CoOportunity Premier Silver Coverage Period: 01/01/ /31/2014
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- Blanche McKenzie
- 5 years ago
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1 IOWA CoOportunity Premier Silver Coverage Period: 01/01/ /31/2014 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at or by calling Important Questions Answers Why this Matters: What is the overall deductible? Are there other deductibles for specific services? Is there an out of pocket limit on my expenses? What is not included in the out of pocket limit? Is there an overall annual limit on what the plan pays? Does this plan use a network of providers? In-network: $4,000 Individual/$8,000 Family Out-of-network: $8,000 Individual/$16,000 Family Copays are not subject to deductible No. Yes. In-network: $6,350 Individual/$12,700 Family Out-of-network: $16,000 Individual/$32,000 Family Premium, balance-billed charges (unless balanced billing is prohibited), and health care this plan doesn't cover. No. Yes. For a list of in-network providers, see /providersearch or call You must pay all the costs up to the deductible amount before this plan begins to pay for covered services you use. Check your policy or plan document to see when the deductible starts over (usually, but not always, January 1 st ). See the chart starting on page 2 for how much you pay for covered services after you meet the deductible. You don t have to meet deductibles for specific services, but see the chart starting on page 2 for other costs for services this plan covers. The out-of-pocket limit is the most you could pay during a coverage period (usually one year) for your share of the cost of covered services. This limit helps you plan for health care expenses. Even though you pay these expenses, they don t count toward the out-of-pocket limit. The chart starting on page 2 describes any limits on what the plan will pay for specific covered services, such as office visits. If you use an in-network doctor or other health care provider, this plan will pay some or all of the costs of covered services. Be aware, your in-network doctor or hospital may use an out-of-network provider for some services. Plans use the term in-network, preferred, or participating for providers in their network. See the chart starting on page 2 for how this plan pays different kinds of providers. Questions: Call or visit us at 1 of 8 If you aren t clear about any of the underlined terms used in this form, see the Glossary. You can view the Glossary at or call to request a copy.
2 Important Questions Answers Why this Matters: Do I need a referral to see a specialist? Are there services this plan doesn t cover? Common Medical Event If you visit a health care provider s office or clinic No. You don't need a referral to see a specialist. Yes. You can see the specialist you choose without permission from this plan. Some of the services this plan doesn t cover are listed on page 5. See your policy or plan document for additional information about excluded services. Copayments are fixed dollar amounts (for example, $15) you pay for covered health care, usually when you receive the service. Coinsurance is your share of the costs of a covered service, calculated as a percent of the allowed amount for the service. For example, if the plan s allowed amount for an overnight hospital stay is $1,000, your coinsurance payment of 20% would be $200. This may change if you haven t met your deductible. The amount the plan pays for covered services is based on the allowed amount. If an out-of-network provider charges more than the allowed amount, you may have to pay the difference. For example, if an out-of-network hospital charges $1,500 for an overnight stay and the allowed amount is $1,000, you may have to pay the $500 difference. (This is called balance billing.) This plan may encourage you to use in-network providers by charging you lower deductibles, co-payments and co-insurance amounts. Services You May Need Primary care visit to treat an injury or illness Your cost if you use a In-Network Out-Of-Network $20 copay 50% coinsurance Specialist visit $40 copay 50% coinsurance Limitations & Exceptions Each family member s first three office or urgent care visits are free. Other services like lab, x-rays, MRI/CT scans are covered at deductible/coinsurance Each family member s first three office or urgent care visits are free. Other services like lab, x-rays, MRI/CT scans are covered at deductible/coinsurance Other practitioner office visit $20 copay 50% coinsurance none Preventive care/screening/immunization No charge 50% coinsurance none If you have a test Diagnostic test (x-ray, blood work) 30% coinsurance 50% coinsurance none 2 of 8
3 Common Medical Event Services You May Need Your cost if you use a In-Network Out-Of-Network Limitations & Exceptions Imaging (CT/PET scans, MRIs) 30% coinsurance 50% coinsurance none If you need drugs to treat your illness or condition Generic drugs $10 copay at retail; $20 copay at mail 50% coinsurance at retail, mail not covered More information about prescription drug coverage is available at ealth.com/druglist Preferred brand drugs Non-preferred brand drugs $40 copay at retail; $80 copay at mail $80 copay at retail; $240 copay at mail 50% coinsurance at retail, mail not covered 50% coinsurance at retail, mail not covered 31 day supply retail / 93 day supply mail order Specialty drugs $150 copay 50% coinsurance; mail not covered Use of specialty drug vendor required If you have outpatient surgery If you need immediate medical attention If you have a hospital stay Facility fee (e.g., ambulatory surgery center) 30% coinsurance 50% coinsurance none Physician/surgeon fees 30% coinsurance 50% coinsurance none Emergency room services $250 copay after deductible, then 30% coinsurance $250 copay after deductible, then 30% coinsurance none Emergency medical transportation 30% coinsurance 30% coinsurance none Urgent care $20 copay 50% coinsurance Facility fee (e.g., hospital room) 30% coinsurance 50% coinsurance none Physician/surgeon fee 30% coinsurance 50% coinsurance none 3 of 8
4 Common Medical Event If you have mental health, behavioral health, or substance abuse needs If you are pregnant If you need help recovering or have other special health needs If your child needs dental or eye care Services You May Need Mental/Behavioral health outpatient services Mental/Behavioral health inpatient services Your cost if you use a In-Network Out-Of-Network $20 copay 50% coinsurance Limitations & Exceptions Free visits do not apply to services performed in a hospital 30% coinsurance 50% coinsurance none Substance use disorder outpatient services $20 copay 50% coinsurance Free visits do not apply to services performed in a hospital Substance use disorder inpatient services 30% coinsurance 50% coinsurance none Prenatal and postnatal care No charge 50% coinsurance none Delivery and all inpatient services 30% coinsurance 50% coinsurance none Home health care 30% coinsurance 50% coinsurance none Primary Care: $20 Rehabilitation services copay; Specialty 50% coinsurance care: $40 copay Primary Care: $20 Habilitation services copay; Specialty 50% coinsurance care: $40 copay Skilled nursing care 30% coinsurance 50% coinsurance Limited to 90 days per confinement Durable medical equipment 30% coinsurance 50% coinsurance none Hospice service 30% coinsurance 50% coinsurance 5 days for respite/15 combined for respite and continuous Eye exam No charge 50% coinsurance none Glasses 30% coinsurance 50% coinsurance Limited to one pair of eyeglasses per year Dental check-up Not Covered Not Covered none 4 of 8
5 Excluded Services & Other Covered Services: Services Your Plan Does NOT Cover (This isn t a complete list. Check your policy or plan document for other excluded services.) Acupuncture Cosmetic surgery Dental care (Adult) Hearing aids Infertility treatment Long-term care Non-emergency care when traveling outside the U.S. Private-duty nursing Routine foot care Routine eye care (Adult) Weight loss programs Other Covered Services (This isn t a complete list. Check your policy or plan document for other covered services and your costs for these services.) Bariatric surgery Chiropractic care Your Rights to Continue Coverage: Federal and State laws may provide protections that allow you to keep this health insurance coverage as long as you pay your premium. There are exceptions, however, such as if: You commit fraud The insurer stops offering services in the State You move outside the coverage area For more information on your rights to continue coverage, contact the insurer at You may also contact your state insurance department at the following: Nebraska Dept of Insurance at Your Grievance and Appeals Rights: If you have a complaint or are dissatisfied with a denial of coverage for claims under your plan, you may be able to appeal or file a grievance. For questions about your rights, this notice, or assistance, you can contact your state insurance department at the following: Nebraska Dept of Insurance at Additionally, a consumer assistance program can help you file your appeal. Contact the following: Nebraska Dept of Insurance at of 8
6 Does this Coverage Provide Minimum Essential Coverage? The Affordable Care Act requires most people to have health care coverage that qualifies as minimum essential coverage. This plan or policy does provide minimum essential coverage. Does this Coverage Meet the Minimum Value Standard? The Affordable Care Act establishes a minimum value standard of benefits of a health plan. The minimum value standard is 60% (actuarial value). This health coverage does meet the minimum value standard for the benefits it provides. Language Access Services: Spanish (Español): Para obtener asistencia en Español, llame al Tagalog (Tagalog): Kung kailangan ninyo ang tulong sa Tagalog tumawag sa Chinese ( 中文 ): 如果需要中文的帮助, 请拨打这个号码 Navajo (Dine): Dinek'ehgo shika at'ohwol ninisingo, kwiijigo holne' To see examples of how this plan might cover costs for a sample medical situation, see the next page. 6 of 8
7 Coverage Examples. About these Coverage Examples: These examples show how this plan might cover medical care in given situations. Use these examples to see, in general, how much financial protection a sample patient might get if they are covered under different plans. This is not a cost estimator. Don t use these examples to estimate your actual costs under this plan. The actual care you receive will be different from these examples, and the cost of that care will also be different. Cost sharing or Patient pays amounts are based on self-only coverage. Having a baby (normal delivery) Amount owed to providers: $7,540 Plan pays $3,020 Patient pays $4,520 Sample care costs: Hospital charges (mother) $2,700 Routine obstetric care $2,100 Hospital charges (baby) $900 Anesthesia $900 Laboratory tests $500 Prescriptions $200 Radiology $200 Vaccines, other preventive $40 Total $7,540 Patient pays: Deductibles $4,000 Copays $20 Coinsurance $350 Limits or exclusions $150 Total $4,520 Managing type 2 diabetes (routine maintenance of a well-controlled condition) Amount owed to providers: $5,400 Plan pays $1,080 Patient pays $4,320 Sample care costs: Prescriptions $2,900 Medical Equipment and Supplies $1,300 Office Visits and Procedures $700 Education $300 Laboratory tests $100 Vaccines, other preventive $100 Total $5,400 Patient pays: Deductibles $4,000 Copays $150 Coinsurance $90 Limits or exclusions $80 Total $4,320 7 of 8
8 Coverage Examples Questions and answers about the Coverage Examples: What are some of the assumptions behind the Coverage Examples? Costs don t include premiums. Sample care costs are based on national averages supplied by the U.S. Department of Health and Human Services, and aren t specific to a particular geographic area or health plan. The patient s condition was not an excluded or preexisting condition. All services and treatments started and ended in the same coverage period. There are no other medical expenses for any member covered under this plan. Out-of-pocket expenses are based only on treating the condition in the example. The patient received all care from innetwork providers. If the patient had received care from out-of-network providers, costs would have been higher. What does a Coverage Example show? For each treatment situation, the Coverage Example helps you see how deductibles, copayments, and coinsurance can add up. It also helps you see what expenses might be left up to you to pay because the service or treatment isn t covered or payment is limited. Does the Coverage Example predict my own care needs? No. Treatments shown are just examples. The care you would receive for this condition could be different based on your doctor s advice, your age, how serious your condition is, and many other factors. Does the Coverage Example predict my future expenses? No. Coverage Examples are not cost estimators. You can t use the examples to estimate costs for an actual condition. They are for comparative purposes only. Your own costs will be different depending on the care you receive, the prices your providers charge, and the reimbursement your health plan allows. Can I use Coverage Examples to compare plans? Yes. When you look at the Summary of Benefits and Coverage for other plans, you ll find the same Coverage Examples. When you compare plans, check the Patient Pays box in each example. The smaller that number, the more coverage the plan provides. Are there other costs I should consider when comparing plans? Yes. An important cost is the premium you pay. Generally, the lower your premium, the more you ll pay in out-ofpocket costs, such as copayments, deductibles, and coinsurance. You should also consider contributions to accounts such as health savings accounts (HSAs), flexible spending arrangements (FSAs) or health reimbursement accounts (HRAs) that help you pay out-of-pocket expenses. Questions: Call or visit us at 8 of 8 If you aren t clear about any of the underlined terms used in this form, see the Glossary. You can view the Glossary at or call to request a copy.
HealthPartners: Peak Individual $1,000 w/copay Gold Coverage Period: 01/01/ /31/2017
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.healthpartners.com or by calling 1-877-838-4949. Important
Bronze Plus: UPMC Health Plan Coverage Period: 12/1/ /30/2017
Bronze Plus: UPMC Health Plan Coverage Period: 12/1/2016-11/30/2017 Summary of Coverage: What this Plan Covers & What it Costs Coverage for: All coverage levels Plan Type: PPO This is only a summary. If
Basic EPO for HSA Native American Coverage Period: Beginning on or after 1/1/2014. Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.blueshieldca.com or by calling 1-855-836-9705. Important
EBC Board of Education #83: PPO Plan Coverage Period: 07/01/ /30/2017
EBC Board of Education #83: PPO Plan Coverage Period: 07/01/2016-06/30/2017 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual + Family Plan Type: PPO This
HealthPartners: Key Embedded 6850 (Bronze) Coverage Period: 01/01/ /31/2016
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.healthpartners.com or by calling 1-877-838-4949. Important
Moda Health Plan, Inc.: Bronze Be Savvy Coverage Period: 01/01/ /31/2014
Coverage for: Individual + Family Plan Type: PPO This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.modahealth.com
Gold: UPMC Health Plan Coverage Period: 12/1/ /30/2017
Gold: UPMC Health Plan Coverage Period: 12/1/2016-11/30/2017 Summary of Coverage: What this Plan Covers & What it Costs Coverage for: All coverage levels Plan Type: PPO This is only a summary. If you want
Archdiocese of Chicago: PRMAA PPO Coverage Period: 07/01/ /30/2016 Summary of Benefits and Coverage: What this Plan Covers & What it Costs
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.bcbsil.com or by calling 1-888-979-4516. Important Questions
Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.bcbstx.com/trs or by calling 1-866-355-5999. Important
HealthPartners: Empower HSA Gold Coverage Period: 01/01/ /31/2016
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.healthpartners.com or by calling 1-800-883-2177. Important
Important Questions Answers Why this Matters:
BCBSND: BlueCare 70 3000 IHS (Silver) Coverage Period: Beginning on or after 01/01/2014 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Single, Family Plan Type: PPO
YRC Worldwide: Silver Plan Coverage Period: 01/01/ /31/2015
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.bcbsil.com/yrcw or by calling 1-866-686-3675. Important
Pathfinder POS % Rx2 Coverage Period: 01/01/ /31/2014
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.healthalliance.org. or by calling 1-800-851-3379. Important
Ultimate PPO Coverage Period: Beginning on or after 1/1/2014
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.blueshieldca.com or by calling 1-855-836-9705. Important
Important Questions Answers Why this Matters: Network: $3,000 Individual, $6,000 Family Non-Network: $6,000 Individual, $12,000 Family
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.healthscopebenefits.com or by calling 1-800-331-2695.
HealthPartners: HSA Gold Rx Plus Coverage Period: 01/01/ /31/2017
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.healthpartners.com or by calling 1-800-883-2177. Important
Aetna Student Health: University of Southern California Coverage Period: beginning on or after 5/17/13
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at http://www.aetnastudenthealth.com/usc or by calling 1-877-626-2299.
Nationwide Life Insurance Co.: Gold Plan - American Academy of Dramatic Arts - New York Coverage Period: 8/15/16-8/14/17
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.chpstudent.com or by calling 1-800-633-7867. Important
P58442 Lake County Medical Society: Blue Cross and Blue Shield of Illinois Coverage Period: 01/01/ /30/2014 Summary of Benefits and Coverage:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.bcbsil.com or by calling 1-800-458-6024. Important Questions
Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.blueshieldca.com or by calling 1-800-642-6155. Important
San Bernardino City USD Shield Spectrum PPO /70 Coverage Period: 07/01/ /30/2015. Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.blueshieldca.com or by calling 1-800-331-2001. Important
Blue Shield of California: Delta Dental of California ASO PPO 500 Coverage Period: 1/1/ /31/2016
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.blueshieldca.com or by calling 1-855-256-9404. Important
Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.bcbsil.com/abbott or by calling 1-800-671-1210 Important
Blue Shield Life & Health: Simple Savings 2500 / 5000 Coverage Period: Beginning On or After 1/1/2014
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.blueshieldca.com or by calling 1-888-319-5999. Important
National Louis University PPO OPT 2: Blue Cross and Blue Shield of Illinois Coverage Period: 07/01/ /30/2014 Summary of Benefits and Coverage:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.bcbsil.com or by calling 1-800-458-6024. Important Questions
Blue Shield of California: County of Sacramento PPO /50 Coverage Period: 01/01/ /31/2013
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.blueshieldca.com or by calling 1-800-642-6155. Important
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan
1 of 8 Buffalo Board of Education: Traditional Blue 901 Coverage Period Beginning: 03/01/2017 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms
AHS Management Inc. Essential Plan Coverage Period: 01/01/ /31/2013 Summary of Benefits and Coverage: What this Plan Covers & What it Costs
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.getardentbenefits.com or by calling 1-800-672-2567. Important
Highmark Health Insurance Company: PPO Coverage Period: 02/01/ /31/2014
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.highmarkblueshield.com or by calling 1-877-986-4571.
$3,500 person / $7,000 family For non-preferred providers
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.blueshieldca.com or by calling 888-852-5345. Important
HealthPartners: Open Access Choice Plan Coverage Period: 01/01/ /31/2017
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.healthpartners.com or by calling 1-800-883-2177. Important
HealthPartners: Empower HSA Plan Coverage Period: 01/01/ /31/2017
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.healthpartners.com or by calling 1-800-883-2177. Important
Yes, Individual: Preferred $3,000 Non-Preferred: $3,000. Penalties, premiums, balance-billed charges, and health care this plan doesn t cover. No.
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at http://www.aetnastudenthealth.com/northernarizona or by calling
Highmark Blue Cross Blue Shield: PPO Coverage Period: 07/01/ /30/2015
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.highmarkbcbs.com or by calling 1-800-241-5704. Important
Bryn Mawr College: International Student Health Plan Coverage Period: 08/15/ /14/2017
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.ibxtpa.com/students or by calling 1-888-547-5080. Important
Village of Glendale Heights PPO: Blue Cross and Blue Shield of Illinois Coverage Period: 07/01/ /30/2017 Summary of Benefits and Coverage:
Village of Glendale Heights PPO: Blue Cross and Blue Shield of Illinois Coverage Period: 07/01/2016-06/30/2017 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: ALL
Important Questions Answers Why this Matters: What is the overall deductible?
Meijer: Advantages Health Plan (AHP) Coverage Period: 01/01/2017 12/31/2017 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: All Coverage Tiers Plan Type: PPO This
Highmark West Virginia: Shared Cost Blue PPO 2500 Coverage Period: 01/01/ /31/2015
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.highmarkbcbswv.com or by calling 1-888-601-2109. Important
P99050 Lake County Medical Society: Blue Cross and Blue Shield of Illinois Coverage Period: 07/01/ /30/2014 Summary of Benefits and Coverage:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.bcbsil.com or by calling 1-800-458-6024. Important Questions
Blue Shield of California: Long Beach Unified School District ASO PPO /60 Coverage Period: 01/01/ /30/2016
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.blueshieldca.com or by calling 1-855-256-9404. Important
Important Questions Answers Why this Matters:
: Blue & U Saver Coverage Period: Beginning on or after 01/01/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: All Coverage Tiers Plan Type: PPO This is only a
Proviso Township High Schools PPO: Blue Cross and Blue Shield of Illinois Coverage Period: 01/01/ /30/2014 Summary of Benefits and Coverage:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.bcbsil.com or by calling 1-800-828-3116 Important Questions
Preferred Full PPO for Small Business 750 Coverage Period: Beginning On or After 1/1/2014
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.blueshieldca.com or by calling 1-888-319-5999. Important
You can see the specialist you choose without permission from this plan.
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.bcbsil.com or by calling 1-800-828-3116 Important Questions
Basic Full PPO for Small Business 4500 Coverage Period: Beginning On or After 1/1/2014
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.blueshieldca.com or by calling 1-888-319-5999. Important
HealthPartners: Empower HSA Plan Coverage Period: 01/01/ /31/2015
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.healthpartners.com or by calling 1-800-883-2177. Important
Highmark Blue Shield: Flex Blue PPO 4000 a Community Blue Plan
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.highmarkblueshield.com or by calling 1-888-510-1084.
Highmark Blue Cross Blue Shield: Community Blue Flex Coverage Period: 04/01/ /31/2016
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.highmarkbcbs.com or by calling 1-800-241-5704. Important
Highmark Health Insurance Company: Shared Cost Blue PPO 1500
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.highmarkblueshield.com or by calling 1-888-510-1064.
$3,000 Individual/$6,000 Family for In Network providers. $6,000 Individual/$12,000 Family for Out of Network providers.
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.anthem.com or by calling 1-866-251-1779. Health Savings
Gregory Poole Equipment Company Buy Up Plan Coverage Period: 01/01/17-12/31/17
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document on the Gregory Poole Intranet or by calling 1-800-952-7460.
Highmark West Virginia: Super Blue Plus WVSBP Coverage Period: Beginning on or after 1/1/2012
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.highmarkbcbswv.com or by calling 1-888-644-2583. Important
TrueBlue Health Care Plan TRUEBLUE HDHP HEALTH CARE PLAN Coverage Period: 01/01/13-12/31/13
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at trueblue.webtpa.com or by calling 1-866-889-8977. Important
ThyssenKrupp North America: HRA Plan Coverage Period: 01/01/ /31/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.bcbsil.com or by calling 1-888-895-1563. Important Questions
CUSD #300 PPO Plus: Blue Cross and Blue Shield of Illinois Summary of Benefits and Coverage: What this Plan Covers & What it Costs
Coverage Period: 01/01/2016-12/31/2016 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.bcbsil.com or
Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.myhnas.com or by calling 1-855-323-1132. Important Questions
SISC Blue Shield of California: 2-Tier Anchor Bronze Plan Coverage Period: 10/01/ /30/2017
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.blueshieldca.com or by calling 1-800-642-6155. Important
Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.usciences.myahpcare.com or by calling 1-888-547-5080.
What is the overall deductible? Are there other deductibles for specific services? No.
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.webtpa.com or by calling 1-800-930-2432. Important Questions
RBP83436 BlueChoice Select: Blue Cross and Blue Shield of Illinois Summary of Benefits and Coverage: What this Plan Covers & What it Costs
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.bcbsil.com or by calling 1-800-541-2768. Important Questions
Bryn Mawr College: Graduate Student Health Plan Coverage Period: 08/23/ /22/2017
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.ibxtpa.com/students or by calling 1-888-547-5080. Important
Public Employees Benefits Program Coverage Period: 07/01/ /30/2016
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.pebp.state.nv.us or by calling 1-800-326-5496 or 775-684-7000.
Important Questions Answers Why this Matters: What is the overall deductible?
Meijer: Core Health Plan (CHP) Coverage Period: 01/01/2014 12/31/2014 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: All Coverage Tiers Plan Type: PPO This is only
Highmark Blue Cross Blue Shield: Balance Blue PPO 500 a Community Blue Flex Plan
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.highmarkbcbs.com or by calling 1-888-510-1084. Important
The University of the Arts: Student Health Plan Coverage Period: 08/15/ /14/2017
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.ibxtpa.com/students or by calling 1-888-547-5080. Important
Highmark Blue Cross Blue Shield: Flex Blue PPO 1200 Penn Highlands Region a Community Blue Plan
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.highmarkbcbs.com or by calling 1-800-544-6679. Important
Highmark Blue Cross Blue Shield: PPO Coverage Period: 05/01/ /30/2015
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.highmarkbcbs.com or by calling 1-800-241-5704. Important
St. Mary s Healthcare System, Inc.: Blue Choice High PPO Option Coverage Period: 01/01/ /31/2016 Summary of Benefits and Coverage:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.bsbcga.com or by calling 1-855-397-9267. Important Questions
$700 Individual/$1,400 Family for In-Network providers.
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.anthem.com or by calling 1-866-253-6066. Important Questions
Highmark Blue Cross Blue Shield: Total Health Blue PPO 1200 a Community Blue Plan
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.highmarkbcbs.com or by calling 1-888-510-1084. Important
Highmark West Virginia: Super Blue Plus 2000 Coverage Period: Beginning on or after 01/01/2012
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.highmarkbcbswv.com or by calling 1-888-644-2583. Important
Blue Cross Blue Shield of Arizona: PPO Coverage Period: 01/01/ /31/2017 Summary of Benefits and Coverage: What this Plan Covers & What it Costs
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.mybenefitshome.com or by calling 1-800-652-9451. Important
Highmark Blue Cross Blue Shield: Shared Cost Blue PPO 5500 a Community Blue Flex Plan
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.highmarkbcbs.com or by calling 1-888-510-1084. Important
Important Questions Answers Why this Matters:
Health Care Assistance Plan, Seventh-day Adventist Church Coverage Period: 01/01/2017 12/31/2017 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Single + Family Plan
MassMutual: Cigna HDHP Option 1 Agent Plan Coverage Period: 01/01/ /31/2013
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at https://benedirect.massmutual.com/irj/portal/beneenroll or
Highmark Blue Cross Blue Shield: PPOBlue Coverage Period: 08/01/ /31/2014
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.highmarkbcbs.com or by calling 1-800-241-5704. Important
Highmark Blue Shield: Flex Blue PPO 1000 a Community Blue Plan
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.highmarkblueshield.com or by calling 1-888-510-1084.
HealthPartners: HRA Coverage Period: 04/01/ /31/2017
HealthPartners: HRA Coverage Period: 04/01/2016-03/31/2017 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at
HealthPartners: HRA Coverage Period: 04/01/ /31/2016
HealthPartners: HRA Coverage Period: 04/01/2015-03/31/2016 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at
Highmark Blue Cross Blue Shield: myblue Care Gold $500 Coverage Period: 01/01/ /31/2016
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.highmarkbcbs.com or by calling 1-888-510-1064. Important
You can see the specialist you choose without permission from this plan.
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.healthpartners.com/3m or by calling 1-877-435-7613. Important
Round Rock ISD: Premium Plan Coverage Period: 10/01/ /30/2014 Summary of Benefits and Coverage: What this Plan Covers & What it Costs
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.bcbstx.com or by calling 1-800-521-2227. Important Questions
RR Donnelley: Copay Value Coverage Period: 01/01/ /31/2017
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.mybenefitsdirectory.com/rrd or by calling 1-877-773-4236.
Aetna Open Choice Coverage Period: 01/01/ /31/2013. Danaher Corporation
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.healthreformplansbc.com or by calling 1-800-231-7729.
Highmark West Virginia: Health Savings Blue PPO 4000 Coverage Period: 01/01/ /31/2016
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.highmarkbcbswv.com or by calling 1-888-601-2109. Important
Important Questions Answers Why this Matters: In-Network $2,500 Individual / $5,000 Family Out-of-Network
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.bcbstx.com or by calling 1-800-521-2227. Important Questions
Roosevelt University Student Health Insurance Plan. Dear Student:
Roosevelt University Student Health Insurance Plan Dear Student: Under the Affordable Care Act, all health insurers and group health plans are required to provide consumers with a Summary of Benefits and
Highmark Blue Cross Blue Shield: Shared Cost Blue PPO 6000 a Community Blue Flex Plan Off Exchange Zone A
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.highmarkbcbs.com or by calling 1-800-544-6679. Important
Oak Harbor Freight Lines, Inc. Employee Health Care Plan: Preferred Plan Coverage Period: 01/01/ /31/2017
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.accessrga.com or by calling 1-866-738-3924. Important
Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.phs.org or by calling 1-866-574-9567. Important Questions
Highmark West Virginia: Shared Cost Blue PPO 1000 Coverage Period: 01/01/ /31/2016
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.highmarkbcbswv.com or by calling 1-888-601-2109. Important
Chemours Company: Highmark Choice Plus Plan Coverage Period: 01/01/ /31/2017
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.highmarkbcbsde.com or by calling 1-866-730-8592. Important
Important Questions Answers Why this Matters: What is the overall deductible?
ConocoPhillips Pre-65 Medicare-eligible Traditional Coverage Period: 01/01/2017 12/31/2017 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual/Family Plan Type:
You can see the specialist you choose without permission from this plan.
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.anthem.com or by calling 1-855-502-6365 Important Questions
Non-Network $2,800 Individual
ConocoPhillips Retiree Medical Plan: High Deductible Health Plan (HDHP) Coverage Period: 01/01/2017 12/31/2017 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual
Stark County Schools Council of Governments: PPO Plan Coverage Period: 07/01/ /30/2014
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.aultcare.com or by calling 1-800-344-8858 or Medical
Capgemini America: Basic PPO Plan Coverage Period: 01/01/ /31/2017 Summary of Benefits and Coverage: What this Plan Covers & What it Costs
Capgemini America: Basic PPO Plan Coverage Period: 01/01/2017-12/31/2017 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: ALL Plan Type: PPO This is only a summary.
Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the Summary Plan Description for ELCA-Primary Health Benefits at myportico.porticobenefits.org
Highmark Select Resources: Alliance Flex Blue PPO 2100 ONX (Base Plan)
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.highmarkblueshield.com or by calling 888-510-1084. Important
Important Questions Answers Why this Matters:
ConocoPhillips Medical Plan: Primary PPO Option Coverage Period: 01/01/2017 12/31/2017 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual and Family Plan Type: