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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

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HumanaOne

Description below is in general terms with Altius

Altius Peak Plan

Description below is in general terms with Altius

 

SelectHealth / IHC

Description below is in general terms with IHC

 

BlueAdvantage
Copays w/ Regence
BlueCross BlueShield

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".  
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  • Refer to official insurance carrier brochure for clarifications.                                                       
  • Comparing prices and benefits can be confusing. Benefits Manager can answer your questions via phone or e-mail. We pride ourselves on providing top quality policies and services and standing by our customers through the years. We'll be here to answer your questions and concerns even after you've purchased your policy. 

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