Benefit

PPO

HMO

Deductible

None

None

Maximum benefit

$1,000,000 per member

$1,000,000 per member

Copayment maximum

None

$1,250 per member; $2,500 per family unit

Office visits for injury/illness

·        Office visits

·        Office diagnostic x-ray and laboratory services

·        Maternity care

·        $15 copayment if expenses are less than $350

·        You pay 20% if expenses are more than $350

·        $15 copayment if expenses are less than $350

·        You pay 20% if expenses are more than $350

Office visits for preventive care

·        $500 per member per calendar year

·        Annual vision exam

·        Annual health exam

·        Children’s immunizations

·        Annual hearing exam

$15 copayment

·        $15 copayment if expenses are less than $350

·        You pay 20% if expenses are more than $350

Inpatient hospital/physician services

·        Semi-private room

·        Related services/supplies

·        Skilled nursing facility

You pay 20% of the billed charge

You pay 20% of the billed charge

Outpatient services

·        Surgery

·        X-rays and lab work

You pay 20% of the billed charge

You pay 20% of the billed charge

Emergency room care

·        Office

·        Urgent care center

·        Hospital emergency room

·        Ambulance

$50 copayment

·        Office—see office visit for injury or illness above

·        Urgent care center—$25 copayment

·        Hospital ER—$75

·        Ambulance—20% of the billed charge

Mental illness and drug/alcohol services

·        Inpatient—10 days max. per calendar year

·        Outpatient—20 visits per calendar year

You pay 20% of the billed charge

·        Inpatient—50% of the billed charge

·        Outpatient—$15 copayment for first two visits, $20 for remaining visits

Durable medical equipment

You pay 20% of the billed charge

You pay 50% of the billed charge

Costs for insurance

·        Single

·        Employee plus one

·        Family

·        $144

·        $304

·        $448

·        $132

·        $277

·        $409

Benefit

HMO

PPO

Maximum benefit

$1,000.00

No maximum

Deductible

·        Per person

·        Per family

·        $50

·        $150

None

Preventive

·        Routine exams

·        Cleanings

100% paid

100% paid

Basic

·        Fillings

·        Endodontics

·        Extractions

·        Oral surgery

80% paid

Deductible applies

100%  paid

Major

·        Crowns

·        Bridges

·        Dentures

·        Periodontics

50% paid

Deductible applies

50% paid

Orthodontics

50% paid

$1,000 maximum

25% fee reduction

No maximum

Specialists

20-25% discount

20-25% fee reduction

Employee cost

·        Single

·        Employee plus one

·        Family

·        $13

·        $24

·        $37

·        $21

·        $42

·        $67