2017 HEALTH INSURANCE OPTIONS
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- Clarence Sanders
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1 INSURANCE PLUS Rose Gagliardi 15 West Main Street President Oyster Bay, NY / fax rose@insuranceplusny.com September 25, HEALTH INSURANCE OPTIONS **2018 OPEN-ENROLLMENT: November 1, 2017 thru January 31, 2018** **In order to enroll on an INDIVIDUAL MARKETPLACE PLAN outside of Open Enrollment, one must have a qualifying event (i.e. loss of employment, involuntary termination of health insurance, marriage, etc.). Please note that this openenrollment period DOES NOT apply to the small and large group programs mentioned in this document. PLEASE BE AWARE THAT CARE CONNECT WILL BE CANCELLING ALL INDIVIDUAL POLICIES AS OF DECEMBER 31, IN ADDITION, EMPIRE BLUE CROSS/BLUE SHIELD (PATHWAYS NETWORK) WILL ALSO BE CANCELLING THEIR INDIVIDUAL PLANS, BUT ANNOUNCED THEY MAY BE OFFERING A FEW PROGRAMS FOR MORE INFORMATION WILL BE ANNOUNCED JUST PRIOR TO NOV. 1 ST. See following pages for plans
2 2017 NY INDIVIDUAL MARKETPLACE PROGRAMS* *additional marketplace programs available on the exchange Emblem Health ( Platinum (SELECT CARE NETWORK) In Network Only, Referrals Required Office Copays PCP $15 after deductible / Specialist $35 after deductible Single $742 Deductible / Coinsurance N/A 10% coins. DME & pediatric eyeglasses Couple $1,484 Maximum Out of Pocket $2,000 / $4,000(Family) Parent/Child $1,262 Prescription Plan $10/$30/$60 Family $2,115 Gold (SELECT CARE NETWORK) In Network Only, Referrals Required Office Copays PCP $25 / Specialist $40 Single $628 Deductible / Coinsurance $600/$1,200(Family) Ded / 20% Coins DME & ped. eyeglasses Couple $1,257 Maximum Out of Pocket $4,000 / $8,000(Family) Parent/Child $1,068 Prescription Plan $10/$35/$70 Family $1,791 Silver (SELECT CARE NETWORK) In Network Only, Referrals Required Office Copays PCP $30 after deductible / Specialist $50 after deductible Single $518 Deductible / Coinsurance $2,000/$4,000(Family) Ded / 30% Coins DME & ped. eyeglasses Couple $1,037 Maximum Out of Pocket $6,750 / $13,500 (Family) Parent/Child $881 Prescription Plan $10/$35/$70 Family $1,477 Bronze (SELECT CARE NETWORK) In Network Only, Referrals Required Office Copays 50% after Deductible Single $421 Deductible / Coinsurance $4,000/$8,000(Family) Deductible / 50% Coinsurance Couple $842 Maximum Out of Pocket $7,150/ $14,300 (Family) Parent/Child $715 Prescription Plan $10/$35/$70 after plan deductible Family $1,199
3 Oscar Not HSA Compatible ( Platinum Market (OSCAR NETWORK) In Network Only, No Referrals Office Copays $15 / Specialist $35 Single $780 Deductible / Coinsurance N/A Couple $1,559 Maximum Out of Pocket $2,000/$4,000(family) Parent/Child $1,325 Prescription Plan $10/$30/$60 Family $2,222 Gold Market (OSCAR NETWORK) In Network Only, No Referrals Office Copays $25 after Deductible / Specialist $40 after Deductible Single $678 Deductible / Coinsurance $600/$1,200(Family) Deductible / 0% Couple $1,356 Maximum Out of Pocket $4,000 / $8,000(Family) Parent/Child $1,153 Prescription Plan $10/$35/$70 Family $1,932 Silver Market (OSCAR NETWORK) In Network Only, No Referrals Office Copays $30 after Deductible / Specialist $50 after Deductible Single $542 Deductible / Coinsurance $2,000/$4,000(Family) Deductible / 0% Couple $1085 Maximum Out of Pocket $6,750 / $13,500 (Family) Parent/Child $922 Prescription Plan $10/$35/$70 Family $1,546 Bronze Market (OSCAR NETWORK) In Network Only, No Referrals Office Copays 50% after Deductible / Specialist 50% after Deductible Single $429 Deductible / Coinsurance $4,000/$8,000(Family) Deductible / 50% Coinsurance Couple $858 Maximum Out of Pocket $7,150 / $14,300(family) Parent/Child $730 Prescription Plan $10/$35/$70 after Plan Deductible Family $1,223 Simple Platinum (OSCAR NETWORK) In Network Only, No Referrals Office Copays $10 copay / Specialist $50 copay then $0 after Deductible Single $736 Deductible / Coinsurance $1,500 / $3,000(Family) Deductible / 0% Couple $1,472 Maximum Out of Pocket $1,500 / $3,000(Family) Parent/Child $1,251 Prescription Plan $0 for Generics/ $0 after Plan Deductible for T2&T3 Family $2,097 Simple Gold (OSCAR NETWORK) In Network Only, No Referrals Office Copays $10 copay / Specialist $50 copay then $0 after Deductible Single $635 Deductible / Coinsurance $3,000 / $6,000(Family) Deductible / 0% Couple $1,269 Maximum Out of Pocket $3,000 / $6,000(Family) Parent/Child $1,079 Prescription Plan $0 for Generics/ $0 after Plan Deductible for T2&T3 Family $1,809 Simple Silver (OSCAR NETWORK) In Network Only, No Referrals Office Copays $10 copay / Specialist $50 copay then $0 after Deductible Single $483 Deductible / Coinsurance $7,150 / $14,300 (Family) Deductible / 0% Couple $967 Maximum Out of Pocket $7,150 / $14,300(Family) Parent/Child $822 Prescription Plan $0 for Generics/ $0 after Plan Deductible for T2&T3 Family $1,378 Simple Bronze (OSCAR NETWORK) In Network Only, No Referrals Office Copays $0 after Deductible / Specialist $0 after Deductible Single $425 Deductible / Coinsurance $7,150 / $14,300(Family) Deductible / 0%Coins. After Deduct. Couple $849 Maximum Out of Pocket $7,150 / $14,300(Family) Parent/Child $722 Prescription Plan $5 for Generics/ $0 after Plan Deductible for T2&T3 Family $1,210
4 HEALTH INSURANCE OPTIONS For CORPORATION / LLC* *Note that small group programs offered through corporations or LLC s are not subject to the open-enrollment period and can be installed any month of the year. OXFORD Platinum FREEDOM PPO: NO REFERRALS REQUIRED When using FREEDOM providers, you have a: Office Visit - $20 Primary Copay / $40 Specialist Copay No Plan Deductible Emergency Room - $200 Outpatient Facility - $100 copay Hospital Admission - $500 copay When using YOUR OWN providers, you have a: Deductible - $3,000/$6,000 Individual/Family Coinsurance - 30% Emergency Room - $200 Outpatient Facility 30% after Deductible Hospital Admission 30% after Deductible Prescription Drug Card - $5/$30/$60 Non-Tier 1 Ded $100 *MONTHLY RATE: $1,073 Single/ $2,147 Couple/ $1,825 Single Parent / $3,059 Family PHYSICIAN DIRECTORY: OXFORD Platinum FREEDOM EPO: NO REFERRALS REQUIRED When using FREEDOM providers, you have a: Office Visit - $20 Primary Copay / $40 Specialist Copay No Plan Deductible Emergency Room - $200 Outpatient Facility Freestanding $100 / Hosp-based $300 copay Hospital Admission - $500 Prescription Drug Card - $5/$30/$60 Non-Tier 1 Ded $100 *MONTHLY RATE: $1,006 Single / $2,011 Couple / $1,703 Single Parent / $2,866 Family PHYSICIAN DIRECTORY:
5 OXFORD Gold FREEDOM EPO: NO REFERRALS REQUIRED When using FREEDOM providers, you have a: Deductible - $1,250/$2,500 Individual/Family Coinsurance - 20 % Office Visit - $25 Primary Copay / $40 Specialist Copay Emergency Room - $400 copay Outpatient Facility $250 after Deductible Hospital Admission 20% after Deductible Prescription Drug Card - Non-Tier 1 $100 Deduct. then $15/$35/$75 *MONTHLY RATE: $847 Single / $1,694 Couple / $1,440 Single Parent / $2,415 Family PHYSICIAN DIRECTORY: OXFORD Silver LIBERTY EPO: NO REFERRALS REQUIRED When using LIBERTY providers, you have a: Deductible - $2,500/$5,000 Individual/Family Coinsurance - 30 % Office Visit - $40 Primary Copay / $70 Specialist Copay Emergency Room $500 copay per visit Outpatient Facility 30% coinsurance after Deductible Hospital Admission 30% coinsurance after Deductible Prescription Drug Card Non-Tier 1 $100 Deduct. then $15/$45/$75 *MONTHLY RATE: $721 Single / $1,442 Couple / $1,226 Single Parent / $2,055 Family PHYSICIAN DIRECTORY:
6 AETNA NY GOLD EPO: REFERRALS REQUIRED When using AETNA providers, you have a: Plan Deductible $1,000/$2,000 Office Visit - $30 Primary Copay /$60 Specialist Copay Emergency Room - $500 Outpatient Facility 10% after deductible Hospital Admission 10% after deductible Prescription Drug Card - $100 deductible waived for T1 - $20/$40/$60 *MONTHLY RATE: $891 Single / $1,783 Couple / $1,515 Single Parent / $2,540 Family PHYSICIAN DIRECTORY: EMBLEM GOLD Select Care HMO: REFERRALS REQUIRED When using Select Care providers, you have a: Annual Deductible - $350/$500 Office Visit Copays after Deductible - $40 PCP /$60 Specialist Emergency Room - $200 co-pay after Deductible Outpatient Facility - $150 copay after Deductible Hospital Admission - $1,500 per visit after Deductible Urgent Care - $60 copay after Deductible Prescription Drug Card - $15/$35/$75 ($100 Deductible) *MONTHLY RATE: $713 Single/ $1,426 Couple/ $1,212 Single Parent / $2,032 Family PHYSICIAN DIRECTORY:
7 LARGE GROUP / PEO PLANS * *Note that large group programs offered through unions, PEO s and associations are not subject to the open-enrollment period and one can enroll any month throughout the year Eligibility Required HIP EMPIRE CIGNA MULTIPLAN/PHCS AETNA
8 DENTAL INSURANCE OPTIONS For CORPORATION/LLC **OXFORD (OBM) DENTAL / VISION PLAN: ELITE SPECIALTY PLAN OPTION DENTAL BENEFIT Can use Oxford provider or provider of choice. No Waiting Period on Basic and Major Services (optional) $50/$150 Annual Deductible $1,000 Annual Maximum ($1,500 optional) Discounts include Wellness, Alternative Medicine, and Infertility When using an Oxf ord PROVIDER, you have a: 100% Coverage for Preventative 80% Coverage after Deductible for Basic Restorative 50% Coverage after Deductible for Major Care When using YOUR OWN DOCTOR**, you have a: 100% Coverage for Preventative 80% Coverage after Deductible for Basic Restorative 50% Coverage after Deductible for Major Care **Out-of-network benefits are paid based on UHC Dental s Maximum Allowable Charge. VISION BENEFIT Can use Oxford provider or provider of choice. Benefits include eye exams, frames, lenses, contact lenses. Benefits are subject to copays and reimbursement schedule. *MONTHLY RATES: $46 Single / $80 Couple / $83 Single Parent / $120 Family *Rates are subject to change and to final underwriting. **ADDITIONAL PROGRAMS ARE AVAILABLE. PROVIDERS DIRECTORY:
9 DENTAL INSURANCE OPTIONS For INDEPENDENT CONTRACTORS GUARDIAN Managed Choice DMO DENTAL PLAN When using a GUARDIAN Managed DentalGuard Network dentist, you have a: *RATES VALID UNTIL 10/31/2017 Deductible - $0 No Annual Maximum No Waiting Period Office Visit - $5 copay Preventive Exam, Cleanings, X-rays No charge Fee Schedule applies for: Diagnostic / Basic Restorative/ Periodontal / Endodontic / Oral Surgery Prosthetics Repairs / Crown and Bridges / Dentures /Orthodontic *MONTHLY RATES: $51 Single / $78 Emp + 1 / $105 Family PROVIDERS DIRECTORY: (MANAGED DENTALGUARD NETWORK) UNITED CONCORDIA DENTAL PLAN: DENTAL BENEFIT Can use United Concordia provider or provider of choice. Deductible - $50 single/$150 family No Waiting Period on Basic and Major Services No Pre-Existing Condition Limitations $1,500 Annual Maximum When using a UNITED CONCORDIA provider, you have a: Preventive Exam, Cleanings, X-rays No charge (deductible waived) Basic Restorative 90% after Deductible Major Care 60% after Deductible When using YOUR OWN DOCTOR, you have a: Preventive Exam, Cleanings, X-rays No charge after Deductible Basic Restorative 80% after Deductible Major Care 50% after Deductible *MONTHLY RATES: $61 Single / $129 Couple / $122 Single Parent / $162 Family *RATES VALID UNTIL 12/31/2017 PROVIDERS DIRECTORY: (ADVANTAGE PLUS NETWORK)
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More informationImportant Questions Answers Why this Matters: In-network: $200/Individual; $400/Family Out-of-network: $1,000/Individual; $2,000/Family
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