|
COSE Health Plan Comparison
Chart - Plans are only available to COSE groups enrolled in program prior to July 1, 2006 |
| |
Medical Mutual (MMO)
Plans Groups
are able to offer any 2 standard plans and 1 HSA, simultaneously. |
Kaiser
Permanente Plan Options**** |
| |
250/500
PLAN
(Only in-network benefit listed) |
500/1000
PLAN
(Only in-network benefit listed) |
750/1500
PLAN
(Only in-network benefit listed) |
1000/2000
PLAN
(Only in-network benefit listed) |
2000/4000
PLAN
(Only in-network benefit listed) |
SUPERMED
MULTIPLE OPTION 100 PLAN |
SUPERMED
MULTIPLE OPTION 90 PLAN |
SUPERMED
MULTIPLE OPTION 80 PLAN |
HMO
HEALTH OHIO **** |
HEALTH
SAVINGS ACCOUNT (HSA) PLANS
(Plans include First Horizon MSAver Administration Feature) |
KAISER
PERMANENTE
HIGH OPTION
|
KAISER
PERMANENTE
STANDARD OPTION
|
KAISER
PERMANENTE
BASIC OPTION
|
*SUPERMED
CLASSIC GOLD OR
**SUPERMED
PLUS |
*SUPERMED
CLASSIC GOLD OR
**SUPERMED
PLUS |
*SUPERMED
CLASSIC GOLD OR
**SUPERMED
PLUS |
*SUPERMED
CLASSIC GOLD OR
**SUPERMED
PLUS |
**SUPERMED
PLUS |
Network |
Non-network |
Network |
Non-network |
Network |
Non-network |
SUPERMED
PLUS HSA 2500/100 |
SUPERMED
PLUS HSA 3000/100 |
SUPERMED
PLUS HSA 4000/100 |
SUPERMED
PLUS HSA 5000/100 |
| Annual
Deductible |
$250
single
$500 family |
$500
single
$1000 family |
$750
single
$1500 family |
$1000
single
$2000 family |
$2000
single
$4000 family |
None |
$250
single
$500 family |
None |
$250
single
$500 family |
$100
single
$200 family |
$250
single
$500 family |
None |
Network:
$2500 single
$5000 family
Non-Network:
$3000 single
$6000 family |
Network:
$3000 single
$6000 family
Non-Network:
$3500 single
$7000 family |
Network:
$4000 single
$8000 family
Non-Network:
$4500 single
$9000 family |
Network:
$5000 single
$10000 family
Non-Network:
$5500 single
$11000 family |
None |
None |
None |
| Out-of-Pocket
Maximum (excluding deductible) |
$1250
single
$2500 family |
$1250
single
$2500 family |
$1500
single
$3000 family |
$1500
single
$3000 family |
None |
None |
$1500
single
$3000 family |
$1250
single
$2500 family |
$3000
single
$6000 family |
$1250
single
$2500 family |
$3000
single
$6000 family |
None |
Network:
100% after deductible
Non-network: 60% after deductible |
None |
None |
None |
Non-Network:
$4500 single
$9000 family |
Non-Network:
$4000 single
$8000 family |
Non-Network:
$3000 single
$6000 family |
Non-Network:
Unlimited |
| Office
Visits |
100%
after $15 copayment |
100%
after $15 copayment |
100%
after $20 copayment |
100%
after $20 copayment |
100%
after deductible |
100%
after $15 copayment |
70%
after $15 copayment |
100%
after $20 copayment |
70%
after $25 copayment |
100%
after $20 copayment |
60%
after $25 copayment |
100%
after $15 copayment |
Network:
100% after deductible
Non-network: 60% after deductible |
$10
copayment |
$15
copayment |
$20
copayment |
| Laboratory,
X Ray, Diagnostic Services |
Plus:
80% after deductible
Classic Gold: 90% after deductible |
Plus:
80% after deductible
Classic Gold: 90% after deductible |
Plus:
80% after deductible
Classic Gold: 90% after deductible |
Plus:
80% after deductible
Classic Gold: 90% after deductible |
100%
after deductible |
100% |
100% |
100% |
100% |
100% |
100% |
100% |
Network:
100% after deductible
Non-network: 60% after deductible |
100% |
100% |
100% |
| Well
Baby & Child Care |
Plus:
$15 copayment, then 100% for exam, 80% after deductible for all other
services
Classic Gold: 90% after deductible |
Plus:
$20 copayment, then 100% for exam, 80% after deductible for all other
services
Classic Gold: 90% after deductible |
Plus:
$20 copayment, then 100% for exam, 80% after deductible for all other
services
Classic Gold: 90% after deductible |
100%
after deductible |
100%
after $15 copayment |
50%
after deductible |
100%
after $20 copayment |
50%
after deductible |
100%
after $20 copayment |
50%
after deductible |
100%
after $15 copayment |
Network:
100% not subject to deductible
Non-network: 60% after deductible |
$10
copayment |
$15
copayment |
$20
copayment |
| Inpatient
Hospital Care |
Plus:
80% after deductible
Classic Gold: 90% after deductible |
100%
after deductible |
100%
after $100 copayment per admission |
70%
after deductible |
90% |
70%
after deductible |
80%
after deductible |
60%
after deductible |
100%
after $100 deductible per admission |
Network:
100% after deductible
Non-network: 60% after deductible |
100% |
100% |
100%
after $250 deductible per admission |
| Inpatient
Maternity Care |
Benefits
are the same as for any other condition |
100%
after deductible |
100%
after $100 deductible per admission |
70%
after deductible |
90% |
70%
after deductible |
80%
after deductible |
60%
after deductible |
100%
after $100 deductible per admission |
Network:
100% after deductible
Non-network: 60% after deductible |
100% |
100% |
100%
after $250 deductible per admission |
| Emergency
Coverage |
Plus:
80% after deductible
Classic Gold: 90% after deductible |
100%
after deductible |
100%
after $75 copayment
(copayment waived if admitted) |
100%
after $75 copayment (emergency)
(90% after $75 copayment (non-emergency) (copayment waived if admitted) |
100%
after $100 copayment (emergency)
(80% after $100 copayment (non-emergency) (copayment waived if admitted) |
100%
after $75 copayment
(copayment waived if admitted) |
100%
after deductible |
$50
copayment |
$50
copayment |
$75
copayment |
| Inpatient
Mental Health & Substance Abuse Treatment |
Plus:
80% after deductible
Classic Gold: 90% after deductible
(maximum 45 days/benefit period) |
100%
after deductible (maximum 45 days/benefits period) |
100%
(maximum 30 days/benefits period) |
50%
after deductible |
90%
(maximum 30 days/benefit period) |
50%
after deductible |
80%
after deductible (maximum 30 days/benefit period) |
50%
after deductible |
100%
after $100 deductible per admission |
Network:
100% after deductible
Non-network: 60% after deductible
(combined in and out-of-network maximum 30 days per benefit period)
|
100%
(maximum 30 days/calendar year) |
100%
(maximum 30 days/calendar year) |
100%
after $250 deductible per admission (maximum 30 days/calendar year) |
| Outpatient
Mental Health & Substance Abuse Treatment |
50%
after deductible (maximum 30 visits/benefit period |
50%
after deductible (maximum 30 visits/benefit period |
100%
after $15 copayment
(combined in and out-of-network maximum of 20 visits per benefit period) |
50%
after $15 copayment |
90%
after $20 copayment
(combined in and out-of-network maximum of 20 visits per benefit period) |
50%
after $25 copayment |
80%
after $20 copayment
(combined in and out-of-network maximum of 20 visits per benefit period) |
50%
after $25 copayment |
100%
after $15 copayment
(maximum 20 visits per benefit period) |
Network:
100% after deductible
Non-network: 60% after deductible
(combined in and out-of-network maximum 20 days per benefit period) |
$10
copayment
(maximum 20 visits/calendar year) |
$15
copayment
(maximum 20 visits/calendar year) |
$20
copayment
(maximum 20 visits/calendar year) |
| Prescription
Drug (Oral Contraceptives & Mail Order Included) |
80%
after deductible (major medical prescription) or $10/$20/$40 retail
$25/$50/$100 mail order prescription drug copay card*** |
80%
after deductible (major medical prescription coverage only) |
100%
after deductible |
$25/$50/$100
mail order prescription drug copay card*** |
100%
after deductible |
$10
copayment |
$15
copayment |
$20
copayment |
Note:
This comparison chart is a general overview of benefits for COSE-sponsored
plans. Please contact the insurance carrier for complete plan
information.
*You may receive services from any hospital or physician. **You must
receive services from a SuperMed hospital and a SuperMed Plus physician to
receive maximum benefits. ***Plans that include a prescription drug
copay card also include the SuperMed Script Program. See your plan
summary highlight sheets for details on this Program.
****This plan utilizes the HMO Health Ohio network and requires the
selection of a Primary Care Provider. Click HERE
for a list of participating providers.
*****Medical service must be provided or arranged by Kaiser Permanente
Medical Group physicians. |