred Provider Organizations (PPO) that save you money if you use these providers. Some plans offer 24-hour medical advice lines to help you make health decisions. These programs try to keep you healthy and avoid unnecessary – and potentially costly and time-consuming – medical treatment. Coverage — check to see if the plan offers the type of services you think you might need. If you are 65 or over, how does the plan coordinate coverage with Medicare? If you regularly see an allergist, do you pay extra for the allergy serum? Does the plan offer a prenatal program? Given the trend toward reducing hospital stays, will your plan pay for home health care? Because health care is expensive, pay attention to the plan’s catastrophic coverage to see how you are protected. See if there are limits on the number of visits for the services you need. Satisfaction — the experience of health plan members form the satisfaction ratings in this Guide. If you are considering joining a FFS plan, chances are you will file a claim. How quickly does the plan process claims? Will the plan be responsive to your questions? As an HMO enrollee, you might be most interested in how the plan is rated in access to care and choice of doctors. Ask your doctor’s office about experiences with different health plans. How the plan works — if predictable cost, comprehensive benefits, no paperwork, and a coordinated approach to health care are high priorities, consider a Health Maintenance Organization (HMO). Most HMOs require you to select a doc2 Accreditations — HMO accreditations reflect the evaluations of independent, nationally-recognized organizations. Plans willing to go through an accreditation review show a commitment to continuous quality improvement and accountability. FEHB and You Getting the most from a plan Within any plan, there are things you can do to minimize your out-of-pocket costs and make the plan work best for you. It is also important to note that all of the services provided in a PPO hospital may not be covered by PPO arrangements. Room and board will be covered, but the anesthesia and radiology services may not be. The only way to find out is to ask ahead of time. Cost — here are some ideas for getting the best value for your premium dollar: l An easy way to save money is to use your Quality — talk openly with your health plan and plan’s mail order drug program, if it has one. drugs. l Request generic drugs instead of brand name l Almost all FFS Plans have Preferred Provider Organizations (PPO, see page 13). Using a PPO will reduce your out-of-pocket expenses. If you do not use a PPO provider, your plan will base its payment on an allowance that probably will be less than the actual billed charge. This means you have to pay the difference, which may be more than the coinsurance amounts stated in this Guide and the plan brochure. You can reduce the chance of this happening by discussing fees in advance with your provider. Remember that plans set their own allowances. providers about the kind of quality you want. Is your HMO rated by a national accrediting organization? Ask your surgeon how frequently he or she performs the procedure you’re considering. If you are pregnant, ask your obstetrician the percentage of cases in which he or she performs a caesarean section and how that compares with the local average. Is your doctor proposing an invasive approach to treatment when a more conservative one is just as effective? Does your doctor discuss possible drug interactions when prescribing a new medication for you? No one has a greater stake in your health than you. Understand how your plan works and don’t be shy about asking questions. An informed consumer is a better decision maker. 3 Program Features Some of our important Program features are: No waiting periods. Your human resource A Government contribution. The Govern- office or retirement system sets the effective date of your coverage. You can use your FEHB benefits as soon as your coverage is effective — there are no waiting periods, required medical examinations or restrictions because of age or physical condition. A choice of coverage. You can choose self only coverage just for you, or self and family coverage for you, your spouse, and unmarried dependent children under age 22. Under certain circumstances, your FEHB enrollment may cover your disabled child 22 years old or older who is incapable of self-support. ment contributes toward the total cost of your premium. In 2000, the Government will pay up to $2,049.58 for each self only enrollment and $4,575.22 for each self and family enrollment, but not more than 75% of the total premium for any plan. The Government contribution for part-time employees may be different. See your human resource office to get the exact amount. Salary deduction. You pay your share of the premium through a payroll deduction. Annual enrollment opportunities. Each year you have the opportunity to enroll or change plans. The 1999 Open Season is from November 8 through December 13, during which you may enroll if you are eligible and not now enrolled, change plans or options, or change from self only to self and family. (You may change from self and family to self only at any time.) A choice of plans and options. l Fee-for-Service plans l Plans offering a Point of Service product l Health Maintenance Organizations 4 Program Features Some of our important Program features are: Continued group coverage. The FEHB Program offers continued FEHB coverage: Coverage after FEHB ends. The FEHB l for you and your family when you retire from Federal service (normally you need to be covered in the FEHB Program for the five years before you retire), Program offers either temporary continuation of FEHB coverage (TCC) or conversion to non-group (private) coverage: l for you and your family if you leave Federal service (including when you can’t carry FEHB into retirement), l for your former spouse if you divorce and he or she has a qualifying court order (see your human resource office for more information), l for your covered dependent child if he or she marries or turns age 22, or l for your family if you die while you covered them, or l for your former spouse if you divorce and he l for you and your family when you move, or she does not have a qualifying court order (see your human resource office for more information). transfer, go on leave without pay, or enter military service (certain rules about coverage and premium amounts apply; see your human resource office). If you lose coverage under the FEHB Program, you should automatically receive a Certificate of Group Health Plan Coverage from the last FEHB Plan to cover you. If not, the plan must give you one on request. This certificate may be important to qualify for benefits if you join a non-FEHB plan. 5 Patients’ Bill of Rights and Responsibilities The President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry has recommended a Patients’ Bill of Rights and Responsibilities that are a mainstay of the FEHB Program. The following are consumer protections and quality initiatives you can count on from your FEHB plan. l Coverage of emergency department services for screening and stabilization without authorization if you have reason to believe serious injury or disability would otherwise result. your network of providers if you have complex or serious medical conditions that need frequent specialty care. Authorizations, when required by a plan, will be for an adequate number of direct access visits under an approved treatment plan. contracts that could limit communication about medically necessary treatment. l Direct access to a qualified specialist within l Transitional care. If you have a chronic or dis- abling condition and your health plan terminates your provider’s contract (unless the termination is for cause), you may be able to continue seeing your provider for up to 90 days after the notice of termination. If you are in the second or third trimester of pregnancy, you may continue seeing your OB/GYN until the end of your postpartum care. If you have a chronic or disabling condition or are in your second or third trimester of pregnancy and your health plan drops out of the FEHB Program, you may be able to continue seeing your provider if you enroll in a new FEHB plan. You may continue to see your current specialist after your old enrollment ends, even if he or she is not associated with your new plan, for up to 90 days after you receive the termination notice or through the end of postpartum care, and pay no greater cost than if your old enrollment had not ended. l The elimination of “gag rules” in provider l Extensive information about plan characteris- tics and performance, provider network characteristics, physician and health care facility characteristics, and care management. OPM’s web site at www.opm.gov/insure lists the specific types of information that your health plan must make available to you. You may also contact your health plan directly for this information. The health care system works best when enrollees take the time to become informed. As responsible consumers, you should: l Medical records. You are allowed to review and obtain copies of your medical records on request. You may ask that a physician amend a record that is not accurate, relevant, or complete. If the physician does not amend your record, you may add a brief statement to the record. for routine and preventive health care services. l Read and understand your health benefits coverage, limitations, and exclusions, health plan processes, and procedures to follow when seeking care. carrying out a treatment plan. l Work with your physician in developing and l Practice healthy habits. l Direct access to women’s health care providers 6 Your Links to Information 2000 Web Site -- www.opm.gov/insure Our 2000 FEHB web site gives current and valuable information to help you choose a health plan. Visit us at www.opm.gov/insure. You will find our site even more informative and easier to use than last year. You can link to most of our topics directly from the front home page this year. We still have our Health Plan Profiler (HPP) that lets you view and print summary information about health plans. This year, enrollees in all states can use our interactive decision tool to narrow your health plan search. You can download and print plan brochures and other materials, access definitions by clicking hyperlinks, and use automated links to navigate to other sites where you can find information about the Patients’ Bill of Rights, mental health, health care quality and general health care information. When you visit www.opm.gov/insure you will see these choices and more: l 2000 Plan Information – gives you access to general information about plans, plan quality indicators (including detailed survey results that are not printed in this Guide), plan brochures, and information about how to choose a plan. You can link to other web sites with valuable information about health plans, including those plans participating in the FEHB Program. You can also view, download and print the Guides to Federal Employees Health Benefits Plans. l Annuitant Information — gives you general information about Open Season for Civil Service Retirement System (CSRS) or Federal Employees Retirement System (FERS) annuitants, including how to make Open Season changes through the Internet. You can also link to the Medicare web site. l Patients’ Bill of Rights – gives you l Health Plan Profiler is an easy-to-use web tool that lets you create plan profiles and summaries. You also can link to FEHB plan web sites from the Health Plan Profiler. Since most plans have web sites, we have deleted the web site column in this Guide. tive survey tool for help in selecting a plan. Based on individual preferences that you enter, PlanSmartChoice will rank specific health plans. information about the Patients’ Bill of Rights and the principle areas of rights and responsibilities. You can also link to the full text of the Patients’ Bill of Rights and related background information. l Frequently Asked Questions — l PlanSmartChoice is a link to an interac- gives you answers to questions about premiums, Employee Express, enrollment, family members, temporary continuation of coverage (TCC), changing plans, retirement and other topics of interest. answer specific questions about our site. We still have our section for your comments and suggestions. Let us know what you think. l Rate Us — is a new feature where you can 7 Your Links to Information Employee Express Employee Express is a user-friendly automated system that allows some Federal employees to make changes to their health insurance, as well as Thrift Savings Plan, financial allotments, deposit of net pay, home address, and state and Federal taxes. Employees can access Employee Express using a touch-tone telephone, a personal computer or computer kiosk. This avoids the need to submit paper forms. Employee Express saves time and is accessible 24 hours a day, 7 days a week. If you are unsure whether you can use Employee Express, contact your human resource or payroll office. You may visit Employee Express at www.employeeexpress.gov or link to it from our web site. We’re Y2K OK The United States Office of Personnel Management is prepared for the year 2000 (Y2K). Our systems are updated, tested, and ready. We have also worked hard with our participating plans to help them get ready. We want you to be ready, too. If you would like more information, we can help! Here are three ways you can get free help: 1. Call the Federal Year 2000 Information Center toll free at 1-888-USA4-Y2K (1-888-872-4925) 2. Call OPM’s toll-free Fax-Back Line at 1-877-750-0177 (Select a topic from the menu and received faxed information immediately) 3. Visit our Y2K HELP site on the Internet at www.opm.gov/Y2K/help Additionally, Government agencies and organizations within the pharmaceutical industry supply system have worked closely together to prepare for Y2K and its potential impact on the supply of medications. Y2K should not affect your ability to receive your normal supply of medications. To receive the medications you need, continue to get a normal refill of your medication when you have a 5 to 7 day supply remaining, and be sure to carry your current insurance card with you, particularly if you will be covered by a different insurance plan in the new year. ¥ Call the FEHB Fraud Hot Line (202) 418-3300 if a provider has billed you for services you did not receive. 8 Quality Indicators Satisfaction Survey OPM and FEHB plans and enrollees participated this year in a broad-based survey effort with other public and private employers by using the Consumer Assessment of Health Plans Survey. This survey is a widely accepted tool for obtaining customer feedback on their experiences with their health plans. Before you join a plan, it may help to know what people who use the plan say about it. The survey results are not provided or influenced by the health plans; they are solely based on the responses of enrolled individuals like yourself. The complete questionnaire (59 questions) is on our web site at www.opm.gov/insure, but for ease of presentation in this Guide we have summarized findings in the following key areas: What the survey asked health plan enrollees: l Courteous and Helpful Office Staff. Did the doctor or some other provider’s staff treat you with courtesy and respect? Was the staff as helpful as you thought they should be? l Getting Needed Care. Did you have problems getting a referral to a specialist? Did you experience delays in obtaining care? Did you have problems getting the care you and your doctor believed necessary? l Customer Service. Were you helped l Getting Care Quickly. When you called during regular office hours, did you get the advice or help you needed? Could you get an appointment for regular or routine health care as soon as you wanted? when you called your plan’s customer service department? Did you have problems with paperwork for your plan? Was it hard to find and understand information in the plan’s written materials? l Claims Processing. Did your plan handle your claims in a reasonable time? Did they handle your claims correctly? l How Well Doctors Communicate. Did the doctors or other health providers listen carefully to you? Did they explain things in a way you could understand? Did they spend enough time with you? l Overall Plan Satisfaction. How would you rate your overall experience with your health plan? A plan may not be rated for one of three reasons: 1) it is new to the FEHB Program, 2) the plan has fewer than 500 Federal subscribers, or 3) the plan failed to administer the survey as we asked. We have identified the plans in this last category with an X. FEHB plans also participated in a separate child’s survey, but this data was not available for publication at the time this Guide went to print. Check our web site for results. The Ratings. A plan’s numbers show how well the plan scored for each question. For overall satisfac- tion the highest value is a 1. The other scores are on a scale of 3 (highest) to 1 (lowest). The numbers atop each category show the national average for the plan type (i.e., fee-for-service compared to fee-for-service and HMO/POS compared to HMO/POS). For more information about individual plan ratings, visit our web site at www.opm.gov/insure. 9 Quality Indicators Accreditation Accreditation is a rigorous and comprehensive evaluation process where independent organizations assess the quality of the key systems and processes that managed care organizations (specifically, an HMO or POS plan) use. Accreditation also includes an assessment of the care and service plans are delivering in important areas of public concern such as immunization rates, mammography rates, and member satisfaction. The National Committee for Quality Assurance (NCQA) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) are independent, private, not-for-profit organizations dedicated to assessing and reporting on the quality of health care organizations. These organizations are completely independent of the health plans and issue their accreditation results without the approval of the health plans they review. We encourage all FEHB plans to get accreditation from a national accrediting organization, who will evaluate their systems and processes and confer accreditation much like educational accrediting institutions confer accreditation to schools. Quality includes 1) the perception of the quality of care received and 2) the quality of medical care provided. The first is measured by annual satisfaction surveys. The second is measured in part by accreditation. As an employer, accreditation to us means accountability to a customer and validation of selected measures of a health plan’s operations. Enrollees can be assured that an independent organization has performed an unbiased assessment of a health plan’s systems and found them to be of a particular quality. We think an accredited plan offers value to your health plan decision making. Note: There are various reasons why a plan is not accredited; check with the plan for an explanation. Both NCQA and JCAHO have multiple levels of accreditation. To find a plan’s specific level of accreditation, visit our web site at www.opm.gov/insure. 10 A Word About Medicare Do you know everything you need to about today’s Medicare? Today’s Medicare offers more. More preventive benefits. More information. More help with your questions. T learn more, call: o (1-800-MEDICARE) (1-800-633-4227) An education program of the Department of Health and Human Services and the Health Care Financing Administration w w w. m e d i c a re . g ov 11 Census 2000 Census 2000 Will Help Our Government Allocate Resources and Make Better Decisions An accurate census is important to your agency —and it’s important to YOU! Census 2000… • Providing vital information for planning schools, hospitals, roads, and more • Alerting rescuers to how many people will need their help in disaster areas • Informing government leaders about who we are and what we need • Apportioning Congress and determining representative voting districts Part-Time Job Opportunities New Office of Personnel Management regulations allow federal workers in participating agencies to moonlight on Census 2000. Federal and military annuitants also can apply for a waiver to work on the census.Visit our website at www.census.gov or call 1-888-325-7733 toll free for information on testing and hiring in your area.The U.S. Census Bureau is an equal opportunity employer. By law, the Census Bureau cannot share your answers with others, including welfare agencies, the Immigration and Naturalization Service, the Internal Revenue Service, courts, police, and the military. All census workers are sworn to secrecy. Individual answers are combined with others to produce statistical summaries. No one can connect your answers with your name and address. 12 Plan Comparisons Nationwide Fee-for Service Plans Open to All (Pages 14 through 16) Fee-for-Service (FFS) with a Preferred Provider Organization (PPO) — A FFS option that allows you to see independent medical providers who reduce their charges to the plan, which means you pay less money out-of-pocket than when you use a non-PPO provider. When you visit a PPO you usually won’t have to file claims or paperwork. However, going to a PPO hospital does not guarantee PPO benefits for all services received within that hospital. For instance, lab work and radiology services from independent practitioners within the hospital may not be covered by the PPO agreement, but room and board would be. Fee-for-Service (FFS) Plan (non-PPO) — A traditional type of insurance in which the health plan will either reimburse you or pay the medical provider directly for each covered medical expense after you receive the service. When you need medical attention, you visit the doctor or hospital of your choice. After receiving medical treatment, you file a claim to your health plan and it pays a benefit, but you usually must first pay a deductible and coinsurance or a copayment. These plans use some managed care features such as a precertification and utilization review to control costs. Managed care is an important force in today’s health care. Generally speaking, managed care is a system of health care delivery that tries to manage the quality of health care, access to health care, and the cost of that care. The following graph compares the extent to which different plan types use managed care. Use of Managed Care Techniques and Concepts Less FFS PPO More POS HMO Important: Some FFS plans also offer a Point of Service product. Check pages 22–59 for details. 13 Nationwide Fee-for-Service Plans Open to All How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. An (*) in any column means an exception to the general rule for that particular plan and we have tried to explain those exceptions here under the applicable column heading. The Deductibles shown are the amount of covered expenses that you pay before your health plan begins to pay. Calendar Year deductibles for families are usually several times the amount shown for individuals and the entire family collectively contributes towards that amount. However, some plans require 3 family members to meet the per person deductible before the family deductible is considered met (*). Some plans apply Prescription Drug purchases to the Calendar Year deductible (CY). Some plans apply a separate deductible to the combined purchase of mail order drugs and drugs from local pharmacies (C), while others apply it to drugs purchased from local pharmacies only (L). Some plans (*) require each family member to meet a per person deductible. The Per Stay Hospital Inpatient deductible is what you pay each time you are admitted to a hospital. Your share of premium Enrollment code Monthly Biweekly Plan name Alliance Health Plan APWU Health Plan◊ Telephone number 202/939-6325 Self only 1R1 Self & family 1R2 Self only 120.44 Self & family 236.17 Self only 55.59 Self & family 109.00 800/222-2798 471 472 86.06 182.43 39.72 84.20 Blue Cross and Blue Shield-High Blue Cross and Blue Shield-Std◊ GEHA Benefit Plan◊ local phone # 101 102 143.63 291.09 66.29 134.35 local phone # 104 105 65.09 144.69 30.04 66.78 800/821-6136 311 312 99.06 200.78 45.72 92.67 Mail Handlers-High 800/410-7778 451 452 98.43 186.61 45.43 86.13 Mail Handlers-Std 800/410-7778 454 455 45.68 99.15 21.08 45.76 NALC 703/729-4677 321 322 101.55 200.76 46.87 92.66 Postmasters-High 703/683-5585 361 362 264.66 558.28 122.15 257.67 Postmasters-Std ◊ Offers a Point of Service product. 703/683-5585 364 365 94.49 192.59 43.61 88.89 14 The Catastrophic Limit is the maximum amount of certain covered charges the plan will require you to pay during the year. Some plans (*) require each family member to meet the limit. What you pay for Doctors inpatient visits and for surgical services is shown. Your share of Outpatient Tests — provided, or ordered, and billed by a physician or physicians’ group — is shown. Your share of Hospital Inpatient Room and Board and Other covered charges (e.g., nursing, supplies, and medications) are shown, usually after any per stay deductible. Services provided and billed by the hospital outpatient department (other than surgery) are shown as Hospital Outpatient Other expenses. Finally, what you pay for Generic and Brand name drugs purchased through Mail Order is shown. Taken together, you can use the highlighted features to compare the richness of plan benefits, but always consult plan brochures before making your final decision. Medical-Surgical — You pay Deductible Per Stay Hospital Calendar Prescription Inpatient Year Drug Coinsurance (%)/Copay ($) Catastrophic Limit Outpatient Tests 10% 30% 10% 30% Hospital Inpatient R&B Other Per Person Mail Order Prescription Drugs Outpatient Other Generic Brand Plan name Alliance Health Plan Benefit type Doctors $150 $250 None $200 None $100 None $250 None None None $250 $150 $300 None $100 None $150 None $250 $2,000* $3,000* $2,000 $3,500 $1,000 $2,700 $2,000 $3,750 $2,500 $3,500 $2,500 $4,000 $4,000 $4,000 $3,000 $3,500 $2,500 $2,500 $3,000 $4,500 10% 30% 10% 30% 5% 20% 10% 25% 10% 25% 10% 30% 10% 30% 15% 30% 10% 15% 10% 30% PPO $100* Non-PPO $300* PPO Non-PPO PPO Non-PPO PPO Non-PPO PPO Non-PPO PPO Non-PPO PPO Non-PPO PPO Non-PPO PPO Non-PPO PPO Non-PPO $250 $250 $150 $150 $200 $200 $300 $300 $150 $150 $200 $200 $275 $275 $200 $275 $200 $350 $200C* $200C* $50L $50L None None None None None None $250C* $250C* $600C* $600C* $25L $25L $50 $100 $50 $100 10% 30% 10% 30% 10% 30% 10% 30% 10% 30% 10% 30% 20% 20% $7 $7 $8 $8 $12 $12 $10 $10 $10 $10 $10 $10 $12 $12 $5 $5 $10 $10 20% 20% $25 $25 $14 $14 $20 $20 $30 $30 $30 $45 $40 $55 $25 $25 $12 $12 $20 $20 APWU Health Plan Blue Cross and Blue Shield-High Blue Cross and Blue Shield-Std GEHA Benefit Plan 5% Nothing Nothing $10 20% 30% 30% $100/d 10% Nothing Nothing $25 25% 30% 30% $150/d 10% Nothing 25% Nothing 10% 25% 10% 25% 10% 30% 10% 30% 15% 30% 10% 20% 10% 30% Mail Handlers-High 10% Nothing Nothing 30% Nothing Nothing 10% Nothing Nothing 30% Nothing Nothing 15% Nothing Nothing 30% 20% 20% 10% Nothing Nothing 20% Nothing 15% 10% Nothing Nothing 30% 30% 30% Mail Handlers-Std NALC Postmasters-High Postmasters-Std 15 Nationwide Fee-for-Service Plans Open to All Satisfaction Indicators — See page 7 for a description of these results. Plan performance based on enrollee rating Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) All others- on a scale of 3 (highest) to 1 (lowest) (average for all FFS plans shown in heading) Courteous and helpful office staff (2.63) Getting care quickly (2.53) How well doctors communicate (2.50) Customer service (2.50) Overall plan satisfaction (.82) Plan name Alliance Health Plan Plan code 1R 0.85 2.88 2.60 2.55 2.73 2.45 APWU Health Plan 47 0.74 2.81 2.50 2.47 2.59 2.37 Blue Cross and Blue Shield-High 10 0.77 2.85 2.40 2.45 2.54 2.43 Blue Cross and Blue Shield-Std 10 0.77 2.85 2.40 2.45 2.54 2.43 GEHA Benefit Plan 31 0.88 2.85 2.54 2.50 2.64 2.64 Mail Handlers-High 45 0.77 2.83 2.46 2.42 2.58 2.47 Mail Handlers-Std 45 0.77 2.83 2.46 2.42 2.58 2.47 NALC 32 0.70 2.77 2.52 2.48 2.64 2.40 Postmasters-High 36 0.84 2.87 2.60 2.57 2.71 2.42 Postmasters-Std 36 0.84 2.87 2.60 2.57 2.71 2.42 16 Claims processing (2.39) Getting needed care (2.85) 2.44 2.26 2.36 2.36 2.54 2.26 2.26 2.26 2.42 2.42 Plan Comparisons Nationwide Fee-for Service Plans Open Only to Specific Groups (Pages 18 through 20) Fee-for-Service (FFS) with a Preferred Provider Organization (PPO) — A FFS option that allows you to see independent medical providers who reduce their charges to the plan, which means you pay less money out-of-pocket than when you use a non-PPO provider. When you visit a PPO you usually won’t have to file claims or paperwork. However, going to a PPO hospital does not guarantee PPO benefits for all services received within that hospital. For instance, lab work and radiology services from independent practitioners within the hospital may not be covered by the PPO agreement, but room and board would be. Fee-for-Service (FFS) Plan (non-PPO) — A traditional type of insurance in which the health plan will either reimburse you or pay the medical provider directly for each covered medical expense after you receive the service. When you need medical attention, you visit the doctor or hospital of your choice. After receiving medical treatment, you file a claim to your health plan and it pays a benefit, but you usually must first pay a deductible and coinsurance or a copayment. These plans use some managed care features such as a precertification and utilization review to control costs. Managed care is an important force in today’s health care. Generally speaking, managed care is a system of health care delivery that tries to manage the quality of health care, access to health care, and the cost of that care. The following graph compares the extent to which different plan types use managed care. Use of Managed Care Techniques and Concepts Less FFS PPO More POS HMO Important: Some FFS plans also offer a Point of Service product. Check pages 22–59 for details. 17 Nationwide Fee-for-Service Plans Open Only to Specific Groups How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. An (*) in any column means an exception to the general rule for that particular plan and we have tried to explain those exceptions here under the applicable column heading. The Deductibles shown are the amount of covered expenses that you pay before your health plan begins to pay. Calendar Year deductibles for families are usually several times the amount shown for individuals and the entire family collectively contributes towards that amount. However, some plans require 3 family members to meet the per person deductible before the family deductible is considered met (*). Some plans apply Prescription Drug purchases to the Calendar Year deductible (CY). Some plans apply a separate deductible to drugs purchased from local pharmacies only (L). The Per Stay Hospital Inpatient deductible is what you pay each time you are admitted to a hospital. Your share of premium Enrollment code Monthly Biweekly Plan name Association Benefit Plan Telephone number 800/634-0069 Self only 421 Self & family 422 Self only † Self & family † Self only † Self & family † Foreign Service 202/833-4910 401 402 70.55 205.64 32.56 94.91 Panama Canal Area 732/222-2229 431 432 53.85 116.79 24.85 53.90 Rural Carrier Benefit Plan 800/638-8432 381 382 86.71 143.71 40.02 66.33 SAMBA 301/984-4101 441 442 99.23 254.69 45.80 117.55 Secret Service 800/424-7474 Y71 Y72 52.68 124.84 24.31 57.62 † See your Personnel Office. 18 The Catastrophic Limit is the maximum amount of certain covered charges the plan will require you to pay during the year. What you pay for Doctors inpatient visits and for surgical services is shown. Your share of Outpatient Tests — provided, or ordered, and billed by a physician or physicians’ group — is shown. Your share of Hospital Inpatient Room and Board and Other covered charges (e.g., nursing, supplies, and medications) are shown, usually after any per stay deductible. Some plans require this for your first admissions only (*). Services provided and billed by the hospital outpatient department (other than surgery) are shown as Hospital Outpatient Other expenses. Finally, what you pay for Generic and Brand name drugs purchased through Mail Order is shown. Taken together, you can use the highlighted features to compare the richness of plan benefits, but always consult plan brochures before making your final decision. Medical-Surgical — You pay Deductible Per Stay Hospital Calendar Prescription Inpatient Year Drug Coinsurance (%)/Copay ($) Catastrophic Limit Outpatient Tests 10% 20% 10% 20% Hospital Inpatient R&B Other Per Person Mail Order Prescription Drugs Outpatient Other Generic Brand Plan name Association Benefit Plan Benefit type PPO Non-PPO PPO Non-PPO No PPO PPO Non-PPO PPO Non-PPO No PPO Doctors None $100 None $175 $125 None $200* $200 $200 $100 $2,000 $3,000 $2,500 $2,500 $1,000 $2,000 $2,500 $1,500 $1,500 $1,000 10% 20% 10% 20% $250 $250 $250 $250 None $250 $250 $300 $300 $200 CY CY None CY $400L CY CY None None None Nothing Nothing 20% 20% Nothing 20% 10% 15% 20% 10% 20% 10% 20% 25% 15% 25% 10% 30% $10 $10 $15 N/A N/A $10 $10 $15 $15 $5 $10 $20 $25 N/A N/A $15 $15 $15 $15 $12 Foreign Service Panama Canal Area Nothing Nothing Nothing 15% 15% 10% 30% 20% 15% 25% 10% 30% 20% Rural Carrier Benefit Plan Nothing Nothing $200* 20% Nothing 30% 10% 30% SAMBA Secret Service Nothing Nothing Nothing 19 Nationwide Fee-for-Service Plans Open Only to Specific Groups Satisfaction Indicators — See page 7 for a description of these results. An (X) means the plan did not conduct the survey as we asked. Plan performance based on enrollee rating Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) All others- on a scale of 3 (highest) to 1 (lowest) (average for all FFS plans shown in heading) Courteous and helpful office staff (2.63) Getting care quickly (2.53) How well doctors communicate (2.50) Customer service (2.50) Overall plan satisfaction (.82) Plan name Association Benefit Plan Plan code 42 0.88 2.92 2.58 2.52 2.66 2.62 Foreign Service 40 0.83 2.88 2.55 2.52 2.67 2.49 Panama Canal Area 43 Rural Carrier Benefit Plan 38 0.88 2.93 2.63 2.54 2.78 2.63 SAMBA 44 0.82 2.73 2.44 2.46 2.56 2.45 Secret Service Y7 X X X X X X 20 Claims processing (2.39) Getting needed care (2.85) 2.50 2.30 2.57 2.35 X Plan Comparisons Health Maintenance Organization Plans and Plans Offering a Point of Service Product (Pages 22 through 59) A change from prior years: We grouped together the HMO and POS plans to make your plan review easier. You can tell the POS plans because they have two rows for “In Network” and “Out of Network.” In Network shows what you pay if you go to the plan’s providers; Out of Network shows what you pay if you decide not to go to the plan’s providers. Health Maintenance Organization (HMO) — A health plan that provides care through a network of physicians and hospitals in particular geographic or service areas. HMOs coordinate the health care service you receive and free you from completing paperwork or being billed for covered services. Your eligibility to enroll in an HMO is determined by where you live or, for some plans, where you work. Some HMOs are affiliated with or have arrangements with HMOs in other service areas for non-emergency care if you travel or are away from home for extended periods. Plans that offer reciprocity discuss it in their benefit brochure under How to Get Benefits. • The HMO provides a comprehensive set of services — as long as you use the doctors and hospitals affiliated with the HMO. HMOs charge a copayment for primary physician and specialist visits and generally no deductible or coinsurance for inhospital care. • Most HMOs ask you to choose a doctor or medical group to be your primary care physician (PCP). Your PCP provides your general medical care. In many HMOs, you must get authorization or a “referral” from your PCP to see other providers. The referral is a recommendation by your physician for you to be evaluated and/or treated by a different physician or medical professional. The referral ensures that you see the right provider for the care most appropriate to your condition. • Care received from a provider not in the plan’s network is not covered unless it’s emergency care or the plan has a reciprocity arrangement. Plans Offering a Point of Service (POS) Product — A product offered by an HMO or FFS plan that has features of both. In an HMO, the POS product lets you use providers who are not part of the HMO network. However, you pay more for using these non-network providers. You usually pay higher deductibles and coinsurances than you pay with a plan provider. You will also need to file a claim for reimbursement, like in an FFS plan. The HMO plan wants you to use its network of providers, but recognizes that sometimes enrollees want to choose their own provider. In an FFS plan, the plan’s regular benefits include deductibles and coinsurance. But in some locations, the plan has set up a POS network of providers similar to what you would find in an HMO, which means you usually must select a primary care physician and obtain a referral to see other providers. The plan encourages you to use these providers, usually by waiving the deductibles and applying a copayment that is smaller than the normal coinsurance. Generally there is no paperwork when you use a network provider. Managed care is an important force in today’s health care. Generally speaking, managed care is a system of health care delivery that tries to manage the quality of health care, access to health care, and the cost of that care. The following graph compares the extent to which different plan types use managed care. Use of Managed Care Techniques and Concepts Less FFS PPO POS 21 HMO More Health Maintenance Organization (HMO) and Point of Service (POS) Plans by State How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Primary Care Doctor Office shows what you pay for each Hospital Room Copay/Coinsurance is your share of hospital room and office visit to your primary care doctor. A (*) means a POS plan board charges. This is separate from any per admission deductible. A (*) pays non-plan doctors based on a fee schedule. means a POS plan pays non-plan hospitals based on a fee schedule. Your share of premium Enrollment code Monthly Biweekly Plan name – location Alabama Health Partners of Alabama - Birmingham/Other areas PrimeHealth of Alabama, Inc. - Central/Southern Alabama Telephone number Self only Self & family Self only Self & family Self only Self & family 800/888-7647 800/236-9421 DF1 AA1 DF2 AA2 59.95 55.18 209.45 160.35 27.67 25.47 96.67 74.01 Arizona Aetna U.S. Healthcare - Phoenix/Tucson areas CIGNA HC of AZ-Phoenix - Phoenix area Health Plan of Nevada - Mohave County United Healthcare of Arizona - Central Arizona United Healthcare of Arizona - Tucson/Southern Arizona Humana Health Plan of AZ - Phoenix/Tucson/Southern Arizona Intergroup of Arizona, Inc. - Maricopa/Pima/Other AZ counties PacifiCare of Arizona - Most of Arizona Premier HealthCare of Arizona - Graham/Greenlee/Maricopa/Pima/Pinal Premier HealthCare of Arizona - Yavapai/Mohave/Coconino/Yuma/Gila 800/537-9384 800/572-9990 702/871-0999 888/780-4333 888/780-4333 888/393-6765 800/289-2818 800/347-8600 800/914-4474 800/914-4474 WQ1 161 NM1 2S1 TD1 DY1 A71 A31 9A1 9B1 WQ2 162 NM2 2S2 TD2 DY2 A72 A32 9A2 9B2 41.17 54.87 40.41 42.01 39.13 40.50 43.28 44.19 34.34 49.74 115.84 134.44 103.44 119.72 109.57 110.16 116.83 123.73 94.61 174.44 19.00 25.32 18.65 19.39 18.06 18.69 19.98 20.40 15.85 22.96 53.46 62.05 47.74 55.25 50.57 50.84 53.92 57.11 43.67 80.51 Arkansas QCA Health Plan - Most of Arkansas 800/235-7111 8Q1 8Q2 54.75 153.38 25.27 70.79 22 Prescription Drugs, Generic, Brand shows what you pay for prescriptions when you use a plan pharmacy. Some plans charge different amounts for refills (*), select drugs and mail orders. In many plans, if you get the brand name instead of a generic substitution, you also pay the difference between the two. Where a copay/coinsurance are both shown, you pay the greater amount. Some POS plans pay a non-plan pharmacy only what they would have paid a plan pharmacy (#); you pay the difference. Primary care doctor office copay Satisfaction Indicators — See page 7 for a description of these results. An (X) means the plan did not conduct the survey as we asked. Accreditation status — N = National Committee for Quality Assurance; J = Joint Commission on Accreditation of Healthcare Organizations Plan performance based on enrollee rating Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) All others- on a scale of 3 (highest) to 1 (lowest) (average for all HMO/POS plans shown in heading) Hospital room copay/coinsurance Prescription drugs, generic Prescription drugs, brand Plan name Alabama Health Partners of Alabama PrimeHealth of Alabama, Inc. $15 $10 Nothing Nothing $5 $10 $15 $10 0.82 0.72 2.67 2.67 2.40 2.37 2.50 2.56 2.59 2.65 2.57 2.37 2.38 2.98 Arizona Aetna U.S. Healthcare CIGNA HC of AZ-Phoenix - In-Network Health Plan of Nevada - Out-of-Network United Healthcare of Arizona United Healthcare of Arizona Humana Health Plan of AZ Intergroup of Arizona, Inc. PacifiCare of Arizona Premier HealthCare of Arizona Premier HealthCare of Arizona $10 $10 $10 20% $10 $10 $10 $10 $10 $10 $10 Nothing Nothing Nothing 20% Nothing Nothing Nothing Nothing Nothing Nothing Nothing $5 $5 $6 $6 $5 $5 $5 $5 $5 $5 $5 $10 $10 $12 $12 $10 $10 $10 $10 $5 $10 $10 0.74 0.76 0.69 0.65 0.67 0.74 0.74 2.59 2.66 2.52 2.45 2.50 2.56 2.56 2.32 2.21 2.32 2.14 2.26 2.44 2.44 2.43 2.40 2.43 2.26 2.34 2.52 2.52 2.49 2.48 2.52 2.37 2.46 2.68 2.68 2.52 2.59 2.33 2.39 2.28 2.38 2.38 2.29 2.47 2.24 2.22 2.38 2.11 2.11 N N N N 0.68 0.72 0.64 2.62 2.62 2.39 2.27 2.27 2.17 2.32 2.24 2.25 2.42 2.44 2.35 2.44 2.46 2.24 2.12 2.30 2.13 N N Arkansas QCA Health Plan - In-Network - Out-of-Network $10 20% Nothing 20% $7 $7 $15 $15 23 Accreditation status NCQA (N) JCAHO (J) How well doctors communicate (2.46) Claims processing (2.22) Courteous and helpful office staff (2.55) Overall plan satisfaction (.74) Getting needed care (2.66) Getting care quickly (2.39) Customer service (2.44) Health Maintenance Organization (HMO) and Point of Service (POS) Plans by State How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Primary Care Doctor Office shows what you pay for each Hospital Room Copay/Coinsurance is your share of hospital room and office visit to your primary care doctor. A (*) means a POS plan board charges. This is separate from any per admission deductible. A (*) pays non-plan doctors based on a fee schedule. means a POS plan pays non-plan hospitals based on a fee schedule. Your share of premium Enrollment code Monthly Biweekly Plan name – location California Aetna U.S. Healthcare - Southern California area Aetna U.S. Healthcare - Northern California area Blue Shield of CA Access+HMO - Most of California Blue Cross CaliforniaCare - Most of California CIGNA HealthCare of California - Northern/Southern California Health Net - Most of California Kaiser Permanente - Northern California Kaiser Permanente - Southern California Maxicare Southern California - Southern California National HMO Health Plan - Northern/Central/Southern California PacifiCare of California - Most of California United Health Plan - LA/Orange/San Bernardino Counties Universal Care - Southern California Western Health Advantage - Northern California Telephone number Self only Self & family Self only Self & family Self only Self & family 800/537-9384 800/537-9384 800/334-5847 800/235-8631 800/832-3211 800/522-0088 800/464-4000 800/464-4000 800/234-6294 800/468-8600 800/624-8822 800/544-0088 800/257-3087 888/563-2250 2X1 BU1 SJ1 M51 9T1 LB1 591 621 CM1 MN1 CY1 C41 6Q1 5Z1 2X2 BU2 SJ2 M52 9T2 LB2 592 622 CM2 MN2 CY2 C42 6Q2 5Z2 43.75 73.49 44.39 48.90 48.97 44.25 46.95 50.43 39.92 33.59 42.16 36.72 39.42 42.40 102.16 165.77 110.14 124.77 107.75 104.75 112.07 116.55 101.42 88.57 104.65 78.25 94.61 101.76 20.19 33.92 20.49 22.57 22.60 20.42 21.67 23.27 18.42 15.50 19.46 16.95 18.19 19.57 47.15 76.51 50.83 57.59 49.73 48.35 51.72 53.79 46.81 40.88 48.30 36.12 43.66 46.96 Colorado Aetna U.S. Healthcare - The Front Range CIGNA HealthCare of CO - Front Range area HMO Colorado/Nevada - Most of Colorado Kaiser Permanente - Denver/Colorado Springs areas PacifiCare of Colorado-High -Denver/Pueblo/Col.Sprgs/FtColins/LaPlata PacifiCare of Colorado-Std - Denver/Pueblo/Col.Sprgs/FtColins/LaPlata Rocky Mountain HMO - Most of Colorado 800/537-9384 800/832-3211 800/533-5643 888/681-7878 800/877-9777 800/877-9777 800/346-4643 6F1 1C1 L21 651 D61 D64 881 6F2 1C2 L22 652 D62 D65 882 42.62 47.64 55.96 43.62 47.41 37.07 54.90 112.55 116.72 178.47 111.36 122.68 96.05 132.32 19.67 21.99 25.83 20.13 21.88 17.11 25.34 51.95 53.87 82.37 51.40 56.62 44.33 61.07 24 Prescription Drugs, Generic, Brand shows what you pay for prescriptions when you use a plan pharmacy. Some plans charge different amounts for refills (*), select drugs and mail orders. In many plans, if you get the brand name instead of a generic substitution, you also pay the difference between the two. Where a copay/coinsurance are both shown, you pay the greater amount. Some POS plans pay a non-plan pharmacy only what they would have paid a plan pharmacy (#); you pay the difference. Primary care doctor office copay Satisfaction Indicators — See page 7 for a description of these results. An (X) means the plan did not conduct the survey as we asked. Accreditation status — N = National Committee for Quality Assurance; J = Joint Commission on Accreditation of Healthcare Organizations Plan performance based on enrollee rating Accreditation status NCQA (N) JCAHO (J) Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) All others- on a scale of 3 (highest) to 1 (lowest) (average for all HMO/POS plans shown in heading) Hospital room copay/coinsurance Prescription drugs, generic Prescription drugs, brand How well doctors communicate (2.46) Plan name California Aetna U.S. Healthcare Aetna U.S. Healthcare Blue Shield of CA Access+HMO Blue Cross CaliforniaCare CIGNA HealthCare of California Health Net Kaiser Permanente Kaiser Permanente Maxicare Southern California National HMO Health Plan PacifiCare of California United Health Plan Universal Care Western Health Advantage $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing $5 $5 $6 $5 $5 $5 $5 $5 $5 $5 $5 $5 $5 $5 $10 $10 $6 $10 $10 $10 $5 $5 $10 $10 $10 $5 $5 $10 0.67 0.65 0.64 0.69 0.65 0.72 0.76 0.87 0.69 2.52 2.53 2.64 2.53 2.48 2.59 2.69 2.74 2.47 2.20 2.35 2.36 2.21 2.19 2.35 2.34 2.32 2.18 2.37 2.37 2.60 2.28 2.28 2.35 2.35 2.40 2.32 2.43 2.45 2.54 2.43 2.33 2.48 2.50 2.58 2.41 2.35 2.26 2.28 2.33 2.30 2.35 2.46 2.50 2.37 Claims processing (2.22) Courteous and helpful office staff (2.55) Overall plan satisfaction (.74) Getting needed care (2.66) Getting care quickly (2.39) Customer service (2.44) 2.10 2.90 1.89 2.43 2.16 2.27 2.00 2.12 2.85 N N N N N N N 0.71 2.51 2.24 2.34 2.44 2.44 2.31 N J,N Colorado Aetna U.S. Healthcare CIGNA HealthCare of CO - In-Network HMO Colorado/Nevada - Out-of-Network Kaiser Permanente PacifiCare of Colorado-High PacifiCare of Colorado-Std Rocky Mountain HMO $10 $10 $10 30% $10 $10 $15 $10 Nothing Nothing Nothing 30% Nothing Nothing Nothing Nothing $5 $10 $5 N/A $5 $5 $10 $10 $10 $20 $15 N/A $5 $10 $20 $15 0.74 0.72 0.72 0.78 2.64 2.58 2.58 2.78 2.34 2.38 2.38 2.57 2.42 2.42 2.42 2.51 2.54 2.52 2.52 2.61 2.45 2.43 2.43 2.50 2.23 2.32 2.32 2.39 N N N N 0.64 2.55 2.39 2.46 2.49 2.27 2.14 0.61 2.58 2.38 2.44 2.58 2.21 1.91 N N 25 Health Maintenance Organization (HMO) and Point of Service (POS) Plans by State How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Primary Care Doctor Office shows what you pay for each Hospital Room Copay/Coinsurance is your share of hospital room and office visit to your primary care doctor. A (*) means a POS plan board charges. This is separate from any per admission deductible. A (*) pays non-plan doctors based on a fee schedule. means a POS plan pays non-plan hospitals based on a fee schedule. Your share of premium Enrollment code Monthly Biweekly Plan name – location Connecticut Aetna U.S. Healthcare - All of Connecticut Blue Cross and Blue Shield-Std - All of Connecticut ConnectiCare - All of Connecticut Harvard Pilgrim Health Care - Northwest Connecticut Health New England - Northern Connecticut Physicians Health Services/CT - All of Connecticut Telephone number Self only Self & family Self only Self & family Self only Self & family 800/537-9384 800/438-5356 800/251-7722 888/333-4742 413/787-4004 877/747-9585 H11 104 TE1 681 DJ1 DP1 H12 105 TE2 682 DJ2 DP2 73.23 65.09 51.80 108.81 61.19 72.37 275.69 144.69 161.37 359.73 131.39 298.28 33.80 127.24 30.04 23.91 66.78 74.48 50.22 166.03 28.24 60.64 33.40 137.67 Delaware Aetna U.S. Healthcare - All of Delaware 800/537-9384 NK1 NK2 150.15 493.22 69.30 227.64 District of Columbia Aetna U.S. Healthcare-High -Washington, DC area Aetna U.S. Healthcare-Std - Washington, DC area CapitalCare - Washington, DC area Free State Health Plan - Washington, DC area George Washington Univ HP - Washington, DC area Kaiser Permanente - Washington, DC area MD-IPA - Washington, DC area Prudential HealthCare HMO - Washington, DC area 800/537-9384 800/537-9384 800/680-9495 800/445-6036 301/941-2000 301/468-6000 800/251-0956 800/856-0764 JN1 JN4 2G1 LD1 E51 E31 JP1 JB1 JN2 JN5 2G2 LD2 E52 E32 JP2 JB2 63.63 40.46 56.03 99.82 52.79 50.92 56.66 72.06 167.55 94.90 167.85 235.78 136.30 125.88 162.82 153.29 29.37 18.67 25.86 77.33 43.80 77.47 46.07 108.82 24.36 23.50 26.15 33.26 62.91 58.10 75.15 70.75 26 Prescription Drugs, Generic, Brand shows what you pay for prescriptions when you use a plan pharmacy. Some plans charge different amounts for refills (*), select drugs and mail orders. In many plans, if you get the brand name instead of a generic substitution, you also pay the difference between the two. Where a copay/coinsurance are both shown, you pay the greater amount. Some POS plans pay a non-plan pharmacy only what they would have paid a plan pharmacy (#); you pay the difference. Primary care doctor office copay Satisfaction Indicators — See page 7 for a description of these results. An (X) means the plan did not conduct the survey as we asked. Accreditation status — N = National Committee for Quality Assurance; J = Joint Commission on Accreditation of Healthcare Organizations Plan performance based on enrollee rating Accreditation status NCQA (N) JCAHO (J) Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) All others- on a scale of 3 (highest) to 1 (lowest) (average for all HMO/POS plans shown in heading) Hospital room copay/coinsurance Prescription drugs, generic Prescription drugs, brand How well doctors communicate (2.46) Plan name Connecticut Aetna U.S. Healthcare Blue Cross and Blue Shield-Std ConnectiCare Harvard Pilgrim Health Care Health New England Physicians Health Services/CT - In-Network - Out-of-Network $10 $10 25% $10 $10 $10 $10 Nothing Nothing 30% Nothing Nothing Nothing Nothing $5 $5 45% $10 $5 $7 $10 $10 $15 45% $10 $15 $15 $20 0.63 0.77 0.83 0.82 0.90 0.76 2.61 2.77 2.78 2.78 2.79 2.73 2.45 2.59 2.54 2.45 2.41 2.42 2.48 2.50 2.56 2.55 2.49 2.50 2.54 2.57 2.65 2.64 2.54 2.53 2.26 2.48 2.50 2.47 2.78 2.25 Claims processing (2.22) Courteous and helpful office staff (2.55) Overall plan satisfaction (.74) Getting needed care (2.66) Getting care quickly (2.39) Customer service (2.44) 1.94 2.34 2.45 2.27 2.57 2.12 N N N N N N Delaware Aetna U.S. Healthcare $10 Nothing $5 $10 District of Columbia Aetna U.S. Healthcare-High Aetna U.S. Healthcare-Std CapitalCare - In-Network Free State Health Plan - Out-of-Network George Washington Univ HP Kaiser Permanente MD-IPA Prudential HealthCare HMO $10 $15 $10 $10 20% $10 $10 $10 $10 Nothing Nothing Nothing Nothing 20% Nothing Nothing Nothing Nothing $5 $10 $5 $10 $10 $5 $7 $5 $5 $10 $15 $10 $20 $20 $15 $7 $10 $15 0.69 0.78 0.74 0.69 2.66 2.63 2.65 2.65 2.29 2.35 2.42 2.38 2.39 2.36 2.46 2.46 2.36 2.55 2.56 2.58 2.22 2.50 2.53 2.23 2.64 2.76 2.33 1.89 N N N N 0.76 0.76 0.75 0.74 2.63 2.63 2.59 2.69 2.33 2.33 2.37 2.38 2.41 2.41 2.45 2.53 2.47 2.47 2.58 2.56 2.42 2.42 2.42 2.43 2.23 2.23 2.32 2.25 N N N N 27 Health Maintenance Organization (HMO) and Point of Service (POS) Plans by State How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Primary Care Doctor Office shows what you pay for each Hospital Room Copay/Coinsurance is your share of hospital room and office visit to your primary care doctor. A (*) means a POS plan board charges. This is separate from any per admission deductible. A (*) pays non-plan doctors based on a fee schedule. means a POS plan pays non-plan hospitals based on a fee schedule. Your share of premium Enrollment code Monthly Biweekly Plan name – location Florida Av-Med Health Plan - Broward/Dade/Palm Beach Counties Av-Med Health Plan - Orlando area Av-Med Health Plan - Tampa Bay area Av-Med Health Plan - Jacksonville area Av-Med Health Plan - Gainesville area Beacon Health Plan - Dade/Broward/Palm Beach Counties Capital Health Plan - Tallahassee area Foundation Health - Northern Florida Foundation Health - Central Florida Foundation Health - Southern Florida HIP Health Plan of FL - Tampa area HIP Health Plan of FL - South Florida Humana Medical Plan - Orlando/Gainesville areas Humana Medical Plan - Pensacola Humana Medical Plan - Southeast/Southcentral/Southwest Florida Humana Medical Plan - Tampa Bay area Humana Medical Plan - Jacksonville area Humana Medical Plan - Daytona area Prudential HealthCare HMO - Jacksonville area Prudential HealthCare HMO - Central Florida area Prudential HealthCare HMO - Broward/Dade/Palm Beach Counties Total Health Choice - Broward/Dade/Palm Beach Counties United HealthCare of Florida - South Florida/Tampa areas Telephone number Self only Self & family Self only Self & family Self only Self & family 800/882-8633 800/882-8633 800/882-8633 800/882-8633 800/882-8633 800/850-0979 850/383-3311 800/441-5501 800/441-5501 800/441-5501 800/447-8255 800/447-8255 888/393-6765 888/393-6765 888/393-6765 888/393-6765 888/393-6765 888/393-6765 800/856-0764 800/856-0764 800/856-0764 305/408-5823 800/543-3145 EM1 GP1 H51 HW1 JF1 4K1 EA1 5C1 5D1 5E1 K71 3N1 7F1 9D1 EE1 JH1 P51 P71 EC1 EH1 HE1 4A1 QK1 EM2 GP2 H52 HW2 JF2 4K2 EA2 5C2 5D2 5E2 K72 3N2 7F2 9D2 EE2 JH2 P52 P72 EC2 EH2 HE2 4A2 QK2 48.24 48.68 52.24 53.49 54.19 39.49 45.99 47.62 47.89 39.59 99.95 55.75 40.53 47.29 43.91 54.90 62.44 69.83 41.86 48.92 49.49 42.54 50.68 149.39 154.27 193.29 207.20 214.78 111.18 122.81 156.54 158.56 108.88 367.23 235.21 113.88 118.21 109.77 167.76 201.85 220.35 115.08 166.49 165.32 105.93 155.91 22.26 22.47 24.11 24.69 25.01 18.22 21.23 21.98 22.10 18.27 68.95 71.20 89.21 95.63 99.13 51.31 56.68 72.25 73.18 50.25 46.13 169.49 25.73 108.56 18.71 21.82 20.26 25.34 28.82 52.56 54.56 50.66 77.43 93.16 32.23 101.70 19.32 22.58 22.84 19.63 23.39 53.11 76.84 76.30 48.89 71.96 28 Prescription Drugs, Generic, Brand shows what you pay for prescriptions when you use a plan pharmacy. Some plans charge different amounts for refills (*), select drugs and mail orders. In many plans, if you get the brand name instead of a generic substitution, you also pay the difference between the two. Where a copay/coinsurance are both shown, you pay the greater amount. Some POS plans pay a non-plan pharmacy only what they would have paid a plan pharmacy (#); you pay the difference. Primary care doctor office copay Satisfaction Indicators — See page 7 for a description of these results. An (X) means the plan did not conduct the survey as we asked. Accreditation status — N = National Committee for Quality Assurance; J = Joint Commission on Accreditation of Healthcare Organizations Plan performance based on enrollee rating Accreditation status NCQA (N) JCAHO (J) Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) All others- on a scale of 3 (highest) to 1 (lowest) (average for all HMO/POS plans shown in heading) Hospital room copay/coinsurance Prescription drugs, generic Prescription drugs, brand How well doctors communicate (2.46) Plan name Florida Av-Med Health Plan Av-Med Health Plan Av-Med Health Plan Av-Med Health Plan Av-Med Health Plan Beacon Health Plan Capital Health Plan Foundation Health Foundation Health Foundation Health HIP Health Plan of FL HIP Health Plan of FL Humana Medical Plan Humana Medical Plan Humana Medical Plan Humana Medical Plan Humana Medical Plan Humana Medical Plan Prudential HealthCare HMO Prudential HealthCare HMO Prudential HealthCare HMO Total Health Choice United HealthCare of Florida $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing $5 $5 $5 $5 $5 $5 $7 $5 $5 $5 $5 $5 $5 $5 $5 $5 $5 $5 $5 $5 $5 $5 $10 $5 $5 $5 $5 $5 $15 $20 $5 $5 $5 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $15 $10 0.78 0.73 0.78 0.80 0.77 2.59 2.54 2.64 2.63 2.66 2.18 2.19 2.37 2.37 2.38 2.39 2.36 2.46 2.59 2.49 2.44 2.43 2.52 2.53 2.58 2.56 2.37 2.48 2.45 2.47 Claims processing (2.22) Courteous and helpful office staff (2.55) Overall plan satisfaction (.74) Getting needed care (2.66) Getting care quickly (2.39) Customer service (2.44) 2.45 2.19 2.40 2.42 2.32 J,N J,N J,N J,N J,N 0.89 0.67 0.67 0.67 0.73 0.73 0.67 2.79 2.52 2.52 2.52 2.60 2.60 2.52 2.44 2.21 2.21 2.21 2.24 2.24 2.23 2.45 2.34 2.34 2.34 2.35 2.35 2.36 2.67 2.40 2.40 2.40 2.45 2.45 2.43 2.64 2.24 2.24 2.24 2.47 2.47 2.26 2.72 2.15 2.15 2.15 2.16 2.16 2.21 N N N N2. N N N 0.68 0.63 0.64 0.67 0.73 0.66 0.67 2.53 2.47 2.50 2.52 2.68 2.67 2.62 2.20 2.15 2.30 2.23 2.39 2.26 2.19 2.34 2.32 2.45 2.36 2.52 2.42 2.30 2.39 2.42 2.49 2.43 2.55 2.43 2.35 2.25 2.27 2.25 2.26 2.30 2.37 2.38 2.28 2.22 2.27 2.21 2.17 2.21 2.54 N N N N N N N 0.72 2.67 2.34 2.38 2.43 2.36 2.19 29 Health Maintenance Organization (HMO) and Point of Service (POS) Plans by State How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Primary Care Doctor Office shows what you pay for each Hospital Room Copay/Coinsurance is your share of hospital room and office visit to your primary care doctor. A (*) means a POS plan board charges. This is separate from any per admission deductible. A (*) pays non-plan doctors based on a fee schedule. means a POS plan pays non-plan hospitals based on a fee schedule. Your share of premium Enrollment code Monthly Biweekly Plan name – location Georgia Aetna U.S. Healthcare - Atlanta/Augusta/Athens/Macon areas Athens Area Health Plan Select - Athens metro area Blue Cross and Blue Shield-Std - Athens/Atl/Augusta/Col/Macon/Savannah Kaiser Permanente - Atlanta area Prudential HealthCare HMO - Atlanta/Macon areas Telephone number Self only Self & family Self only Self & family Self only Self & family 800/537-9384 706/549-0549 800/282-2473 800/255-0568 800/856-0764 2U1 8Y1 104 F81 EZ1 2U2 8Y2 105 F82 EZ2 51.16 46.80 65.09 49.38 43.35 146.16 120.10 144.69 125.35 118.62 23.61 21.60 30.04 22.79 20.01 67.46 55.43 66.78 57.85 54.75 Guam Guam Memorial Health Plan-High -Guam/Palau/N. Mariana Islands Guam Memorial Health Plan-Std - Guam/Palau/N. Mariana Islands PacifiCare Asia Pacific-High -Guam/N. Mariana Islands/Palau PacifiCare Asia Pacific-Std - Guam/N. Mariana Islands/Palau 671/646-4647 671/646-4647 671/647-3526 671/647-3526 ZA1 ZA4 JK1 JK4 ZA2 ZA5 JK2 JK5 71.22 44.38 54.23 33.79 232.24 126.38 148.70 100.92 32.87 107.19 20.48 25.03 15.59 58.33 68.63 46.58 Hawaii HMSA - All of Hawaii Kaiser Permanente-High -Islands of Hawaii/Maui/Oahu/Kauai Kaiser Permanente-Std - Islands of Hawaii/Maui/Oahu/Kauai 808/948-6499 808/597-5955 808/597-5955 871 631 634 872 632 635 49.43 87.36 54.07 110.01 173.77 116.25 22.81 40.32 24.95 50.77 80.20 53.65 Idaho Group Health Cooperative - Kootenai and Latah Premera HealthPlus - Washington border counties 800/497-2210 800/527-6675 VR1 8F1 VR2 8F2 65.71 53.99 228.00 140.59 30.33 105.23 24.92 64.89 30 Prescription Drugs, Generic, Brand shows what you pay for prescriptions when you use a plan pharmacy. Some plans charge different amounts for refills (*), select drugs and mail orders. In many plans, if you get the brand name instead of a generic substitution, you also pay the difference between the two. Where a copay/coinsurance are both shown, you pay the greater amount. Some POS plans pay a non-plan pharmacy only what they would have paid a plan pharmacy (#); you pay the difference. Primary care doctor office copay Satisfaction Indicators — See page 7 for a description of these results. An (X) means the plan did not conduct the survey as we asked. Accreditation status — N = National Committee for Quality Assurance; J = Joint Commission on Accreditation of Healthcare Organizations Plan performance based on enrollee rating Accreditation status NCQA (N) JCAHO (J) Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) All others- on a scale of 3 (highest) to 1 (lowest) (average for all HMO/POS plans shown in heading) Hospital room copay/coinsurance Prescription drugs, generic Prescription drugs, brand How well doctors communicate (2.46) Plan name Georgia Aetna U.S. Healthcare Athens Area Health Plan Select Blue Cross and Blue Shield-Std Kaiser Permanente Prudential HealthCare HMO - In-Network - Out-of-Network $10 $10 $10 25% $10 $10 Nothing Nothing Nothing 30% Nothing Nothing $5 $5 $5 45% $11 $5 $10 $10 $15 45% $11 $15 0.66 2.58 2.33 2.45 2.56 2.27 0.69 0.84 0.65 2.63 2.68 2.65 2.33 2.44 2.18 2.45 2.48 2.38 2.52 2.62 2.36 2.38 2.55 2.28 Claims processing (2.22) Courteous and helpful office staff (2.55) Overall plan satisfaction (.74) Getting needed care (2.66) Getting care quickly (2.39) Customer service (2.44) 1.87 2.22 2.13 2.12 N N N Guam Guam Memorial Health Plan-High Guam Memorial Health Plan-Std PacifiCare Asia Pacific-High PacifiCare Asia Pacific-Std $10 $12 $10 $15 Nothing 20% Nothing Nothing $5/20% $10/20% $5 $5 $5/20% $10/20% $5 $5 0.82 0.82 0.71 0.71 2.75 2.75 2.54 2.54 2.36 2.36 2.12 2.12 2.63 2.63 2.35 2.35 2.66 2.66 2.36 2.36 2.45 2.45 2.33 2.33 2.21 2.21 1.89 1.89 Hawaii HMSA Kaiser Permanente-High Kaiser Permanente-Std - In-Network - Out-of-Network 20% 30% $10 $15 Nothing Nothing Nothing 10% $5 $5# $7 $7 $10 $10# $7 $7 0.88 0.88 2.77 2.77 2.59 2.59 2.59 2.59 2.67 2.67 2.61 2.61 2.34 2.34 N N 0.89 2.92 2.69 2.64 2.75 2.60 2.54 Idaho Group Health Cooperative Premera HealthPlus $10 $10 Nothing Nothing $7 $5 $7 $10 0.79 X 2.74 X 2.49 X 2.57 X 2.66 X 2.55 X 2.47 X N 31 Health Maintenance Organization (HMO) and Point of Service (POS) Plans by State How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Primary Care Doctor Office shows what you pay for each Hospital Room Copay/Coinsurance is your share of hospital room and office visit to your primary care doctor. A (*) means a POS plan board charges. This is separate from any per admission deductible. A (*) pays non-plan doctors based on a fee schedule. means a POS plan pays non-plan hospitals based on a fee schedule. Your share of premium Enrollment code Monthly Biweekly Plan name – location Illinois Aetna U.S. Healthcare - Metro St Louis area Aetna U.S. Healthcare - Chicago area American HMO - Chicago area/Central/South/Western IL Group Health Plan - Southern/Metro East/Central Health Alliance HMO - Central/E.Central/N.West/South/West IL Health Partners of the Midwest - St. Louis area Humana Health Plan Inc. - Chicago area John Deere Health Plan - Bloomingtn/Joliet/Moline/Peoria/RockIsld Mercy Health Plans/Premier - Southwest Illinois OSF HealthPlans - Central/Northern Illinois PersonalCare's HMO - East Central Illinois Prudential HealthCare HMO - Southern Illinois Rush Prudential HMO - Chicago area Union Health Service - Chicago area Telephone number Self only Self & family Self only Self & family Self only Self & family 800/537-9384 800/537-9384 800/242-7460 800/743-3901 800/851-3379 800/338-4123 888/393-6765 800/247-9110 800/327-0763 800/673-5222 800/431-1211 800/856-0764 312/234-7747 312/829-4224 6T1 XC1 AC1 MM1 FX1 RN1 751 3J1 7M1 9F1 GE1 VZ1 171 761 6T2 XC2 AC2 MM2 FX2 RN2 752 3J2 7M2 9F2 GE2 VZ2 172 762 42.71 37.96 47.90 55.22 69.12 74.99 54.18 51.38 53.52 41.63 42.76 43.33 48.15 45.00 113.52 120.24 155.26 120.38 178.73 152.10 138.51 173.66 124.48 109.47 109.97 109.43 124.97 112.08 19.71 17.52 22.11 25.49 31.90 34.61 25.01 23.71 24.70 19.21 19.73 20.00 22.22 20.77 52.39 55.49 71.66 55.56 82.49 70.20 63.93 80.15 57.45 50.52 50.75 50.50 57.68 51.73 Indiana Aetna U.S. Healthcare - Southern Indiana Aetna U.S. Healthcare - Lake/Porter Counties American HMO - Northwest Indiana Arnett HMO - Lafayette area Health Alliance HMO - Fountain/Vermillion/Warren Counties Humana Care Plan - Southern Indiana Humana Health Plan - Southern Indiana Humana Health Plan Inc. - Lake/ Porter Counties Maxicare Indiana - Most of Indiana PARTNERS Nat'l HPs of IN - Northern Indiana Physicians HP of N. Indiana - Northern Indiana Prudential HealthCare HMO Midwest - Dearborn County Rush Prudential HMO - Lake/Porter Counties 800/537-9384 800/537-9384 800/242-7460 765/448-7440 800/851-3379 888/393-6765 888/393-6765 888/393-6765 800/441-3355 800/967-5439 219/432-6690 800/856-0764 888/234-7747 RD1 XC1 AC1 G21 FX1 181 D21 751 GK1 MC1 DQ1 S31 171 RD2 XC2 AC2 G22 FX2 182 D22 752 GK2 MC2 DQ2 S32 172 56.49 37.96 47.90 59.80 69.12 55.19 63.07 54.18 52.18 48.89 57.42 52.22 48.15 178.03 120.24 155.26 218.36 178.73 170.69 203.36 138.51 122.53 127.31 133.12 161.13 124.97 26.07 17.52 22.11 82.17 55.49 71.66 27.60 100.78 31.90 25.47 29.11 25.01 24.08 22.56 26.50 24.10 22.22 82.49 78.78 93.86 63.93 56.55 58.76 61.44 74.37 57.68 32 Prescription Drugs, Generic, Brand shows what you pay for prescriptions when you use a plan pharmacy. Some plans charge different amounts for refills (*), select drugs and mail orders. In many plans, if you get the brand name instead of a generic substitution, you also pay the difference between the two. Where a copay/coinsurance are both shown, you pay the greater amount. Some POS plans pay a non-plan pharmacy only what they would have paid a plan pharmacy (#); you pay the difference. Primary care doctor office copay Satisfaction Indicators — See page 7 for a description of these results. An (X) means the plan did not conduct the survey as we asked. Accreditation status — N = National Committee for Quality Assurance; J = Joint Commission on Accreditation of Healthcare Organizations Plan performance based on enrollee rating Accreditation status NCQA (N) JCAHO (J) Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) All others- on a scale of 3 (highest) to 1 (lowest) (average for all HMO/POS plans shown in heading) Hospital room copay/coinsurance Prescription drugs, generic Prescription drugs, brand How well doctors communicate (2.46) Plan name Illinois Aetna U.S. Healthcare Aetna U.S. Healthcare American HMO Group Health Plan Health Alliance HMO Health Partners of the Midwest Humana Health Plan Inc. John Deere Health Plan Mercy Health Plans/Premier OSF HealthPlans PersonalCare's HMO Prudential HealthCare HMO Rush Prudential HMO Union Health Service - In-Network - Out-of-Network $10 $10 $10 $10 $10 $10 $10 $10 $10 30% $10 $10 $10 $10 $10 Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing 30% Nothing Nothing Nothing Nothing Nothing $5 $5 $5 $7 $7 $7 $3 $5 $7 $7 $7 $5 $5 $5 $5 $10 $10 $10 $12 $14 $12 $7 $15 $12 $12 $15 $10 $15 $5 $5 0.86 0.68 0.65 2.80 2.68 2.52 2.54 2.47 2.28 2.48 2.46 2.41 2.64 2.60 2.48 2.57 2.27 2.25 2.49 2.38 1.86 N N N 0.66 0.82 2.60 2.65 2.27 2.56 2.37 2.40 2.41 2.54 2.24 2.43 2.25 2.35 N 0.62 0.56 0.72 0.83 2.57 2.60 2.62 2.75 2.37 2.45 2.38 2.57 2.45 2.43 2.44 2.55 2.45 2.51 2.53 2.65 2.37 2.86 2.28 2.52 1.81 1.83 2.89 2.39 N N Indiana Aetna U.S. Healthcare Aetna U.S. Healthcare American HMO Arnett HMO Health Alliance HMO Humana Care Plan Humana Health Plan Humana Health Plan Inc. Maxicare Indiana PARTNERS Nat'l HPs of IN Physicians HP of N. Indiana Prudential HealthCare HMO Midwest Rush Prudential HMO $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing $5 $5 $5 $5 $7 $5 $5 $3 $5 $4 $10 $5 $5 $10 $10 $10 $15 $14 $10 $10 $7 $10 $7.50 $10 $15 $5 0.66 0.65 2.65 2.52 2.40 2.28 2.38 2.41 2.49 2.48 2.24 2.25 1.91 1.86 N N 0.62 0.62 0.56 0.83 0.83 0.70 0.72 0.66 0.66 2.57 2.57 2.60 2.77 2.75 2.70 2.62 2.60 2.65 2.45 2.37 2.45 2.49 2.57 2.31 2.39 2.27 2.42 2.49 2.45 2.43 2.49 2.55 2.44 2.47 2.37 2.44 2.56 2.45 2.51 2.62 2.65 2.54 2.55 2.41 2.57 2.28 2.37 2.86 2.59 2.52 2.32 2.32 2.24 2.30 1.84 1.81 1.83 2.52 2.39 2.97 2.17 2.25 2.28 N N N 33 Claims processing (2.22) Courteous and helpful office staff (2.55) Overall plan satisfaction (.74) Getting needed care (2.66) Getting care quickly (2.39) Customer service (2.44) Health Maintenance Organization (HMO) and Point of Service (POS) Plans by State How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Primary Care Doctor Office shows what you pay for each Hospital Room Copay/Coinsurance is your share of hospital room and office visit to your primary care doctor. A (*) means a POS plan board charges. This is separate from any per admission deductible. A (*) pays non-plan doctors based on a fee schedule. means a POS plan pays non-plan hospitals based on a fee schedule. Your share of premium Enrollment code Monthly Biweekly Plan name – location Indiana (continued) The M•Plan - Central/Northeast/Southwest Indiana Welborn HMO - Evansville area Telephone number Self only Self & family Self only Self & family Self only Self & family 317/571-5320 812/426-6600 IN1 H31 IN2 H32 56.24 50.41 125.21 139.94 25.96 23.26 57.79 64.59 Iowa Care Choices - Northwest Iowa Health Alliance HMO - Central Iowa John Deere Health Plan - Central/Eastern Iowa Principal Health Care of Iowa - Des Moines/Central Iowa/Waterloo SecureCare of Iowa - Central and Eastern Iowa areas 800/535-6252 888/536-5300 800/247-9110 800/257-4692 888/881-8820 FA1 7X1 3J1 SV1 3Q1 FA2 7X2 3J2 SV2 3Q2 48.34 49.08 51.38 45.49 43.17 139.25 119.05 173.66 122.84 113.09 22.31 22.65 23.71 20.99 19.92 64.27 54.94 80.15 56.70 52.20 Kansas Aetna U.S. Healthcare - Kansas City Metro Area Blue Cross and Blue Shield-Std - Most of Kansas Humana Kansas City, Inc.-High -Kansas City area Humana Kansas City, Inc.-Std - Kansas City area Kaiser Permanente - Kansas City area Preferred Plus of Kansas - S. Central & Jefferson/Shawnee Counties Principal Health Care of KC - Wichita/Salinas areas Prudential HealthCare HMO - Kansas City/Topeka areas 800/537-9384 800/432-0379 888/393-6765 888/393-6765 913/642-2662 800/660-8114 800/969-3343 800/856-0764 7K1 104 MS1 MS4 HA1 VA1 7W1 1K1 7K2 105 MS2 MS5 HA2 VA2 7W2 1K2 45.75 65.09 51.00 48.01 43.40 56.29 46.22 51.32 121.19 144.69 122.36 115.17 111.99 217.68 117.87 122.96 21.11 30.04 23.54 22.16 20.03 55.93 66.78 56.47 53.15 51.69 25.98 100.47 21.33 23.69 54.40 56.75 Kentucky Advantage Care, Inc. - Central/Eastern Kentucky Aetna U.S. Healthcare - Lexington/Louisville areas Bluegrass Family Health - Central/Eastern Kentucky Humana Care Plan - Louisville area Humana Care Plan - Lexington area Humana Health Plan - Lexington/Louisville 800/850-8585 800/537-9384 606/269-4475 888/393-6765 888/393-6765 888/393-6765 XW1 RD1 2B1 181 HR1 D21 XW2 RD2 2B2 182 HR2 D22 50.93 56.49 60.93 55.19 54.80 63.07 147.90 178.03 118.12 170.69 166.70 203.36 23.50 26.07 28.12 25.47 25.29 29.11 68.26 82.17 54.52 78.78 76.94 93.86 34 Prescription Drugs, Generic, Brand shows what you pay for prescriptions when you use a plan pharmacy. Some plans charge different amounts for refills (*), select drugs and mail orders. In many plans, if you get the brand name instead of a generic substitution, you also pay the difference between the two. Where a copay/coinsurance are both shown, you pay the greater amount. Some POS plans pay a non-plan pharmacy only what they would have paid a plan pharmacy (#); you pay the difference. Primary care doctor office copay Satisfaction Indicators — See page 7 for a description of these results. An (X) means the plan did not conduct the survey as we asked. Accreditation status — N = National Committee for Quality Assurance; J = Joint Commission on Accreditation of Healthcare Organizations Plan performance based on enrollee rating Accreditation status NCQA (N) JCAHO (J) Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) All others- on a scale of 3 (highest) to 1 (lowest) (average for all HMO/POS plans shown in heading) Hospital room copay/coinsurance Prescription drugs, generic Prescription drugs, brand How well doctors communicate (2.46) Plan name Indiana (continued) The M•Plan Welborn HMO $10 $10 Nothing Nothing $5 $5 $10 $15 0.77 0.90 2.66 2.86 2.47 2.61 2.47 2.52 2.57 2.70 2.43 2.67 Claims processing (2.22) Courteous and helpful office staff (2.55) Overall plan satisfaction (.74) Getting needed care (2.66) Getting care quickly (2.39) Customer service (2.44) 2.18 2.65 N N Iowa Care Choices Health Alliance HMO John Deere Health Plan Principal Health Care of Iowa SecureCare of Iowa $10 $10 $10 $10 $10 Nothing Nothing Nothing Nothing Nothing $5 $7 $5 $5/25% 25% $5 $14 $15 $5/25% 25% X 0.83 0.82 0.75 X 2.75 2.65 2.69 X 2.57 2.56 2.48 X 2.55 2.40 2.38 X 2.65 2.54 2.51 X 2.52 2.43 2.45 X 2.39 2.35 2.36 N Kansas Aetna U.S. Healthcare Blue Cross and Blue Shield-Std - In-Network - Out-of-Network $10 $10 25% $10 $15 $10 $10 $10 $10 Nothing Nothing 30% Nothing Nothing Nothing Nothing Nothing Nothing $5 $5 45% $5 $10 $5 $5 $5 $5 $10 $15 45% $10 $20 $5 $15 $10 $10 0.76 0.65 2.69 2.56 2.48 2.34 2.52 2.36 2.66 2.47 2.50 2.23 2.49 1.95 N N 0.72 2.64 2.37 2.35 2.59 2.51 2.25 N N N 0.75 2.73 2.50 2.47 2.58 2.44 2.43 Humana Kansas City, Inc.-High Humana Kansas City, Inc.-Std Kaiser Permanente Preferred Plus of Kansas Principal Health Care of KC Prudential HealthCare HMO Kentucky Advantage Care, Inc. Aetna U.S. Healthcare - In-Network Bluegrass Family Health - Out-of-Network Humana Care Plan Humana Care Plan Humana Health Plan $10 $10 $10 30% $10 $10 $10 Nothing Nothing Nothing Nothing Nothing Nothing Nothing $5 $5 $5 $5 $5 $5 $5 $5 $10 $10 $10 $10 $10 $10 0.70 0.74 0.72 2.70 2.62 2.62 2.31 2.47 2.39 2.44 2.52 2.47 2.54 2.59 2.55 2.32 2.32 2.32 2.97 2.25 2.17 0.72 0.62 2.68 2.57 2.44 2.45 2.59 2.49 2.62 2.56 2.52 2.28 2.46 1.84 N 35 Health Maintenance Organization (HMO) and Point of Service (POS) Plans by State How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Primary Care Doctor Office shows what you pay for each Hospital Room Copay/Coinsurance is your share of hospital room and office visit to your primary care doctor. A (*) means a POS plan board charges. This is separate from any per admission deductible. A (*) pays non-plan doctors based on a fee schedule. means a POS plan pays non-plan hospitals based on a fee schedule. Your share of premium Enrollment code Monthly Biweekly Plan name – location Kentucky (continued) PacifiCare of Ohio, Inc. - Northern Kentucky Prudential HealthCare HMO Midwest - Northern Kentucky United Health Care of Ohio - Northern Kentucky Telephone number Self only Self & family Self only Self & family Self only Self & family 800/824-0428 800/856-0764 800/231-2918 R81 S31 3U1 R82 S32 3U2 48.72 52.22 60.95 103.76 161.13 151.75 22.49 24.10 28.13 47.89 74.37 70.04 Louisiana Aetna U.S. Healthcare - New Orleans area Aetna U.S. Healthcare - Baton Rouge/Lafayette areas Blue Cross and Blue Shield-Std - New Orleans area 800/537-9384 800/537-9384 800/272-3029 NG1 TK1 104 NG2 TK2 105 49.25 38.42 65.09 130.87 125.35 144.69 22.73 17.73 30.04 60.40 57.85 66.78 Maxicare Louisiana - Baton Rouge/New Orleans areas 800/933-6294 JA1 JA2 44.16 102.56 20.38 47.34 Maine Aetna U.S. Healthcare - All of Maine Harvard Pilgrim Health Care - Southeastern Maine 800/537-9384 888/333-4742 9M1 681 9M2 682 98.80 108.81 218.77 359.73 45.60 100.97 50.22 166.03 Maryland Aetna U.S. Healthcare-High -North/Central/Southern Maryland Aetna U.S. Healthcare-Std - North/Central/Southern Maryland CapitalCare - South/Central Maryland Free State Health Plan - All of Maryland George Washington Univ HP - Central/Southern Maryland Kaiser Permanente - Baltimore/Washington, DC areas MD-IPA - All of Maryland Prudential HealthCare HMO - Most of Maryland 800/537-9384 800/537-9384 800/680-9495 800/445-6036 301/941-2000 301/468-6000 800/251-0956 800/856-0764 JN1 JN4 2G1 LD1 E51 E31 JP1 JB1 JN2 JN5 2G2 LD2 E52 E32 JP2 JB2 63.63 40.46 56.03 99.82 52.79 50.92 56.66 72.06 167.55 94.90 167.85 235.78 136.30 125.88 162.82 153.29 29.37 18.67 25.86 77.33 43.80 77.47 46.07 108.82 24.36 23.50 26.15 33.26 62.91 58.10 75.15 70.75 36 Prescription Drugs, Generic, Brand shows what you pay for prescriptions when you use a plan pharmacy. Some plans charge different amounts for refills (*), select drugs and mail orders. In many plans, if you get the brand name instead of a generic substitution, you also pay the difference between the two. Where a copay/coinsurance are both shown, you pay the greater amount. Some POS plans pay a non-plan pharmacy only what they would have paid a plan pharmacy (#); you pay the difference. Primary care doctor office copay Satisfaction Indicators — See page 7 for a description of these results. An (X) means the plan did not conduct the survey as we asked. Accreditation status — N = National Committee for Quality Assurance; J = Joint Commission on Accreditation of Healthcare Organizations Plan performance based on enrollee rating Accreditation status NCQA (N) JCAHO (J) Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) All others- on a scale of 3 (highest) to 1 (lowest) (average for all HMO/POS plans shown in heading) Hospital room copay/coinsurance Prescription drugs, generic Prescription drugs, brand How well doctors communicate (2.46) Plan name Kentucky (continued) PacifiCare of Ohio, Inc. Prudential HealthCare HMO Midwest United Health Care of Ohio $10 $10 $10 Nothing Nothing Nothing $10 $5 $10 $10 $15 $15 0.72 0.66 0.76 2.69 2.65 2.79 2.48 2.40 2.44 2.49 2.38 2.42 2.64 2.49 2.53 2.39 2.24 2.49 Claims processing (2.22) Courteous and helpful office staff (2.55) Overall plan satisfaction (.74) Getting needed care (2.66) Getting care quickly (2.39) Customer service (2.44) 2.15 1.91 2.22 N N Louisiana Aetna U.S. Healthcare Aetna U.S. Healthcare Blue Cross and Blue Shield-Std Maxicare Louisiana - In-Network - Out-of-Network - In-Network - Out-of-Network $10 $10 $10 25% $10 20% Nothing Nothing Nothing 30% Nothing 20% $5 $5 $5 45% $7 N/A $10 $10 $15 45% $12 N/A 0.75 2.65 2.21 2.41 2.46 2.43 2.76 X X X X X X X N X X X X X X X Maine Aetna U.S. Healthcare Harvard Pilgrim Health Care $10 $10 Nothing Nothing $5 $5 $10 $15 0.82 2.78 2.45 2.55 2.64 2.47 2.27 N Maryland Aetna U.S. Healthcare-High Aetna U.S. Healthcare-Std CapitalCare - In-Network Free State Health Plan - Out-of-Network George Washington Univ HP Kaiser Permanente MD-IPA Prudential HealthCare HMO $10 $15 $10 $10 20% $10 $10 $10 $10 Nothing Nothing Nothing Nothing 20% Nothing Nothing Nothing Nothing $5 $10 $5 $10 $10 $5 $7 $5 $5 $10 $15 $10 $20 $20 $15 $7 $10 $15 0.69 0.78 0.74 0.69 2.66 2.63 2.65 2.65 2.29 2.35 2.42 2.38 2.39 2.36 2.46 2.46 2.36 2.55 2.56 2.58 2.22 2.50 2.53 2.23 2.64 2.76 2.33 1.89 N N N N 0.76 0.76 0.75 0.74 2.63 2.63 2.59 2.69 2.33 2.33 2.37 2.38 2.41 2.41 2.45 2.53 2.47 2.47 2.58 2.56 2.42 2.42 2.42 2.43 2.23 2.23 2.32 2.25 N N N N 37 Health Maintenance Organization (HMO) and Point of Service (POS) Plans by State How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Primary Care Doctor Office shows what you pay for each Hospital Room Copay/Coinsurance is your share of hospital room and office visit to your primary care doctor. A (*) means a POS plan board charges. This is separate from any per admission deductible. A (*) pays non-plan doctors based on a fee schedule. means a POS plan pays non-plan hospitals based on a fee schedule. Your share of premium Enrollment code Monthly Biweekly Plan name – location Massachusetts Aetna U.S. Healthcare - Central/Eastern MA/Hampden Blue Chip, Coord Hlth Partners - Southeastern Massachusetts Telephone number Self only Self & family Self only Self & family Self only Self & family 800/537-9384 401/459-5500 NE1 DA1 NE2 DA2 81.40 54.31 288.40 174.89 37.57 133.11 25.06 80.72 Blue Cross and Blue Shield-Std - All of Massachusetts Fallon Community Health Plan - Central/Eastern Massachusetts Harvard Pilgrim Health Care - Eastern/Western Massachusetts Harvard Pilgrim Hlth Care-NE - Southeastern Massachusetts Health New England - Western Massachusetts 800/433-7766 800/868-5200 888/333-4742 888/333-4742 413/787-4004 104 JV1 681 701 DJ1 105 JV2 682 702 DJ2 65.09 47.34 108.81 71.46 61.19 144.69 122.00 359.73 200.18 131.39 30.04 21.85 66.78 56.31 50.22 166.03 32.98 28.24 92.39 60.64 Michigan Aetna U.S. Healthcare - Greater Detroit Metro area Blue Care Network West MI - Western Michigan Blue Care Network West MI - East Michigan Region Blue Care Network West MI - Western Michigan Blue Care Network West MI - East Michigan Region Blue Care Network West MI - Western Michigan Blue Care Network West MI - Mid Michigan Blue Care Network West MI - Southeast MI Grand Valley Health Plan - Grand Rapids area Health Alliance - Southeastern Michigan/Flint area HealthPlus MI - Flint/Saginaw areas M-Care - Mid/Southeastern Michigan OmniCare - Southeastern Michigan Physicians Health Plan - Muskegon/Western Michigan Priority Health - West Michigan SelectCare HMO - Southeast Michigan The Wellness Plan - Southeastern Michigan Total Health Care - Greater Detroit/Flint areas 800/537-9384 800/775-2583 800/890-0871 800/775-2583 800/890-0871 800/775-2583 888/227-2345 800/662-6667 616/949-2410 313/872-8100 800/332-9161 800/658-8878 313/259-4000 616/728-6333 616/942-1221 800/332-2365 800/875-9355 800/826-2862 8Z1 G71 K51 KF1 KN1 KR1 LN1 LX1 RL1 521 X51 EG1 KA1 U81 BQ1 K61 K31 N21 8Z2 G72 K52 KF2 KN2 KR2 LN2 LX2 RL2 522 X52 EG2 KA2 U82 BQ2 K62 K32 N22 46.26 97.80 52.04 44.17 52.87 48.48 56.44 35.67 49.89 47.82 54.54 47.32 38.33 42.08 57.50 39.43 42.49 42.50 120.68 296.94 198.94 121.22 208.22 176.58 161.65 116.90 128.87 126.71 153.64 125.45 95.85 100.85 263.81 110.43 115.59 107.79 21.35 55.70 45.14 137.05 24.02 20.39 24.40 22.38 26.05 16.46 23.03 22.07 25.17 21.84 17.69 19.42 91.82 55.95 96.10 81.50 74.61 53.95 59.48 58.48 70.91 57.90 44.24 46.54 26.54 121.76 18.20 19.61 19.61 50.97 53.35 49.75 38 Prescription Drugs, Generic, Brand shows what you pay for prescriptions when you use a plan pharmacy. Some plans charge different amounts for refills (*), select drugs and mail orders. In many plans, if you get the brand name instead of a generic substitution, you also pay the difference between the two. Where a copay/coinsurance are both shown, you pay the greater amount. Some POS plans pay a non-plan pharmacy only what they would have paid a plan pharmacy (#); you pay the difference. Primary care doctor office copay Satisfaction Indicators — See page 7 for a description of these results. An (X) means the plan did not conduct the survey as we asked. Accreditation status — N = National Committee for Quality Assurance; J = Joint Commission on Accreditation of Healthcare Organizations Plan performance based on enrollee rating Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) All others- on a scale of 3 (highest) to 1 (lowest) (average for all HMO/POS plans shown in heading) Hospital room copay/coinsurance Plan name Massachusetts Aetna U.S. Healthcare Blue Chip, Coord Hlth Partners Blue Cross and Blue Shield-Std - In-Network - Out-of-Network - In-Network - Out-of-Network $10 $10 20% $10 25% $10 $10 $10 $10 Nothing Nothing 20% Nothing 30% Nothing Nothing Nothing Nothing $5 $5 $5 $5 45% $5 $5 $5 $7 $10 $15 $15 $15 45% $10 $15 $15 $15 0.63 0.74 2.66 2.75 2.55 2.48 2.55 2.58 2.63 2.64 2.19 2.45 1.86 2.25 0.85 0.89 0.82 0.84 0.90 2.77 2.78 2.78 2.79 2.79 2.51 2.53 2.45 2.46 2.41 2.52 2.61 2.55 2.52 2.49 2.63 2.72 2.64 2.59 2.54 2.53 2.63 2.47 2.46 2.78 2.33 2.53 2.27 2.26 2.57 Fallon Community Health Plan Harvard Pilgrim Health Care Harvard Pilgrim Hlth Care-NE Health New England Michigan Aetna U.S. Healthcare Blue Care Network West MI Blue Care Network West MI Blue Care Network West MI Blue Care Network West MI Blue Care Network West MI Blue Care Network West MI Blue Care Network West MI Grand Valley Health Plan Health Alliance HealthPlus MI M-Care OmniCare Physicians Health Plan Priority Health SelectCare HMO The Wellness Plan Total Health Care $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing $5 $5 $5 $5 $5 $5 $5 $5 $5 $2 $5 $5 $2 $5 $5 $2 $5 Nothing $10 $5 $5 $5 $5 $5 $5 $5 $5 $2 $5 $10 $2 $5 $5 $2 $5 Nothing 0.81 0.85 0.73 0.60 2.77 2.79 2.61 2.51 2.53 2.50 2.41 2.25 2.52 2.55 2.49 2.31 2.63 2.62 2.59 2.38 2.55 2.59 2.41 2.15 2.43 2.53 2.23 1.88 N N 0.82 2.76 2.41 2.55 2.57 2.59 2.36 0.82 2.70 2.35 2.42 2.49 2.52 2.40 N N N N N N N N N N N N 39 Accreditation status NCQA (N) JCAHO (J) Prescription drugs, generic Prescription drugs, brand How well doctors communicate (2.46) Claims processing (2.22) Courteous and helpful office staff (2.55) Overall plan satisfaction (.74) Getting needed care (2.66) Getting care quickly (2.39) Customer service (2.44) N N N N N N N Health Maintenance Organization (HMO) and Point of Service (POS) Plans by State How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Primary Care Doctor Office shows what you pay for each Hospital Room Copay/Coinsurance is your share of hospital room and office visit to your primary care doctor. A (*) means a POS plan board charges. This is separate from any per admission deductible. A (*) pays non-plan doctors based on a fee schedule. means a POS plan pays non-plan hospitals based on a fee schedule. Your share of premium Enrollment code Monthly Biweekly Plan name – location Minnesota APWU Health Plan - Minneapolis/St Paul Telephone number Self only Self & family Self only Self & family Self only Self & family 800/222-2798 471 472 86.06 182.43 39.72 84.20 Blue Cross and Blue Shield-Std - All of Minnesota HealthPartners Classic-High -Minneapolis/St. Paul areas HealthPartners Classic-Std - Minneapolis/St. Paul areas HealthPartners Health Plan - Minneapolis/St. Paul/St. Cloud areas 800/859-2128 612/883-5000 612/883-5000 612/883-5000 104 531 534 HQ1 105 532 535 HQ2 65.09 69.64 51.38 94.18 144.69 195.71 123.28 254.76 30.04 32.14 23.71 66.78 90.33 56.90 43.47 117.58 Mississippi Prudential HealthCare HMO - Desoto/Marshall/Tate/Tunica Cos. 800/856-0764 UB1 UB2 42.21 133.21 19.48 61.48 Missouri Aetna U.S. Healthcare - Metro St Louis area BlueCHOICE - StLouis/Central/SW/Poplar Bluff area Group Health Plan - St. Louis area Health Partners of the Midwest - St. Louis and Columbia areas Humana Kansas City, Inc.-High -Kansas City area Humana Kansas City, Inc.-Std - Kansas City area Kaiser Permanente - Kansas City area Mercy Health Plans/Premier - East/Central/Southwest Missouri Prudential HealthCare HMO - Kansas City area Prudential HealthCare HMO - St. Louis area 800/537-9384 800/634-4395 800/743-3901 800/338-4123 888/393-6765 888/393-6765 913/642-2662 800/327-0763 800/856-0764 800/856-0764 6T1 9G1 MM1 RN1 MS1 MS4 HA1 7M1 1K1 VZ1 6T2 9G2 MM2 RN2 MS2 MS5 HA2 7M2 1K2 VZ2 42.71 70.83 55.22 74.99 51.00 48.01 43.40 53.52 51.32 43.33 113.52 141.85 120.38 152.10 122.36 115.17 111.99 124.48 122.96 109.43 19.71 32.69 25.49 34.61 23.54 22.16 20.03 24.70 23.69 20.00 52.39 65.47 55.56 70.20 56.47 53.15 51.69 57.45 56.75 50.50 40 Prescription Drugs, Generic, Brand shows what you pay for prescriptions when you use a plan pharmacy. Some plans charge different amounts for refills (*), select drugs and mail orders. In many plans, if you get the brand name instead of a generic substitution, you also pay the difference between the two. Where a copay/coinsurance are both shown, you pay the greater amount. Some POS plans pay a non-plan pharmacy only what they would have paid a plan pharmacy (#); you pay the difference. Primary care doctor office copay Satisfaction Indicators — See page 7 for a description of these results. An (X) means the plan did not conduct the survey as we asked. Accreditation status — N = National Committee for Quality Assurance; J = Joint Commission on Accreditation of Healthcare Organizations Plan performance based on enrollee rating Accreditation status NCQA (N) JCAHO (J) Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) All others- on a scale of 3 (highest) to 1 (lowest) (average for all HMO/POS plans shown in heading) Hospital room copay/coinsurance Prescription drugs, generic Prescription drugs, brand How well doctors communicate (2.46) Plan name Minnesota APWU Health Plan - In-Network - Out-of-Network Blue Cross and Blue Shield-Std - In-Network - Out-of-Network $10 30% $10 25% $10 $15 $10 Nothing 30% Nothing 30% Nothing Nothing Nothing 20%* 40% $5 45% $8 $10 $8 20%* 40% $15 45% $8 $10 $8 0.77 0.77 0.77 2.76 2.76 2.76 2.39 2.39 2.39 2.48 2.48 2.48 2.56 2.56 2.56 2.47 2.47 2.47 2.30 2.30 2.30 N N N 0.76 2.69 2.37 2.42 2.52 2.35 2.40 HealthPartners Classic-High HealthPartners Classic-Std HealthPartners Health Plan Mississippi Prudential HealthCare HMO $10 Nothing $5 $15 0.64 2.64 2.82 2.37 2.38 2.25 1.89 N Missouri Aetna U.S. Healthcare BlueCHOICE Group Health Plan Health Partners of the Midwest Humana Kansas City, Inc.-High Humana Kansas City, Inc.-Std Kaiser Permanente Mercy Health Plans/Premier - In-Network - Out-of-Network $10 $10 $10 $10 $10 $15 $10 $10 30% $10 $10 Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing 30% Nothing Nothing $5 $5 $7 $7 $5 $10 $5 $7 $7 $5 $5 $10 $10 $12 $12 $10 $20 $5 $12 $12 $10 $15 0.65 0.68 2.56 2.68 2.34 2.47 2.36 2.46 2.47 2.60 2.23 2.27 1.95 2.38 N N 0.68 0.72 X X X 0.72 2.67 2.62 X X X 2.64 2.43 2.38 X X X 2.37 2.51 2.44 X X X 2.35 2.59 2.53 X X X 2.59 2.37 2.28 X X X 2.51 2.15 2.89 X X X 2.25 N N N N N Prudential HealthCare HMO Prudential HealthCare HMO 41 Claims processing (2.22) Courteous and helpful office staff (2.55) Overall plan satisfaction (.74) Getting needed care (2.66) Getting care quickly (2.39) Customer service (2.44) Health Maintenance Organization (HMO) and Point of Service (POS) Plans by State How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Primary Care Doctor Office shows what you pay for each Hospital Room Copay/Coinsurance is your share of hospital room and office visit to your primary care doctor. A (*) means a POS plan board charges. This is separate from any per admission deductible. A (*) pays non-plan doctors based on a fee schedule. means a POS plan pays non-plan hospitals based on a fee schedule. Your share of premium Enrollment code Monthly Biweekly Plan name – location Nebraska Care Choices - Northeastern Nebraska GEHA Benefit Plan - Omaha area Telephone number Self only Self & family Self only Self & family Self only Self & family 800/535-6252 800/821-6136 FA1 311 FA2 312 48.34 99.06 139.25 200.78 22.31 45.72 64.27 92.67 Nevada Aetna U.S. Healthcare - Southern Nevada/Las Vegas area Health Plan of Nevada - Las Vegas/Reno areas 800/537-9384 702/871-0999 8L1 NM1 8L2 NM2 39.77 40.41 104.17 103.44 18.35 18.65 48.08 47.74 HMO Colorado/Nevada - Most of Nevada Humana Health Plan, Inc. - Las Vegas area PacifiCare of Nevada - LasVegas/Carson City/Reno 800/438-5270 888/393-6765 800/811-7305 VS1 TL1 K91 VS2 TL2 K92 79.10 36.13 41.43 215.65 103.96 104.96 36.51 16.68 19.12 99.53 47.98 48.44 New Hampshire Harvard Pilgrim Health Care - Southern New Hampshire 888/333-4742 681 682 108.81 359.73 50.22 166.03 New Jersey Aetna U.S. Healthcare-High -All of New Jersey Aetna U.S. Healthcare-Std - All of New Jersey AmeriHealth HMO - All of New Jersey Blue Cross and Blue Shield-Std - All of New Jersey CIGNA CoMED HealthCare - All of New Jersey Physicians Health Services of NJ - All of New Jersey GHI Health Plan - Northern New Jersey Prudential HealthCare HMO - All of New Jersey QualMed Plans for Health - Burlington/Camden/Gloucester Counties 800/537-9384 800/537-9384 800/454-7651 800/624-5078 800/462-6633 877/747-9585 201/623-6000 800/856-0764 800/998-2840 P31 P34 FK1 104 P41 2F1 801 8P1 271 P32 P35 FK2 105 P42 2F2 802 8P2 272 125.58 55.19 128.37 65.09 115.50 47.16 56.80 58.02 96.33 389.22 199.53 283.14 144.69 219.94 113.16 186.72 195.89 239.76 57.96 179.64 25.47 92.09 59.25 130.68 30.04 66.78 53.31 101.51 21.76 26.21 26.78 52.23 86.18 90.41 44.46 110.66 42 Prescription Drugs, Generic, Brand shows what you pay for prescriptions when you use a plan pharmacy. Some plans charge different amounts for refills (*), select drugs and mail orders. In many plans, if you get the brand name instead of a generic substitution, you also pay the difference between the two. Where a copay/coinsurance are both shown, you pay the greater amount. Some POS plans pay a non-plan pharmacy only what they would have paid a plan pharmacy (#); you pay the difference. Primary care doctor office copay Satisfaction Indicators — See page 7 for a description of these results. An (X) means the plan did not conduct the survey as we asked. Accreditation status — N = National Committee for Quality Assurance; J = Joint Commission on Accreditation of Healthcare Organizations Plan performance based on enrollee rating Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) All others- on a scale of 3 (highest) to 1 (lowest) (average for all HMO/POS plans shown in heading) Hospital room copay/coinsurance Plan name Nebraska Care Choices GEHA Benefit Plan - In-Network - Out-of-Network $10 $10 25% Nothing Nothing Nothing $5 $5* $5* $5 $15* $15* X X X X X X X Nevada Aetna U.S. Healthcare - In-Network Health Plan of Nevada - Out-of-Network - In-Network HMO Colorado/Nevada - Out-of-Network Humana Health Plan, Inc. PacifiCare of Nevada $10 $10 20% $10 30% $10 $10 Nothing Nothing 20% Nothing 30% Nothing Nothing $5 $6 $6 $5 N/A $5 $5 $10 $12 $12 $15 N/A $10 $5 0.54 2.42 2.23 2.25 2.35 2.25 2.20 N N 0.64 2.39 2.17 2.25 2.35 2.24 2.13 N New Hampshire Harvard Pilgrim Health Care $10 Nothing $5 $15 0.82 2.78 2.45 2.55 2.64 2.47 2.27 N New Jersey Aetna U.S. Healthcare-High Aetna U.S. Healthcare-Std AmeriHealth HMO Blue Cross and Blue Shield-Std - In-Network - Out-of-Network $10 $15 $10 $10 25% $10 $10 $10 50%* $10 $10 Nothing Nothing Nothing Nothing 30% Nothing Nothing Nothing 50%* Nothing Nothing $5 $10 $5 $5 45% $10 $10 $5 $5 $5 $4 $10 $15 $5 $15 45% $20 $20 $15 $15 $15 $4 0.52 0.66 2.65 2.53 2.36 2.49 2.38 2.48 2.38 2.56 2.17 2.32 1.72 2.16 N N 0.62 0.76 0.75 2.57 2.73 2.80 2.26 2.42 2.42 2.32 2.50 2.50 2.35 2.53 2.62 2.23 2.25 2.29 1.84 2.12 2.23 0.79 0.79 0.78 0.67 2.79 2.79 2.74 2.63 2.48 2.48 2.60 2.35 2.51 2.51 2.60 2.41 2.59 2.59 2.62 2.58 2.46 2.46 2.44 2.34 2.25 2.25 2.21 1.91 N N N N CIGNA CoMED HealthCare Physicians Health Services of NJ GHI Health Plan - In-Network - Out-of-Network Prudential HealthCare HMO QualMed Plans for Health 43 Accreditation status NCQA (N) JCAHO (J) Prescription drugs, generic Prescription drugs, brand How well doctors communicate (2.46) Claims processing (2.22) Courteous and helpful office staff (2.55) Overall plan satisfaction (.74) Getting needed care (2.66) Getting care quickly (2.39) Customer service (2.44) Health Maintenance Organization (HMO) and Point of Service (POS) Plans by State How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Primary Care Doctor Office shows what you pay for each Hospital Room Copay/Coinsurance is your share of hospital room and office visit to your primary care doctor. A (*) means a POS plan board charges. This is separate from any per admission deductible. A (*) pays non-plan doctors based on a fee schedule. means a POS plan pays non-plan hospitals based on a fee schedule. Your share of premium Enrollment code Monthly Biweekly Plan name – location New Mexico Lovelace Health Plan - All of New Mexico Presbyterian Health Plan - All NM counties except Otero & S. Eddy QualMed Plans for Health - Albuquerque/Santa Fe areas Telephone number Self only Self & family Self only Self & family Self only Self & family 505/262-7363 505/923-5678 800/365-0009 Q11 P21 PX1 Q12 P22 PX2 51.52 44.63 41.66 154.55 116.41 109.97 23.78 20.60 19.23 71.33 53.73 50.76 New York Aetna U.S. Healthcare - NYC area and Dutchess/Sullivan/Ulster Blue Choice - Rochester area Blue Cross and Blue Shield-Std - NYC/LI/Rocklnd/Wstchstr/Mid-Hudson BlueChoice HMO - Albany area BlueChoice HMO - Downstate area C.D.P.H.P. - Capital District area CIGNA HealthCare of NY - New York City area GHI Health Plan - All of New York GHI HMO Select - Bronx/Brklyn/Manhattan/Queens/Westchster GHI HMO Select - Capital/Hudson Valley Regions Harvard Pilgrim Health Care - New York adjacent to Massachusetts HealthCarePlan - Western New York HIP of Greater New York - New York City area HMO Blue - Utica/Rome/Central New York areas HMO-CNY - Syracuse/Binghamton/Elmira areas Independent Health Assoc - Metro Hudson Independent Health Assoc - Western New York Kaiser Permanente - Albany/Cooperstown areas Kaiser Permanente - Hudson Valley area Kaiser Permanente - Westchester County MDNY Healthcare, Inc. - Nassau/Suffolk Counties 800/537-9384 716/238-4300 800/522-5566 800/453-0113 800/453-0113 518/862-3750 800/345-9458 212/501-4444 800/438-9269 800/438-9269 888/333-4742 716/847-0881 800/HIP-TALK 800/722-7884 800/447-6369 800/486-5840 800/453-1910 800/597-3872 800/597-3872 800/597-1990 516/454-1900 JC1 MK1 104 5L1 S71 SG1 HU1 801 6V1 X41 681 Q81 511 AH1 EB1 C11 QA1 PW1 QB1 QH1 5Y1 JC2 MK2 105 5L2 S72 SG2 HU2 802 6V2 X42 682 Q82 512 AH2 EB2 C12 QA2 PW2 QB2 QH2 5Y2 53.21 48.53 65.09 48.77 82.44 44.97 52.72 56.80 47.03 49.18 108.81 40.53 46.40 48.71 49.02 63.18 37.50 54.75 64.26 122.05 55.27 153.72 121.36 144.69 130.28 297.85 115.41 177.64 186.72 199.68 131.86 359.73 114.81 175.54 123.95 138.73 240.17 105.30 164.06 212.22 332.06 228.30 24.56 22.40 30.04 22.51 70.95 56.01 66.78 60.13 38.05 137.47 20.76 24.33 26.21 21.71 22.70 53.26 81.99 86.18 92.16 60.86 50.22 166.03 18.70 21.41 22.48 22.62 52.99 81.02 57.21 64.03 29.16 110.85 17.31 25.27 29.66 48.60 75.72 97.95 56.33 153.26 25.51 105.37 44 Prescription Drugs, Generic, Brand shows what you pay for prescriptions when you use a plan pharmacy. Some plans charge different amounts for refills (*), select drugs and mail orders. In many plans, if you get the brand name instead of a generic substitution, you also pay the difference between the two. Where a copay/coinsurance are both shown, you pay the greater amount. Some POS plans pay a non-plan pharmacy only what they would have paid a plan pharmacy (#); you pay the difference. Primary care doctor office copay Satisfaction Indicators — See page 7 for a description of these results. An (X) means the plan did not conduct the survey as we asked. Accreditation status — N = National Committee for Quality Assurance; J = Joint Commission on Accreditation of Healthcare Organizations Plan performance based on enrollee rating Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) All others- on a scale of 3 (highest) to 1 (lowest) (average for all HMO/POS plans shown in heading) Hospital room copay/coinsurance Plan name New Mexico Lovelace Health Plan Presbyterian Health Plan QualMed Plans for Health $10 $10 $10 Nothing Nothing Nothing $5 $5 $5 $10 $15 $8 0.73 2.65 2.33 2.45 2.47 2.28 2.12 0.78 2.63 2.35 2.49 2.46 2.44 2.37 New York Aetna U.S. Healthcare Blue Choice Blue Cross and Blue Shield-Std BlueChoice HMO BlueChoice HMO C.D.P.H.P. CIGNA HealthCare of NY GHI Health Plan GHI HMO Select GHI HMO Select Harvard Pilgrim Health Care HealthCarePlan HIP of Greater New York HMO Blue HMO-CNY Independent Health Assoc Independent Health Assoc Kaiser Permanente Kaiser Permanente Kaiser Permanente MDNY Healthcare, Inc. - In-Network - Out-of-Network - In-Network - Out-of-Network $10 $10 $10 25% $10 $10 $10 $10 $10 50%* $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 Nothing Nothing Nothing 30% Nothing Nothing Nothing Nothing Nothing 50%* Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing $5 $8 $5 45% $5 $5 $5 $7 $5 $5 $10 $10 $5 $5 $10 $5 $5 $5 $5 20% 20% $5 $5 $10 $8 $15 45% $5 $5 $10 $14 $15 $15 $10 $10 $15 $5 $10 $20 $20 $10 $10 20% 20% $10 $15 X X 0.82 0.82 0.71 0.73 0.77 0.77 0.83 0.75 0.75 0.75 X X X 2.78 2.78 2.67 2.78 2.76 2.69 2.79 2.73 2.73 2.73 X X X 2.45 2.56 2.10 2.52 2.49 2.43 2.44 2.49 2.49 2.49 X X X 2.55 2.52 2.31 2.57 2.49 2.56 2.57 2.54 2.54 2.54 X X X 2.64 2.67 2.32 2.69 2.61 2.68 2.67 2.61 2.61 2.61 X X X 2.47 2.53 2.42 2.49 2.47 2.46 2.65 2.39 2.39 2.39 X X X 2.27 2.36 2.12 2.22 2.29 2.19 2.51 2.33 2.33 2.33 X N N N N N N N N N N X X 0.88 0.58 0.75 X X 2.87 2.47 2.80 X X 2.53 2.23 2.42 X X 2.54 2.27 2.50 X X 2.59 2.28 2.62 X X 2.66 2.29 2.29 X X 2.58 1.88 2.23 N N N 0.78 0.87 0.72 2.69 2.80 2.69 2.33 2.55 2.45 2.44 2.52 2.50 2.45 2.64 2.53 2.52 2.67 2.34 2.19 2.64 2.11 N N N 45 Accreditation status NCQA (N) JCAHO (J) Prescription drugs, generic Prescription drugs, brand How well doctors communicate (2.46) Claims processing (2.22) Courteous and helpful office staff (2.55) Overall plan satisfaction (.74) Getting needed care (2.66) Getting care quickly (2.39) Customer service (2.44) J,N Health Maintenance Organization (HMO) and Point of Service (POS) Plans by State How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Primary Care Doctor Office shows what you pay for each Hospital Room Copay/Coinsurance is your share of hospital room and office visit to your primary care doctor. A (*) means a POS plan board charges. This is separate from any per admission deductible. A (*) pays non-plan doctors based on a fee schedule. means a POS plan pays non-plan hospitals based on a fee schedule. Your share of premium Enrollment code Monthly Biweekly Plan name – location New York (continued) MDNY Healthcare, Inc. - Erie/Niagara Counties MVP Health Plan - Eastern Region MVP Health Plan - Central Region MVP Health Plan - Mid-Hudson Region Partners Health Plans - Northern/Capital/Mid-Hudson areas PHP/Mohawk Valley Region - Utica area Physicians Health Srvs of NY - NYC/LI/Dtchs/Orng/Putnm/Rklnd/Wschs Preferred Care - Rochester area Prepaid Health Plan - Syracuse/Southern Tier areas Prudential HealthCare HMO - NYC/Long Island/Hudson Valley Cos. Vytra Health Plans - Queens/Nassau/Suffolk Counties Telephone number Self only Self & family Self only Self & family Self only Self & family 516/454-1900 888/687-6277 888/687-6277 888/687-6277 800/447-8610 315/797-7019 877/747-9585 716/325-3113 315/638-2133 800/856-0764 516/694-4000 8U1 GA1 M91 MX1 7Y1 SH1 PD1 GV1 QE1 9P1 J61 8U2 GA2 M92 MX2 7Y2 SH2 PD2 GV2 QE2 9P2 J62 37.22 53.02 52.84 64.35 60.75 54.87 54.25 43.57 61.32 47.41 72.26 93.77 151.95 150.67 206.59 219.07 200.65 179.68 110.54 233.83 113.87 254.60 17.18 24.47 24.39 29.70 43.28 70.13 69.54 95.35 28.04 101.11 25.32 25.04 20.11 92.61 82.93 51.02 28.30 107.92 21.88 52.56 33.35 117.51 North Carolina Aetna U.S. Healthcare - Charlotte/Metrolina area Doctors Health Plan, Inc. - Greater Tri/Char/Up-Low Cape Fear areas Generations Family Health Plan - Triangle area:Raleigh/Durham/Chapel Hill PARTNERS NHP of NC - Most of North Carolina Prudential HealthCare HMO - Charlotte/Raleigh areas QualChoice of North Carolina - Northwestern North Carolina UHC of North Carolina - Central/Eastern/Western 800/537-9384 800/476-2303 888/256-5563 800/942-5695 800/856-0764 800/816-0911 800/999-1147 3G1 6D1 8B1 EQ1 Q41 7Q1 XM1 3G2 6D2 8B2 EQ2 Q42 7Q2 XM2 47.31 53.32 48.53 53.69 47.12 52.95 72.54 122.79 194.54 121.31 120.81 146.18 134.38 167.92 21.83 24.61 22.40 24.78 21.75 24.44 33.48 56.67 89.79 55.99 55.76 67.47 62.02 77.50 North Dakota Blue Cross and Blue Shield-Std - Fargo/Moorehead area Heart of America HMO - Northcentral North Dakota 800/548-4026 701/776-5848 104 RU1 105 RU2 65.09 51.01 144.69 130.80 30.04 23.54 66.78 60.37 46 Prescription Drugs, Generic, Brand shows what you pay for prescriptions when you use a plan pharmacy. Some plans charge different amounts for refills (*), select drugs and mail orders. In many plans, if you get the brand name instead of a generic substitution, you also pay the difference between the two. Where a copay/coinsurance are both shown, you pay the greater amount. Some POS plans pay a non-plan pharmacy only what they would have paid a plan pharmacy (#); you pay the difference. Primary care doctor office copay Satisfaction Indicators — See page 7 for a description of these results. An (X) means the plan did not conduct the survey as we asked. Accreditation status — N = National Committee for Quality Assurance; J = Joint Commission on Accreditation of Healthcare Organizations Plan performance based on enrollee rating Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) All others- on a scale of 3 (highest) to 1 (lowest) (average for all HMO/POS plans shown in heading) Hospital room copay/coinsurance Plan name New York (continued) MDNY Healthcare, Inc. MVP Health Plan MVP Health Plan MVP Health Plan Partners Health Plans PHP/Mohawk Valley Region Physicians Health Srvs of NY Preferred Care Prepaid Health Plan Prudential HealthCare HMO Vytra Health Plans $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing $5 $5 $5 $5 $5 $5 $10 $5 $5 $5 $5 $15 $10 $10 $10 $10 $10 $20 $10 $10 $15 $5 0.81 0.76 0.84 0.81 0.52 0.84 2.76 2.73 2.79 2.76 2.65 2.75 2.53 2.42 2.52 2.53 2.36 2.38 2.54 2.50 2.53 2.54 2.38 2.49 2.70 2.53 2.60 2.70 2.38 2.53 2.52 2.25 2.57 2.52 2.17 2.46 2.38 2.12 2.52 2.38 1.72 2.18 N N N 0.85 0.85 0.85 2.79 2.79 2.79 2.57 2.57 2.57 2.57 2.57 2.57 2.65 2.65 2.65 2.55 2.55 2.55 2.44 2.44 2.44 N N N North Carolina Aetna U.S. Healthcare Doctors Health Plan, Inc. Generations Family Health Plan PARTNERS NHP of NC Prudential HealthCare HMO QualChoice of North Carolina - In-Network - Out-of-Network $10 $10 $10 $10 $10 $10 $10 $10 Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing $5 $5 $5 $10 $5 $6 $6 $10 $10 $10 $15 $10 $15 $12 $12 $15 0.82 2.83 2.48 2.52 2.62 2.59 2.45 N 0.58 0.77 0.79 0.82 0.56 2.56 2.67 2.60 2.74 2.52 2.44 2.41 2.36 2.46 2.33 2.52 2.47 2.42 2.44 2.37 2.62 2.57 2.47 2.54 2.42 2.12 2.41 2.55 2.54 2.24 1.77 2.54 2.36 2.41 1.94 N N UHC of North Carolina North Dakota Blue Cross and Blue Shield-Std - In-Network - Out-of-Network $10 25% $10 Nothing 30% Nothing $5 45% 50% $15 45% 50% 0.87 2.81 2.50 2.51 2.67 2.52 2.52 Heart of America HMO 47 Accreditation status NCQA (N) JCAHO (J) Prescription drugs, generic Prescription drugs, brand How well doctors communicate (2.46) Claims processing (2.22) Courteous and helpful office staff (2.55) Overall plan satisfaction (.74) Getting needed care (2.66) Getting care quickly (2.39) Customer service (2.44) Health Maintenance Organization (HMO) and Point of Service (POS) Plans by State How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Primary Care Doctor Office shows what you pay for each Hospital Room Copay/Coinsurance is your share of hospital room and office visit to your primary care doctor. A (*) means a POS plan board charges. This is separate from any per admission deductible. A (*) pays non-plan doctors based on a fee schedule. means a POS plan pays non-plan hospitals based on a fee schedule. Your share of premium Enrollment code Monthly Biweekly Plan name – location Ohio Aetna U.S. Healthcare - Most of Ohio AultCare HMO - Stark/Carroll/Holmes/Tuscarawas/Wayne Co Blue Cross and Blue Shield-Std - Cincinnati area CHP of Ohio - Northeastern/Central/Southern Ohio Health Maintenance Plan(HMP) - Most of Ohio Health Plan Upper OH Valley - Eastern Ohio HMO Health Ohio - Northeast Ohio Kaiser Permanente - Akron/Cleveland areas PacifiCare of Ohio, Inc. - Cincinnati area Paramount Health Care - Northwest/North Central Ohio Telephone number Self only Self & family Self only Self & family Self only Self & family 800/537-9384 330/438-6360 888/818-4767 740/348-1449 800/228-4375 800/624-6961 800/258-3466 800/686-7100 800/824-0428 800/462-3589 RD1 3A1 104 MG1 R51 U41 L41 641 R81 U21 Q91 S31 QJ1 5W1 5M1 3U1 VC1 6A1 RD2 3A2 105 MG2 R52 U42 L42 642 R82 U22 Q92 S32 QJ2 5W2 5M2 3U2 VC2 6A2 56.49 51.22 65.09 31.65 54.07 49.18 53.61 50.72 48.72 57.05 54.64 52.22 50.45 44.00 56.93 60.95 70.48 50.76 178.03 125.63 144.69 75.10 122.20 122.90 167.29 124.47 103.76 222.41 131.13 161.13 142.15 121.01 201.22 151.75 173.66 125.80 26.07 23.64 30.04 14.61 24.96 22.70 24.74 23.41 22.49 82.17 57.98 66.78 34.66 56.40 56.72 77.21 57.45 47.89 26.33 102.65 25.22 24.10 23.28 20.31 26.27 28.13 32.53 23.43 60.52 74.37 65.61 55.85 92.87 70.04 80.15 58.06 Prudential HealthCare HMO Midwest - Cleveland/Akron/Youngstown areas 800/856-0764 Prudential HealthCare HMO Midwest - Cincinnati/Southwest areas QualMed Plans for Health OH/WV - Eastern Ohio SummaCare Health Plan - Northern Ohio Super Med HMO - Northeast Ohio United Health Care of Ohio - Cincinnati/Dayton/Springfield/Toledo United Health Care of Ohio - Central/South Central Ohio Vantage Health Plan - North Central Ohio 800/856-0764 800/333-3930 330/996-8410 800/574-2583 800/231-2918 800/225-7951 800/878-4394 Oklahoma Aetna U.S. Healthcare - Northeast Oklahoma Blue Cross and Blue Shield-Std - Lawton/OK City/Tulsa/Other areas BlueLincs HMO - OK City/Tulsa/Lawton/SW Oklahoma areas CommunityCare HMO - Oklahoma City/Tulsa areas Healthcare Oklahoma - Oklahoma City/Lawton/Tulsa/Enid areas PacifiCare OK - Oklahoma City/Tulsa areas Prudential HealthCare HMO - Oklahoma City area Prudential HealthCare HMO - Tulsa area 800/537-9384 800/722-3130 800/722-5675 800/777-4890 800/535-2244 800/825-9355 800/856-0764 800/856-0764 8V1 104 N51 7C1 6W1 2N1 RR1 RS1 8V2 105 N52 7C2 6W2 2N2 RR2 RS2 38.51 65.09 48.63 47.01 41.46 39.80 47.48 53.63 99.65 144.69 106.86 121.16 107.72 103.48 126.38 118.69 17.77 30.04 22.44 21.70 19.13 18.37 21.91 24.75 45.99 66.78 49.32 55.92 49.72 47.76 58.33 54.78 48 Prescription Drugs, Generic, Brand shows what you pay for prescriptions when you use a plan pharmacy. Some plans charge different amounts for refills (*), select drugs and mail orders. In many plans, if you get the brand name instead of a generic substitution, you also pay the difference between the two. Where a copay/coinsurance are both shown, you pay the greater amount. Some POS plans pay a non-plan pharmacy only what they would have paid a plan pharmacy (#); you pay the difference. Primary care doctor office copay Satisfaction Indicators — See page 7 for a description of these results. An (X) means the plan did not conduct the survey as we asked. Accreditation status — N = National Committee for Quality Assurance; J = Joint Commission on Accreditation of Healthcare Organizations Plan performance based on enrollee rating Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) All others- on a scale of 3 (highest) to 1 (lowest) (average for all HMO/POS plans shown in heading) Hospital room copay/coinsurance Plan name Ohio Aetna U.S. Healthcare AultCare HMO Blue Cross and Blue Shield-Std CHP of Ohio Health Maintenance Plan(HMP) Health Plan Upper OH Valley HMO Health Ohio Kaiser Permanente PacifiCare of Ohio, Inc. Paramount Health Care Prudential HealthCare HMO Midwest Prudential HealthCare HMO Midwest QualMed Plans for Health OH/WV SummaCare Health Plan Super Med HMO United Health Care of Ohio United Health Care of Ohio Vantage Health Plan - In-Network - Out-of-Network $10 $10 $10 25% $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 Nothing Nothing Nothing 30% Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing $5 $5 $5 45% $5 $5 $5 $5 $5 $10 $5 $5 $5 $10 $5 $5 $10 $10 $10 $10 $10 $15 45% $5 $12 $10 $5 $5 $10 $10 $15 $15 $10 $10 $5 $15 $15 $10 0.62 0.82 0.72 0.78 0.71 2.57 2.64 2.72 2.66 2.72 2.45 2.51 2.46 2.48 2.46 2.49 2.55 2.45 2.55 2.45 2.56 2.63 2.53 2.64 2.53 2.28 2.54 2.37 2.62 2.37 1.84 2.47 2.15 2.44 2.15 0.72 0.78 0.72 0.86 0.66 0.66 0.69 2.64 2.70 2.69 2.82 2.65 2.65 2.55 2.37 2.35 2.48 2.48 2.40 2.40 2.57 2.45 2.39 2.49 2.56 2.38 2.38 2.56 2.54 2.58 2.64 2.58 2.49 2.49 2.69 2.32 2.58 2.39 2.65 2.24 2.24 2.28 2.20 2.29 2.15 2.54 1.91 1.91 2.30 0.76 0.73 2.79 2.74 2.44 2.46 2.42 2.48 2.53 2.58 2.49 2.42 2.22 2.18 Oklahoma Aetna U.S. Healthcare Blue Cross and Blue Shield-Std BlueLincs HMO CommunityCare HMO Healthcare Oklahoma PacifiCare OK Prudential HealthCare HMO Prudential HealthCare HMO - In-Network - Out-of-Network $10 $10 25% $10 $10 $10 $10 $10 $10 Nothing Nothing 30% Nothing Nothing Nothing Nothing Nothing Nothing $5 $5 45% $5 $5 $5 $5 $5 $5 $10 $15 45% $10 $5 $10 $10 $15 $15 0.75 0.71 0.76 0.76 2.70 2.56 2.63 2.63 2.43 2.28 2.36 2.36 2.53 2.39 2.42 2.42 2.58 2.52 2.55 2.55 2.43 2.45 2.38 2.38 2.27 2.35 1.98 1.98 N N N 0.67 2.55 2.35 2.39 2.55 2.33 2.71 N J 0.69 2.57 2.43 2.46 2.52 2.22 2.86 49 Accreditation status NCQA (N) JCAHO (J) Prescription drugs, generic Prescription drugs, brand How well doctors communicate (2.46) Claims processing (2.22) Courteous and helpful office staff (2.55) Overall plan satisfaction (.74) Getting needed care (2.66) Getting care quickly (2.39) Customer service (2.44) N N N N N N N N N N N N Health Maintenance Organization (HMO) and Point of Service (POS) Plans by State How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Primary Care Doctor Office shows what you pay for each Hospital Room Copay/Coinsurance is your share of hospital room and office visit to your primary care doctor. A (*) means a POS plan board charges. This is separate from any per admission deductible. A (*) pays non-plan doctors based on a fee schedule. means a POS plan pays non-plan hospitals based on a fee schedule. Your share of premium Enrollment code Monthly Biweekly Plan name – location Oregon Kaiser Permanente-High -Portland/Salem areas Kaiser Permanente-Std - Portland/Salem areas PacifiCare of Oregon - Counties along I-5 Corridor Telephone number Self only Self & family Self only Self & family Self only Self & family 800/813-2000 800/813-2000 800/932-3004 571 574 7Z1 572 575 7Z2 64.44 48.15 51.27 158.58 110.50 113.59 29.74 22.22 23.66 73.19 51.00 52.42 Pennsylvania Aetna U.S. Healthcare-High -Southwestern/Central/NE PA Aetna U.S. Healthcare-Std - Southwestern/Central/NE PA Aetna U.S. Healthcare-High -Southeastern PA Aetna U.S. Healthcare-Std - Southeastern PA First Priority Hlth - Northeastern Pennsylvania Free State Health Plan - Southern Pennsylvania HealthAmerica Pennsylvania - Greater Pittsburgh area HealthAmerica Pennsylvania - Central Pennsylvania HealthGuard - Berks/Cmbrlnd/Dauphine/Lanc/Lebanon/York Keystone Health Plan Central - Harrisburg/Norther Region/Lehigh Valley Keystone Health Plan East - Philadelphia area KeystoneBlue - Pittsburgh/Altoona/Erie areas Penn State Geisinger HlthPlan - Central/Northeastern Pennsylvania Prudential HealthCare HMO - Philadelphia/Lehigh Valley areas QualMed Plans for Health -Pa. - Pittsburgh area QualMed Plans for Health - Southern Pennsylvania QualMed Plans for Health - Scranton/Wilkes Barre UPMC Health Plan - Pittsburgh Area 800/537-9384 800/537-9384 800/537-9384 800/537-9384 800/822-8753 800/445-6036 800/735-4404 800/788-8445 800/822-0350 800/622-2843 800/227-3115 800/421-0959 800/447-4000 800/856-0764 800/333-3930 800/998-2840 800/998-2840 412/454-7652 KL1 KL4 SU1 SU4 C81 LD1 261 SW1 NQ1 S41 ED1 EF1 N91 VV1 241 271 2K1 8W1 KL2 KL5 SU2 SU5 C82 LD2 262 SW2 NQ2 S42 ED2 EF2 N92 VV2 242 272 2K2 8W2 49.26 41.39 80.12 53.61 52.14 99.82 47.46 51.21 45.11 63.85 50.46 52.20 35.39 52.57 42.63 96.33 47.69 39.29 143.15 110.39 259.72 172.55 156.37 235.78 123.40 151.34 117.55 187.03 151.12 238.25 107.96 197.06 104.44 239.76 115.78 116.43 22.73 19.10 66.07 50.95 36.98 119.87 24.74 24.06 79.64 72.17 46.07 108.82 21.90 23.64 20.82 29.47 23.29 56.95 69.85 54.25 86.32 69.75 24.09 109.96 16.33 24.26 19.67 49.83 90.95 48.20 44.46 110.66 22.01 18.13 53.44 53.74 50 Prescription Drugs, Generic, Brand shows what you pay for prescriptions when you use a plan pharmacy. Some plans charge different amounts for refills (*), select drugs and mail orders. In many plans, if you get the brand name instead of a generic substitution, you also pay the difference between the two. Where a copay/coinsurance are both shown, you pay the greater amount. Some POS plans pay a non-plan pharmacy only what they would have paid a plan pharmacy (#); you pay the difference. Primary care doctor office copay Satisfaction Indicators — See page 7 for a description of these results. An (X) means the plan did not conduct the survey as we asked. Accreditation status — N = National Committee for Quality Assurance; J = Joint Commission on Accreditation of Healthcare Organizations Plan performance based on enrollee rating Accreditation status NCQA (N) JCAHO (J) Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) All others- on a scale of 3 (highest) to 1 (lowest) (average for all HMO/POS plans shown in heading) Hospital room copay/coinsurance Prescription drugs, generic Prescription drugs, brand How well doctors communicate (2.46) Plan name Oregon Kaiser Permanente-High Kaiser Permanente-Std PacifiCare of Oregon $10 $12 $10 Nothing Nothing Nothing $10 $15 $10 $10 $15 $15 0.76 0.76 2.69 2.69 2.34 2.34 2.39 2.39 2.51 2.51 2.62 2.62 Claims processing (2.22) Courteous and helpful office staff (2.55) Overall plan satisfaction (.74) Getting needed care (2.66) Getting care quickly (2.39) Customer service (2.44) 2.58 2.58 N N Pennsylvania Aetna U.S. Healthcare-High Aetna U.S. Healthcare-Std Aetna U.S. Healthcare-High Aetna U.S. Healthcare-Std First Priority Hlth - In-Network Free State Health Plan - Out-of-Network HealthAmerica Pennsylvania HealthAmerica Pennsylvania HealthGuard Keystone Health Plan Central Keystone Health Plan East KeystoneBlue - In-Network Penn State Geisinger HlthPlan - Out-of-Network Prudential HealthCare HMO QualMed Plans for Health -Pa. QualMed Plans for Health QualMed Plans for Health UPMC Health Plan $10 $15 $10 $15 $10 $10 20% $10 $10 $10 $10 $10 $10 $10 20% $10 $10 $10 $10 $10 Nothing Nothing Nothing Nothing Nothing Nothing 20% Nothing Nothing Nothing Nothing Nothing Nothing Nothing 20% Nothing Nothing Nothing Nothing Nothing $5 $10 $5 $10 $8 $10 $10 $5 $5 $5 $10 $5 $8 $8 N/A $5 $5 $4 $4 $5 $10 $15 $10 $15 $8 $20 $20 $10 $10 $15 $10 $5 $14 $8 N/A $15 $8 $4 $4 $15 0.52 0.59 0.66 2.65 2.69 2.53 2.36 2.48 2.49 2.38 2.55 2.48 2.38 2.59 2.56 2.17 2.21 2.32 1.72 1.87 2.16 N N N 0.76 0.76 0.85 0.84 0.77 0.72 0.85 2.73 2.73 2.75 2.73 2.81 2.74 2.79 2.49 2.49 2.53 2.49 2.46 2.43 2.54 2.49 2.49 2.49 2.47 2.58 2.46 2.55 2.59 2.59 2.59 2.54 2.60 2.54 2.65 2.40 2.40 2.66 2.55 2.52 2.47 2.55 2.34 2.34 2.52 2.47 2.37 2.48 2.48 N N N N N N 0.74 0.74 0.77 0.77 0.78 0.74 2.72 2.72 2.76 2.76 2.77 2.69 2.46 2.46 2.53 2.53 2.59 2.38 2.51 2.51 2.50 2.50 2.70 2.53 2.58 2.58 2.56 2.56 2.67 2.56 2.38 2.38 2.45 2.45 2.50 2.43 2.10 2.10 2.40 2.40 2.47 2.25 N N N N N N 51 Health Maintenance Organization (HMO) and Point of Service (POS) Plans by State How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Primary Care Doctor Office shows what you pay for each Hospital Room Copay/Coinsurance is your share of hospital room and office visit to your primary care doctor. A (*) means a POS plan board charges. This is separate from any per admission deductible. A (*) pays non-plan doctors based on a fee schedule. means a POS plan pays non-plan hospitals based on a fee schedule. Your share of premium Enrollment code Monthly Biweekly Plan name – location Puerto Rico Triple-S - All of Puerto Rico Telephone number Self only Self & family Self only Self & family Self only Self & family 787/749-4777 891 892 46.14 99.10 21.30 45.74 United HealthCare Puerto Rico - All of Puerto Rico 888/761-4139 7U1 7U2 39.07 84.27 18.03 38.89 Rhode Island Aetna U.S. Healthcare - All of Rhode Island Blue Chip, Coord Hlth Partners - All of Rhode Island Harvard Pilgrim Hlth Care-NE - All of Rhode Island 800/537-9384 401/459-5500 888/333-4742 5U1 DA1 701 5U2 DA2 702 40.36 54.31 71.46 106.79 174.89 200.18 18.63 25.06 32.98 49.29 80.72 92.39 South Carolina Doctors Health Plan, Inc. - York County PARTNERS NHP of NC - Upstate South Carolina Prudential HealthCare HMO - York County 800/476-2303 800/942-5695 800/856-0764 6D1 EQ1 Q41 6D2 EQ2 Q42 53.32 53.69 47.12 194.54 120.81 146.18 24.61 24.78 21.75 89.79 55.76 67.47 South Dakota Care Choices - Clay/Union Counties 800/535-6252 FA1 FA2 48.34 139.25 22.31 64.27 Tennessee Aetna U.S. Healthcare - Nashville/Middle Tennessee areas American Healthcare Trust, Inc - Knoxville/Memphis/Nashville areas John Deere Health Plan - Chattanooga/Kingsprt/Knoxville/Grnville Prudential HealthCare HMO - Nashville area Prudential HealthCare HMO - Memphis area 800/537-9384 888/523-9527 800/247-9110 800/856-0764 800/856-0764 6J1 4U1 3J1 UA1 UB1 6J2 4U2 3J2 UA2 UB2 40.62 38.79 51.38 49.98 42.21 113.17 107.66 173.66 182.52 133.21 18.75 17.90 23.71 23.07 19.48 52.23 49.69 80.15 84.24 61.48 52 Prescription Drugs, Generic, Brand shows what you pay for prescriptions when you use a plan pharmacy. Some plans charge different amounts for refills (*), select drugs and mail orders. In many plans, if you get the brand name instead of a generic substitution, you also pay the difference between the two. Where a copay/coinsurance are both shown, you pay the greater amount. Some POS plans pay a non-plan pharmacy only what they would have paid a plan pharmacy (#); you pay the difference. Primary care doctor office copay Satisfaction Indicators — See page 7 for a description of these results. An (X) means the plan did not conduct the survey as we asked. Accreditation status — N = National Committee for Quality Assurance; J = Joint Commission on Accreditation of Healthcare Organizations Plan performance based on enrollee rating Accreditation status NCQA (N) JCAHO (J) Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) All others- on a scale of 3 (highest) to 1 (lowest) (average for all HMO/POS plans shown in heading) Hospital room copay/coinsurance Prescription drugs, generic Prescription drugs, brand How well doctors communicate (2.46) Plan name Puerto Rico Triple-S - In-Network - Out-of-Network - In-Network United HealthCare Puerto Rico - Out-of-Network $7.50 $7.50 $7.50 20% Nothing All over $60/day Nothing 20% Nothing Nothing Nothing 20% $10 $10 $5 20% 0.90 2.93 2.27 2.56 2.55 2.64 Rhode Island Aetna U.S. Healthcare Blue Chip, Coord Hlth Partners - In-Network - Out-of-Network $10 $10 20% $10 Nothing Nothing 20% Nothing $5 $5 $5 $5 $10 $15 $15 $15 0.84 2.79 2.46 2.52 2.59 2.46 2.26 N 0.74 2.75 2.48 2.58 2.64 2.45 2.25 N Harvard Pilgrim Hlth Care-NE South Carolina Doctors Health Plan, Inc. PARTNERS NHP of NC Prudential HealthCare HMO $10 $10 $10 Nothing Nothing Nothing $5 $10 $5 $10 $10 $15 0.77 0.82 0.56 2.67 2.74 2.52 2.41 2.46 2.33 2.47 2.44 2.37 2.57 2.54 2.42 2.41 2.54 2.24 2.54 2.41 1.94 N N South Dakota Care Choices $10 Nothing $5 $5 X X X X X X X Tennessee Aetna U.S. Healthcare American Healthcare Trust, Inc John Deere Health Plan Prudential HealthCare HMO Prudential HealthCare HMO $10 $10 $10 $10 $10 Nothing Nothing Nothing Nothing Nothing $5 $10 $5 $5 $5 $10 $10 $15 $15 $15 0.76 0.64 2.70 2.64 2.40 2.82 2.49 2.37 2.58 2.38 2.40 2.25 2.91 1.89 N N 0.61 2.64 2.36 2.60 2.54 2.28 1.89 53 Claims processing (2.22) Courteous and helpful office staff (2.55) Overall plan satisfaction (.74) Getting needed care (2.66) Getting care quickly (2.39) Customer service (2.44) 2.19 Health Maintenance Organization (HMO) and Point of Service (POS) Plans by State How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Primary Care Doctor Office shows what you pay for each Hospital Room Copay/Coinsurance is your share of hospital room and office visit to your primary care doctor. A (*) means a POS plan board charges. This is separate from any per admission deductible. A (*) pays non-plan doctors based on a fee schedule. means a POS plan pays non-plan hospitals based on a fee schedule. Your share of premium Enrollment code Monthly Biweekly Plan name – location Texas Aetna U.S. Healthcare - Houston area Aetna U.S. Healthcare - San Antonio area Aetna U.S. Healthcare - Dallas/Ft. Worth areas APWU Health Plan - Eastern and Central Texas FIRSTCARE - Waco area FIRSTCARE - West Texas Humana Health Plan of Texas - Dallas/Ft. Worth and Austin areas Humana Health Plan of Texas - Corpus Christi area Humana Health Plan of Texas - Houston/Beaumont area Humana Health Plan of Texas - San Antonio area NYLCare Health Plans SW - Dallas/Ft. Worth/East & West Texas NYLCare HP of the Gulf Coast - Houston area NYLCare HP of the Gulf Coast - Austin/C.Christi/S.Antonio/Victoria NYLCare HP of the Gulf Coast - Beaumont/Lufkin areas PacifiCare of Texas - S Ant/Hston/Glvston/Da/Ft Wor/Glf Coast Prudential HealthCare HMO - Houston area Prudential HealthCare HMO - San Antonio area Scott and White - Austin/Bryan/ColSta./Killeen/Temple/Waco Texas Health Choice, L. C. - Houston/Beaumont areas Texas Health Choice, L. C. - Dallas/Ft. Worth areas Telephone number Self only Self & family Self only Self & family Self only Self & family 800/537-9384 800/537-9384 800/537-9384 800/222-2798 800/884-4901 800/884-4901 888/393-6765 888/393-6765 888/393-6765 888/393-6765 800/486-3040 800/833-5318 800/833-5318 800/833-5318 800/825-9355 800/856-0764 800/856-0764 254/298-3000 713/952-6868 972/458-5000 5B1 8X1 TS1 471 6U1 CK1 TW1 TX1 UE1 UR1 V21 UM1 ZE1 ZF1 GF1 UP1 VX1 UF1 2T1 UK1 5B2 8X2 TS2 472 6U2 CK2 TW2 TX2 UE2 UR2 V22 UM2 ZE2 ZF2 GF2 UP2 VX2 UF2 2T2 UK2 47.36 40.80 53.22 86.06 49.92 76.05 55.21 54.45 41.48 44.41 56.03 54.07 36.14 45.41 39.31 47.38 46.78 150.71 37.15 43.98 149.74 114.40 215.43 182.43 107.23 148.96 186.27 141.53 116.29 114.15 122.76 181.18 94.04 101.27 102.20 169.56 121.54 451.25 95.09 112.58 21.86 18.83 24.56 39.72 23.04 35.10 25.48 25.13 19.14 20.50 25.86 24.96 16.68 20.96 18.14 21.87 21.59 69.11 52.80 99.43 84.20 49.49 68.75 85.97 65.32 53.67 52.68 56.66 83.62 43.40 46.74 47.17 78.26 56.09 69.56 208.27 17.14 20.30 43.89 51.96 Utah Altius Health Plans - Wasatch Front 800/377-4161 9K1 9K2 82.64 176.28 38.14 81.36 Vermont Harvard Pilgrim Health Care - Southern Vermont MVP Health Plan - Bennington/Chittenden/Rutland/Wash. Cos. 888/333-4742 888/687-6277 681 VW1 682 VW2 108.81 63.40 359.73 209.21 50.22 166.03 29.26 96.56 54 Prescription Drugs, Generic, Brand shows what you pay for prescriptions when you use a plan pharmacy. Some plans charge different amounts for refills (*), select drugs and mail orders. In many plans, if you get the brand name instead of a generic substitution, you also pay the difference between the two. Where a copay/coinsurance are both shown, you pay the greater amount. Some POS plans pay a non-plan pharmacy only what they would have paid a plan pharmacy (#); you pay the difference. Primary care doctor office copay Satisfaction Indicators — See page 7 for a description of these results. An (X) means the plan did not conduct the survey as we asked. Accreditation status — N = National Committee for Quality Assurance; J = Joint Commission on Accreditation of Healthcare Organizations Plan performance based on enrollee rating Accreditation status NCQA (N) JCAHO (J) Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) All others- on a scale of 3 (highest) to 1 (lowest) (average for all HMO/POS plans shown in heading) Hospital room copay/coinsurance Prescription drugs, generic Prescription drugs, brand How well doctors communicate (2.46) Plan name Texas Aetna U.S. Healthcare Aetna U.S. Healthcare Aetna U.S. Healthcare APWU Health Plan FIRSTCARE FIRSTCARE Humana Health Plan of Texas Humana Health Plan of Texas Humana Health Plan of Texas Humana Health Plan of Texas NYLCare Health Plans SW NYLCare HP of the Gulf Coast NYLCare HP of the Gulf Coast NYLCare HP of the Gulf Coast PacifiCare of Texas Prudential HealthCare HMO Prudential HealthCare HMO Scott and White Texas Health Choice, L. C. Texas Health Choice, L. C. - In-Network - Out-of-Network $10 $10 $10 $10 30% $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 Nothing Nothing Nothing Nothing 30% Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing $5 $5 $5 20%* 40% $5 $5 $5 $5 $5 $5 $5 $5 $5 $5 $5 $5 $5 $10 $6 $6 $10 $10 $10 20%* 40% $15 $15 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $15 $12 $12 0.76 2.56 2.36 2.32 2.50 2.28 2.24 N X 0.68 0.75 0.88 X 2.60 2.65 2.82 X 2.10 2.28 2.48 X 2.25 2.44 2.56 X 2.37 2.50 2.68 X 2.32 2.44 2.54 X 1.97 2.24 2.60 N N N 0.82 0.82 0.64 0.79 0.59 0.72 0.70 X 2.72 2.72 2.57 2.57 2.43 2.44 2.53 X 2.46 2.46 2.38 2.34 2.24 2.22 2.28 X 2.53 2.53 2.46 2.46 2.39 2.36 2.36 X 2.62 2.62 2.55 2.59 2.43 2.45 2.47 X 2.61 2.61 2.19 2.43 2.23 2.38 2.43 X 2.53 2.53 2.25 2.30 1.94 2.16 2.22 X N N N N N N N 0.64 2.59 2.32 2.44 2.54 2.32 2.88 N Utah Altius Health Plans $10 Nothing $10 $15 0.69 2.55 2.36 2.42 2.53 2.17 2.36 N Vermont Harvard Pilgrim Health Care MVP Health Plan $10 $10 Nothing Nothing $5 $5 $15 $10 0.82 2.78 2.45 2.55 2.64 2.47 2.27 N N 55 Claims processing (2.22) Courteous and helpful office staff (2.55) Overall plan satisfaction (.74) Getting needed care (2.66) Getting care quickly (2.39) Customer service (2.44) Health Maintenance Organization (HMO) and Point of Service (POS) Plans by State How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Primary Care Doctor Office shows what you pay for each Hospital Room Copay/Coinsurance is your share of hospital room and office visit to your primary care doctor. A (*) means a POS plan board charges. This is separate from any per admission deductible. A (*) pays non-plan doctors based on a fee schedule. means a POS plan pays non-plan hospitals based on a fee schedule. Your share of premium Enrollment code Monthly Biweekly Plan name – location Virginia Aetna U.S. Healthcare-High -N.VA/Fredericksburg Aetna U.S. Healthcare-Std - N.VA/Fredericksburg Aetna U.S. Healthcare - Richmond/Central/Tri-City areas CapitalCare - Northern Virginia CIGNA HealthCare of VA - Southeastern Virginia CIGNA HealthCare of VA - Central Virginia George Washington Univ HP - N. Virginia/Fredericksburg/Winchester Healthkeepers - Peninsula/Richmond/Frdburg/Roanoke areas John Deere Health Plan - Bristol/Roanoke areas Kaiser Permanente - Washington, DC area MD-IPA - N.VA/Cntrl VA/Richmond/Tidewater/Roanoke OPTIMA Health Plan - Peninsula/Southside Hampton Roads PARTNERS NHP of NC - Southwest Virginia Piedmont Community Healthcare - Lynchburg Prudential HealthCare HMO - Washington, DC area/Northern Virginia Prudential HealthCare HMO - Richmond/Tri-City areas Telephone number Self only Self & family Self only Self & family Self only Self & family 800/537-9384 800/537-9384 800/537-9384 800/680-9495 800/533-1708 800/533-1708 301/941-2000 800/421-1880 800/247-9110 301/468-6000 800/251-0956 757/552-7500 800/942-5695 888/674-3368 800/856-0764 800/856-0764 JN1 JN4 Z11 2G1 W21 W31 E51 X81 3J1 E31 JP1 9R1 EQ1 2C1 JB1 V61 JN2 JN5 Z12 2G2 W22 W32 E52 X82 3J2 E32 JP2 9R2 EQ2 2C2 JB2 V62 63.63 40.46 55.19 56.03 45.40 48.63 52.79 47.77 51.38 50.92 56.66 61.40 53.69 48.59 72.06 51.81 167.55 94.90 172.83 167.85 101.52 109.69 136.30 121.31 173.66 125.88 162.82 168.18 120.81 182.39 153.29 178.03 29.37 18.67 25.47 25.86 20.95 22.44 24.36 22.05 23.71 23.50 26.15 28.34 24.78 22.42 33.26 23.91 77.33 43.80 79.77 77.47 46.85 50.63 62.91 55.99 80.15 58.10 75.15 77.62 55.76 84.18 70.75 82.17 Washington Aetna U.S. Healthcare - Western/Southeast Washington First Choice Health Plan - Greater Seattle area Group Health Cooperative - Most of Western Washington Group Health Cooperative - Central WA/Spokane/Colville/Pullman Kaiser Permanente-High -Vancouver/Longview Kaiser Permanente-Std - Vancouver/Longview Kitsap Physicians Service-High -Kitsap/Mason/Jefferson Counties Kitsap Physicians Service-Std - Kitsap/Mason/Jefferson Counties PacifiCare of Oregon - Clark County PacifiCare of Washington - Puget Sound/Most West WA/Walla Walla Premera HealthPlus - Most of Washington QualMed WA Health Plan - Most of Washington 56 800/537-9384 800/783-7312 206/448-4140 800/497-2210 800/813-2000 800/813-2000 800/552-7114 800/552-7114 800/932-3004 800/932-3004 800/527-6675 800/869-7165 8J1 5G1 541 VR1 571 574 VT1 VT4 7Z1 WB1 8F1 TM1 8J2 5G2 542 VR2 572 575 VT2 VT5 7Z2 WB2 8F2 TM2 39.63 53.56 61.75 65.71 64.44 48.15 154.44 56.02 51.27 42.89 53.99 69.81 103.79 175.80 143.41 228.00 158.58 110.50 314.40 122.42 113.59 111.08 140.59 203.41 18.29 24.72 28.50 47.90 81.14 66.19 30.33 105.23 29.74 22.22 73.19 51.00 71.28 145.11 25.86 23.66 19.80 24.92 32.22 56.50 52.42 51.27 64.89 93.88 Prescription Drugs, Generic, Brand shows what you pay for prescriptions when you use a plan pharmacy. Some plans charge different amounts for refills (*), select drugs and mail orders. In many plans, if you get the brand name instead of a generic substitution, you also pay the difference between the two. Where a copay/coinsurance are both shown, you pay the greater amount. Some POS plans pay a non-plan pharmacy only what they would have paid a plan pharmacy (#); you pay the difference. Primary care doctor office copay Satisfaction Indicators — See page 7 for a description of these results. An (X) means the plan did not conduct the survey as we asked. Accreditation status — N = National Committee for Quality Assurance; J = Joint Commission on Accreditation of Healthcare Organizations Plan performance based on enrollee rating Accreditation status NCQA (N) JCAHO (J) Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) All others- on a scale of 3 (highest) to 1 (lowest) (average for all HMO/POS plans shown in heading) Hospital room copay/coinsurance Prescription drugs, generic Prescription drugs, brand How well doctors communicate (2.46) Plan name Virginia Aetna U.S. Healthcare-High Aetna U.S. Healthcare-Std Aetna U.S. Healthcare CapitalCare CIGNA HealthCare of VA CIGNA HealthCare of VA George Washington Univ HP Healthkeepers John Deere Health Plan Kaiser Permanente MD-IPA OPTIMA Health Plan PARTNERS NHP of NC Piedmont Community - In-Network Healthcare - Out-of-Network Prudential HealthCare HMO Prudential HealthCare HMO $10 $15 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 $10 30% $10 $10 Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing 10% 30% Nothing Nothing $5 $10 $5 $5 $5 $5 $5 $5 $5 $7 $5 $8 $10 $5 $5 $5 $5 $10 $15 $10 $10 $10 $10 $15 $10 $15 $7 $10 $8 $10 $15 $15 $15 $15 0.76 0.76 0.63 0.75 0.72 0.72 0.69 0.75 2.63 2.63 2.62 2.59 2.64 2.64 2.66 2.77 2.33 2.33 2.40 2.37 2.37 2.37 2.29 2.40 2.41 2.41 2.47 2.45 2.40 2.40 2.39 2.47 2.47 2.47 2.52 2.58 2.49 2.49 2.36 2.57 2.42 2.42 2.18 2.42 2.45 2.45 2.22 2.45 Claims processing (2.22) Courteous and helpful office staff (2.55) Overall plan satisfaction (.74) Getting needed care (2.66) Getting care quickly (2.39) Customer service (2.44) 2.23 2.23 1.96 2.32 2.21 2.21 2.64 2.33 N N N N N N N N 0.78 0.74 0.84 0.82 2.63 2.65 2.75 2.74 2.35 2.42 2.40 2.46 2.36 2.46 2.53 2.44 2.55 2.56 2.59 2.54 2.50 2.53 2.63 2.54 2.76 2.33 2.46 2.41 N N N N 0.69 0.69 2.65 2.65 2.38 2.38 2.46 2.46 2.58 2.58 2.23 2.23 1.89 1.89 N N Washington Aetna U.S. Healthcare First Choice Health Plan Group Health Cooperative Group Health Cooperative Kaiser Permanente-High Kaiser Permanente-Std Kitsap Physicians Service-High Kitsap Physicians Service-Std PacifiCare of Oregon PacifiCare of Washington Premera HealthPlus QualMed WA Health Plan $10 $10 $10 $10 $10 $12 $10 20% $10 $10 $10 $10 Nothing Nothing Nothing Nothing Nothing Nothing Nothing 20% Nothing Nothing Nothing Nothing $5 $5 $7 $7 $10 $15 50% 20% $10 $5 $5 $10 57 $10 $10 $7 $7 $10 $15 50% 20% $15 $10 $10 $20 0.69 X 0.73 2.60 X 2.60 2.34 X 2.56 2.45 X 2.56 2.56 X 2.66 2.45 X 2.42 2.38 X 2.25 N 0.64 0.78 0.79 0.76 0.76 0.86 0.86 2.56 2.74 2.74 2.69 2.69 2.87 2.87 2.37 2.47 2.49 2.34 2.34 2.58 2.58 2.51 2.54 2.57 2.39 2.39 2.52 2.52 2.57 2.68 2.66 2.51 2.51 2.74 2.74 2.25 2.42 2.55 2.62 2.62 2.54 2.54 1.98 2.34 2.47 2.58 2.58 2.54 2.54 N N N N N Health Maintenance Organization (HMO) and Point of Service (POS) Plans by State How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Primary Care Doctor Office shows what you pay for each Hospital Room Copay/Coinsurance is your share of hospital room and office visit to your primary care doctor. A (*) means a POS plan board charges. This is separate from any per admission deductible. A (*) pays non-plan doctors based on a fee schedule. means a POS plan pays non-plan hospitals based on a fee schedule. Your share of premium Enrollment code Monthly Biweekly Plan name – location West Virginia Carelink Health Plans - Northern/Central/Southern West Virginia Free State Health Plan - Northeastern West Virginia Health Plan Upper OH Valley - Northern/Central West Virginia HealthAssurance HMO - North Central/Panhandle QualMed Plans for Health OH/WV - Panhandle/N. Central/Charleston area SuperBlue HMO - Chas/Pkg/Mgtn/Beck/Clkb/Whlg/Lew/Fmt/Blu Telephone number Self only Self & family Self only Self & family Self only Self & family 800/348-2922 800/445-6036 800/624-6961 800/735-2202 800/333-3930 800/391-4441 4C1 LD1 U41 6L1 QJ1 8T1 4C2 LD2 U42 6L2 QJ2 8T2 44.35 99.82 49.18 55.70 50.45 54.32 141.31 235.78 122.90 181.13 142.15 164.82 20.47 65.22 46.07 108.82 22.70 25.71 23.28 25.07 56.72 83.60 65.61 76.07 Wisconsin Compcare Health Services - Southeastern Wisconsin Compcare Health Services - Northcentral/Northwest Wisconsin Dean Health Plan - South Central Wisconsin Family Health Plan - Milwaukee area Group Health Coop - Greater Dane and Jefferson Counties Group Hlth Coop/Eau Claire - West Central Wisconsin HealthPartners Classic-High -Pierce/St. Croix Counties HealthPartners Classic-Std - Pierce/St. Croix Counties HealthPartners Health Plan - West Central Wisconsin Humana Wisconsin Hlth Org. - Southeastern Wisconsin Physicians Plus HMO - South Central/Southeastern Wisconsin Unity Health Plans - Southern/Central Wisconsin Valley Health Plan - Western Wisconsin 414/226-6744 800/242-9635 800/279-1301 414/256-0040 608/251-3356 715/552-4300 612/883-5000 612/883-5000 612/883-5000 888/393-6765 608/282-8920 800/362-3310 715/832-3235 691 6X1 WD1 WH1 WJ1 WT1 531 534 HQ1 X11 7P1 W41 VH1 692 6X2 WD2 WH2 WJ2 WT2 532 535 HQ2 X12 7P2 W42 VH2 56.49 63.01 52.01 74.90 46.65 77.26 69.64 51.38 94.18 97.17 55.56 53.93 81.55 203.60 224.08 180.46 255.43 124.53 258.89 195.71 123.28 254.76 287.39 192.07 169.15 264.72 26.07 93.97 29.08 103.42 24.00 83.29 34.57 117.89 21.53 57.48 35.66 119.49 32.14 23.71 90.33 56.90 43.47 117.58 44.85 132.64 25.64 24.89 88.65 78.07 37.64 122.18 58 Prescription Drugs, Generic, Brand shows what you pay for prescriptions when you use a plan pharmacy. Some plans charge different amounts for refills (*), select drugs and mail orders. In many plans, if you get the brand name instead of a generic substitution, you also pay the difference between the two. Where a copay/coinsurance are both shown, you pay the greater amount. Some POS plans pay a non-plan pharmacy only what they would have paid a plan pharmacy (#); you pay the difference. Primary care doctor office copay Satisfaction Indicators — See page 7 for a description of these results. An (X) means the plan did not conduct the survey as we asked. Accreditation status — N = National Committee for Quality Assurance; J = Joint Commission on Accreditation of Healthcare Organizations Plan performance based on enrollee rating Accreditation status NCQA (N) JCAHO (J) Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) All others- on a scale of 3 (highest) to 1 (lowest) (average for all HMO/POS plans shown in heading) Hospital room copay/coinsurance Prescription drugs, generic Prescription drugs, brand How well doctors communicate (2.46) Plan name West Virginia Carelink Health Plans - In-Network Free State Health Plan - Out-of-Network Health Plan Upper OH Valley HealthAssurance HMO QualMed Plans for Health OH/WV SuperBlue HMO $10 $10 20% $10 $10 $10 $10 Nothing Nothing 20% Nothing Nothing Nothing Nothing $10 $10 $10 $5 $10 $10 $10 $20 $20 $20 $10 $10 $10 $20 0.74 0.69 2.68 2.55 2.51 2.57 2.56 2.56 2.70 2.69 2.24 2.28 2.89 2.30 N 0.74 2.69 2.38 2.53 2.56 2.43 2.25 N Wisconsin Compcare Health Services Compcare Health Services Dean Health Plan Family Health Plan Group Health Coop Group Hlth Coop/Eau Claire HealthPartners Classic-High HealthPartners Classic-Std HealthPartners Health Plan Humana Wisconsin Hlth Org. Physicians Plus HMO Unity Health Plans Valley Health Plan $10 $10 $10 $10 $10 $10 $10 $15 $10 $10 $10 $10 $10 Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing $7 $7 $6 Nothing Nothing $7.50 $8 $10 $8 $10 $6 $5 $4 $12 $12 $10 Nothing Nothing $7.50 $8 $10 $8 $20 $12 $10 $8 0.82 0.91 2.74 2.86 2.45 2.59 2.48 2.57 2.58 2.69 2.52 2.68 2.46 2.69 0.88 0.70 0.85 0.86 0.77 0.77 0.77 0.75 2.86 2.72 2.74 2.79 2.76 2.76 2.76 2.66 2.53 2.38 2.49 2.57 2.39 2.39 2.39 2.55 2.53 2.39 2.49 2.55 2.48 2.48 2.48 2.56 2.68 2.44 2.58 2.64 2.56 2.56 2.56 2.65 2.58 2.44 2.65 2.63 2.47 2.47 2.47 2.29 2.51 1.98 2.67 2.52 2.30 2.30 2.30 2.24 N N N N 0.62 2.70 2.47 2.47 2.58 2.17 1.92 N N N 59 Claims processing (2.22) Courteous and helpful office staff (2.55) Overall plan satisfaction (.74) Getting needed care (2.66) Getting care quickly (2.39) Customer service (2.44) Notes 60 Notes 61 Notes 62