| Benefit |
Applicable
Provider Network |
Benefit
Level |
| General Provisions |
|
|
|
General |
|
|
|
Eligibility |
|
|
|
Dependent Eligibility To |
All |
19 years |
|
Dependent Maximum Age Limit |
All |
24 years |
|
Maximum Copayments |
|
|
|
Single Party Copayment Maximum |
HMO |
$1,500 |
|
Two Party Copayment Maximum |
HMO |
$3,000 |
|
Family Copayment Maximum |
HMO |
$4,500 |
| HMO Benefits |
|
|
|
Inpatient Hospital-Medical |
|
|
|
Blood Copayment |
HMO |
$0 |
|
Skilled Nursing Facilities |
|
|
|
Skilled Nursing Facility Med/Rtc Ab88 Calendar Year Maximum Comb |
HMO |
100 days |
|
Emergency Room And Emergency Diagnosis Benef |
|
|
|
Emergency Room In Area Copayment |
HMO |
$50 |
|
Physical Therapy |
|
|
|
Physical Therapy Copayment |
HMO |
$10 |
|
Physical Therapy Maximum Per Illness |
HMO |
60 days |
|
Physical Therapy Maximum Per Injury |
HMO |
60 days |
|
Rehabilitation Therapies |
|
|
|
Speech Therapy Copayment |
HMO |
$10 |
|
Speech Therapy Maximum Per Illness/Injury |
HMO |
60 days |
|
Occupational Therapy Copayment |
HMO |
$10 |
|
Occupational Therapy Maximum Per Illness/Injury |
HMO |
60 days |
|
Durable Medical Equipment |
|
|
|
Durable Medical Equipment Calendar Year Maximum |
HMO |
$2,000 |
|
Obstetrical Benefits |
|
|
|
Obstetrical Copayment |
HMO |
$10 |
|
Obstetrical Consultation Copayment |
HMO |
$10 |
|
Obstetrical Counseling Copayment |
HMO |
$10 |
|
Family Planning Copayment |
HMO |
$10 |
|
Abortion Copayment |
HMO |
$150 |
|
Sterilization/Infertility |
|
|
|
Tubal Ligation Copayment |
HMO |
$150 |
|
Vasectomy Copayment |
HMO |
$100 |
|
Infertility Treatment Copayment |
HMO |
50% |
|
Home Health Care Benefits |
|
|
|
Home Health Per Visit Copayment |
HMO |
$10 |
|
Hospice Care Benefits |
|
|
|
Hospice Life Maximum |
HMO |
$5,000 |
|
Mental Health Parity |
|
|
|
Inpatient Hospital-Nervous/Menta |
|
|
|
Inpatient Copayment Per Day |
HMO |
$100 |
|
Inpatient Psychiatric Calendar Year Maximum |
HMO |
30 days |
|
Outpatient Nervous/Mental |
|
|
|
Outpatient Nervous/Mental Copayment |
HMO |
$35 |
|
Outpatient Nervous/Mental Calendar Year Maximum |
HMO |
20 visits |
|
Professional Nervous/Mental |
|
|
|
Nervous/Mental Medical While Hospitalized Copayment |
HMO |
$35 |
|
Nervous/Mental Medical While Hospitalized Maximum Per Day |
HMO |
1 visit |
|
Nervous/Mental Medical While Hospitalized Maximum Per Calendar Year |
HMO |
30 visits |
|
Inpatient Substance Abuse |
|
|
|
Inpatient Substance Abuse Per Day Copayment |
HMO |
$100 |
| Drug Rider Benefits |
|
|
|
Drug Rider Coverage |
|
|
|
Brand Name Retail Copayment |
All |
$15 |
|
Brand Name Mail Order Copayment |
All |
$30 |
|
Generic Retail Copayment |
All |
$7 |
|
Generic Mail Order Copayment |
All |
$14 |
|
Rx Mail Order Supply Maximum |
All |
90 days |
|
Rx Retail Supply Maximum |
All |
30 days |