|
Consumer Choice 1 HSA Advance |
Consumer Choice 1
|
Consumer Choice 2 |
HSA Funding | $1,000 employee only $2,000 family | Employee election
| Employee election
|
Deductible
|
Employee only: $1,650 Family: $3,300 |
Employee only: $3,600 Family: $7,200
|
In-Network Annual Out-of-Pocket Maximum (includes deductible) |
Employee only $3,300
Family $6,600
|
Employee only $3,600
Family $7,200 |
Out-of-Network Annual Out-of-Pocket Maximum (includes deductible) |
Employee only $6,600
Family $13,200
|
Employee only $7,200
Family $14,400 |
Coinsurance Paid After Deductible (Applies to all professional services except those noted below.) |
You Pay 20%, plan pays 80%
| No coninsurance, plan pays 100% after the deductible is met |
Office Visit Copays (Copays do not apply to deductible or out-of-pocket maximum) |
Subject to Deductible and Coinsurance |
Lab Work/ Professional Services | Subject to Deductible
and Coinsurance | Subject to Deductible and Coinsurance, then Plan Pays 100% |
Emergency Room Visit Copayment | Subject to Deductible
and Coinsurance | Subject to Deductible and Coinsurance, then Plan Pays 100% |
Preventive Care | You pay $0
|
Benefit Limits |
Maximum Lifetime Benefit (Unless noted) | Unlimited |
Substance Abuse Treatment | Subject to Deductible and Coinsurance |
Mental Illness | Subject to Deductible and Coinsurance |
Chiropractic | Subject to Deductible and Coinsurance
|
Hearing Aids |
Up to $1,500 After the Deductible is Met Every 3 Years Per Person Covered |
Temporomandibular Joint Dysfunction and Related Disorders | Subject to Deductible and Coinsurance |
Physical, Occupational
and Speech Therapy | Subject to Deductible and Coinsurance
|