Spreadsheet of individual and family plan benefits by Utah carriers

Note: The benefit spreadsheet below reflects "In-Network" benefits payable to participating doctors / hospitals. The intention of the spreadsheet is to point out general differences between the health insurance carriers. This is not a sales brochure or a official brochure from the carriers. It is simply an interpretation of benefits payable by carrier. THEREFORE for details please download the official brochure and application kit from the carrier of your choice.

Benefits See Tips at Bottom	HumanaOne Download health insurance applications & help kits! Description below is in general terms with Altius	Altius Peak Plan Download health insurance applications & help kits! Description below is in general terms with Altius	SelectHealth / IHC Download health insurance applications & help kits! Description below is in general terms with IHC	BlueAdvantage Copays w/ Regence BlueCross BlueShield Download health insurance applications & help kits! Description below is in general terms with BCBS

Customer Service // Hours of operation	Monday - Saturday between hours of 9am to 9pm	Monday - Friday between hours of 9am to 5pm	Monday - Friday between hours of 9am to 5pm	Monday - Friday between hours of 9am to 5pm

Claim Payment Guarantee	Yes in network. Yes out of network.	Yes in network. No out of network.	Yes in network. No out of network.	Yes in network. No out of network.
Claim Filing Requirements	None	None	None	None

Office Visit Copay	$35 Copay	$15	$15	$20

Calendar Yr. Ded.	Deductible does not apply for Office Visit or any other copays	Deductible does not apply for Office Visit or any other copays	Deductible does not apply for Office Visit or any other copays for High and Mid level plans	Deductible does not apply for Office Visit or any other copays

Out of Pocket Max. Single Family	2000 4000	2000 4000	3000 6000	2000 4000

Lifetime Max.	5,000,000	2,000,000	Unlimited	2,000,000

Pre-Existing Waiting Period There is a 12 month waiting period for prior medical conditions at the point of effective date here IF you do not have current coverage being replaced by us	12 Month for prior medical conditions. Waived if you are replacing	12 Month for prior medical conditions. Waived if you are replacing	12 Month for prior medical conditions. Waived if you are replacing	12 Month for prior medical conditions. Waived if you are replacing

Prescription Coverage's
Generic Name Brand Non-Preferred	$15 $35 $55	$15 $30 $60	$10 25% of Cost of RX 50% of Cost of RX	$10 25% of Cost of RX 50% of Cost of RX

Hospitalization
Room & Board Inpatient Physician Surgeon & Anesthesiologist	You pay 20% after Ded. The insurance carrier pays the difference.	You pay 20% after Ded. The insurance carrier pays the difference.	You pay 20% after Ded. The insurance carrier pays the difference.	You pay 20% after Ded. The insurance carrier pays the difference.

Maternity
Outpatient Care Physician Delivery Fee Hospital Room & Board	You pay 20% after Ded. The insurance carrier pays the difference. COMPLICATIONS ONLY COVERAGE.	$7,500 Deductible. 100% coverage thereafter	$5,000 Deductible. 100% coverage thereafter	$5,000 Deductible. 100% coverage thereafter. NOTE: Maternity not covered in the first policy year with Regence BlueCross BlueShield

Out-Patient Care

Doctor Office Coverage's:
Preventative Care-By Primary Doctor Annual Physical Immunizations	20%	$15 copay - No Ded. 100% coverage No Limit Maximum	For High and Mid level plans a $15 copay - No Ded. 100% coverage No Limit Maximum For Base level plans you must meet a deductible first BEFORE your copay kicks in.	$20 copay - No Ded. 100% coverage No Limit Maximum

Office Visits - Primary Care Office Visits - After Hours Office Visits Specialist Minor Lab/X-ray w/ mammography	$35 Copay $200 cash benefit than 20% after deductible	$15 copay - No Ded. $25 copay - No Ded. $25 copay - No Ded. 100% No Deductible	For High and Mid level plans a $15 copay - No Ded. $25 copay - No Ded. $15 copay - No Ded. 100% No Deductible For Base level plans you must meet a deductible first BEFORE your copay kicks in.	$20 copay - No Ded. $20 copay - No Ded. $20 copay - No Ded. 100% No Deductible

Major Lab/X-ray w/ CT scan, MRI/MRA	You pay 20% after Ded.	You pay 20% after Ded.	You pay 20% after Ded.	You pay 20% after Ded.

Physiotherapy - Physiotherapy - Providers Office - Outpatient Facility	You pay 20% after Ded.	No max No max $25 copay - No Ded. You pay 20% after Ded.	No max No max $15 copay - No Ded. You pay 20% after Ded.	No max No max $20 copay - No Ded. You pay 20% after Ded.

Out Patient Surgery	You pay 20% after Ded.	You pay 20% after Ded.	You pay 20% after Ded.	You pay 20% after Ded.

Outpatient Hospital Services Chemotherapy, Radiation therapy Kidney Dialysis	You pay 20% after Ded.	You pay 20% after Ded.	You pay 20% after Ded.	You pay 20% after Ded.

Eye Exams - Optometrist	Discount Plan	$15 copay - No Ded.	100% Coverage after copay	No Coverage

Emergency Care

Emergency Room Visit In-network Hospital Out-of-network Hospital Non - Accidental Visit Accidental Visit	You pay 20% after Ded.	Full Coverage $75 Copay - No Ded. $150 Copay - No Ded. $75 Copay - No Ded. $75 Copay - No Ded.	Full Coverage $100 & then ded. then 20% $200 & then ded. then 20% $100 & then ded. then 20%	Full Coverage Full Coverage Full Coverage $75 & Ded. & 20% $75 then 20%

Urgent Care at Dr. Office Urgent Care at Facility (Clinic)	$35 Copay	$25 copay - No Ded. $25 copay - No Ded.	$15 copay - No Ded. $25 copay - No Ded.	$20 copay - No Ded. $20copay - No Ded.

Ambulance, Paramedics Air Ambulance	You pay 20% after Ded. You pay 20% after Ded.	You pay 20% after Ded. You pay 20% after Ded.	You pay 20% after Ded. You pay 20% after Ded.	You pay 20% after Ded. You pay 20% after Ded.

Other Benefits

Medical Supplies Accident-Related Dental Services Lifetime Max	You pay 20% after Ded. You pay 20% after Ded.	You pay 20% after Ded. You pay 50% after Ded. $1,000	You pay 20% after Ded. You pay 50% after Ded. $1,000	You pay 20% after Ded. You pay 50% after Ded. $1,000

Allergy Conditions Testing & Treatment Injections	$35 Copay	$25 copay - No Ded. 100% Coverage	$15 copay - No Ded. You pay 20% after Ded. For Base level plans you must meet a deductible first BEFORE your copay kicks in.	No Coverage For Test No Coverage

Serum:	You pay 20% after Ded.	You pay 20% after Ded.	You pay 20% after Ded.	Limited Coverage

Infertility Treatment - Limited To: Yearly Maximum Benefit Lifetime Maximum Benefit	Diagnostic Only $1,500 $5,000	Diagnostic Only $1,500 $5,000	Diagnostic Only $1,500 $5,000	Diagnostic Only $1,500 $5,000

Adoption Benefit Payable to You	$3,155 Per Adoption	$3,155 Per Adoption	$3,155 Per Adoption	$3,155 Per Adoption

Chiropractic Care -	$35 Copay	$25 copay - No Ded.	Not Covered	$20 copay - No Ded.
Maximum Visits per year		10 per member		$1500 max benefit

Mental Health	You pay 50% after deductible. Day limit for inpatient is 10 per calendar year. Visit limit for outpatient is 15 per calendar year.	Not Covered	You pay 50% after deductible. Day limit for inpatient is 10 per calendar year. Visit limit for outpatient is 15 per calendar year.	After Ded. 50% copay to maximum of $1,500. Coinsurance does not apply to "out-of-pocket maximum".
Substance Abuse	You pay 50% after deductible. Day limit for inpatient is 10 per calendar year. Visit limit for outpatient is 15 per calendar year.		You pay 50% after deductible. Day limit for inpatient is 10 per calendar year. Visit limit for outpatient is 15 per calendar year.	After Ded. 50% copay to maximum of $1,500. Coinsurance does not apply to "out-of-pocket maximum".