Consumer Choice 1

 

The Consumer Choice 1 is a qualified consumer-driven health plan (CDHP) that when combined with a Health Savings Account (HSA) provides insurance coverage and a tax-advantage way to help save for future health care expenses.

  • Deductibles: The Consumer Choice 1 plan has a $1,500 annual deductible for employee coverage or $3,000 annual deductible for all other tiers. One family member or a combination of family members can satisfy the family deductible and the full family deductible must be met before post-deductible benefits are paid.

  • Coinsurance: Once the deductible is met the Consumer Choice 1 plan will pay 80% of covered expenses from in-network providers or 60% of covered expenses from out-of-network providers.

  • Annual Out-of-Pocket Maximums: Your maximum annual out-of-pocket expenses from in-network providers for the plan year is $3,000 for employee-only coverage and $6,000 for all other tier levels (employee + spouse, employee + child(ren) or family). Out-of-network annual out-of-pocket maximum is $6,000 for employee only and $12,000 for all other tier levels. Once you meet the out-of-pocket maximum, the plan will pay 100% of eligible expenses.

  • Office Visit Charges: Under the Consumer Choice 1 plan, office visits are subject to your deductible. Copays do not apply for the Consumer Choice 1 plan – you are responsible for the entire office visit charge until you have satisfied the deductible.

  • Prescription Drug Coverage (administered by CVS Caremark): Under the Consumer Choice 1 plan, prescription drugs are subject to your deductible. Copays do not apply for the Consumer Choice 1 plan. You are responsible for payment of 100% of the cost of prescription drugs until you have satisfied the deductible. Learn More ...

Coverage at a Glance

 

Consumer Choice 1

Pre-Existing Condition Exclusion

None

Out-of-Pocket Expenses

In-Network

Out-of-Network

Deductible

Employee only: $1,500
Family: $3,000

Annual Out-of-Pocket Maximum
(Includes deductible)

Employee only
$3,000

Family
$6,000

Employee only
$6,000

Family
$12,000

Benefits

In-Network

Out-of-Network

Coinsurance Paid After Deductible
(Applies to all professional services except those noted below.)

You Pay 20%

You Pay 40%

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

Emergency Room Visit Copayment

Subject to Deductible
and Coinsurance

Wellness Benefit

100% of In-Network
Eligible Charges

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


What is a Deductible?

The deductible is the amount you must pay for covered medical services each year before the medical plan begins to pay benefits. The deductible starts over each January 1.

Coverage for an Individual

  • If you elect coverage for yourself, the individual deductible applies to you. You must pay for covered medical services for yourself.

  • The plan will not begin to pay for benefits until you meet the individual deductible.

Coverage for an Individual and One or More Dependents

  • If you elect coverage for yourself and one or more eligible dependents, a family deductible applies to all as a single-family unit.

  • Full family deductible must be met by at least one person before the plan begins to pay.

  • After the deductible has been met, the plan will pay for benefits for the rest of the family members.


 


 

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