Here are the six HMO plan designs offered by Priority Health for HealthbyChoice Incentives SM in 2009.
|
HMO 1 - $0 vs. $750
DEDUCTIBLE |
HMO 2 - $250 vs. $1,000
DEDUCTIBLE |
HMO 3 - $500 vs. $1,250
DEDUCTIBLE |
|
Choice Level |
Standard Level |
Choice Level |
Standard Level |
Choice Level |
Standard Level |
| Deductible (ind./family) |
N/A |
$750/$1,500 |
$250/$500 |
$1,000/$2,000 |
$500/$1,000 |
$1,250/$2,500 |
Coinsurance
|
100% |
80% |
90% |
70% |
90% |
70% |
| Out-of-pocket (ind./family) |
N/A |
$750/$1,500 |
$500/$1,000 |
$1,250/$2,500 |
$1,000/$2,000 |
$1,750/$3,500 |
| Copays |
|
|
|
|
|
|
| Primary care |
$10 |
$20 |
$15 |
$25 |
$15 |
$25 |
| Specialist care |
$25 |
$35 |
$30 |
$40 |
$30 |
$40 |
| Urgent care |
$40 |
$50 |
$45 |
$55 |
$45 |
$55 |
| ER |
$100 |
$100 |
$100 |
$100 |
$100 |
$100 |
| Advanced diagnostic imaging |
$150 |
$150 |
$150 |
$150 |
$150 |
$150 |
Rx
Option 1
Option 2
(with or without CM)
|
$10/$40
$15/$50
|
$10/$40
$15/$50
|
$10/$40
$15/$50
|
$10/$40
$15/$50
|
$10/$40
$15/$50
|
$10/$40
$15/$50
|
|
HMO 4 - $750 vs. $1,500
DEDUCTIBLE |
HMO 5 - $1,000 vs. $2,000
DEDUCTIBLE |
HMO 6 - $2,000 vs. $3,000
DEDUCTIBLE |
|
Choice Level |
Standard Level |
Choice Level |
Standard Level |
Choice Level |
Standard Level |
| Deductible (ind./family) |
$750/$1,500 |
$1,500/$3,000 |
$1,000/$2,000 |
$2,000/$4,000 |
$2,000/$4,000 |
$3,000/$6,000 |
Coinsurance
|
80% |
60% |
90% |
70% |
90% |
70% |
| Out-of-pocket (ind./family) |
$1,500/$3,000 |
$2,250/$4,500 |
$2,000/$4,000 |
$3,000/$6,000 |
$3,000/$6,000 |
$4,000/$8,000 |
| Copays |
|
|
|
|
|
|
| Primary care |
$15 |
$25 |
$15 |
$25 |
$15 |
$25 |
| Specialist care |
$30 |
$40 |
$30 |
$40 |
$30 |
$40 |
| Urgent care |
$45 |
$55 |
$45 |
$55 |
$45 |
$55 |
| ER |
$100 |
$100 |
$100 |
$100 |
$100 |
$100 |
| Advanced diagnostic imaging |
$150 |
$150 |
$150 |
$150 |
$150 |
$150 |
Rx
Option 1
Option 2
(with or without CM)
|
$10/$40
$15/$50 |
$10/$40
$15/$50 |
$10/$40
$15/$50 |
$10/$40
$15/$50 |
$10/$40
$15/$50 |
$10/$40
$15/$50 |
Last modified
05/18/09
|
