Health Insurance Comparison Chart: Staff, Auxiliary, and Carpenters
| Plan Features | Aetna Meritain PPO for Staff | Aetna Meritain EPO | MVP Health Plan |
|---|---|---|---|
| Network coverage | Network and Out of Network Coverage | Network Only | Network Only |
| Primary Care Provider Required | No | No | Yes |
| Medical services Deductible (Individual) | In Network: $0. Out of Network: $200. | Not Applicable | Not Applicable |
| Medical services Deductible (Family) | In Network: $0. Out of Network: $500. | Not Applicable | Not Applicable |
| Coinsurance: the % you pay after deductible | In Network: None Out of Network: 20% | Not Applicable | Not Applicable |
| Maximum Out of Pocket (Individual) | In Network: $5,080 (All In-Network copays) Out of Network: $1,000 | $5,080 (All In-Network copays) | $5,080 (All In-Network copays) |
| Maximum Out of Pocket (Family) | In Network: $12,700. (All In-Network copays) Out of Network: $2,000. | $12,700 (All In-Network copays) | $12,700 (All In-Network copays) |
| Emergency Room | $35 – waived if admitted in 24 hours | $75 – waived if admitted inpatient within 24 hours | $50 waived if hospitalized |
| Office Visit | In Network: $12 copay. Out of Network: Deductible & Coinsurance. | $25 copay | $15 copay |
| Lab & Testing | In Network: $0 if in a freestanding lab; $12 copay for office visit if in a medical center such as Optum. Out of Network: Deductible & Coinsurance | $0 if in a freestanding lab; $25 copay for office visit if in a medical center such as Optum. | $15 copay |
| Annual Physical / Well-Woman care | $0 copay | $0 copay | $15 copay |
| Inpatient Surgery | $0 copay | $250 copay | $0 copay |
| Vision: Exam every 2 years | $15 copay | ||
| Prescriptions | Optum RX: $5 copay for Generic, $15 / $25 for Brand. | Optum RX: $10 copay for Generic, $35 / $70 for Brand after $200 deductible. | $5 copay for Generic $20 / $40 Brand. |
| Children’s Preventive Dental Care | Not covered | Not covered | 2 visits per year for children under 19 |
| Mental Health | In-network inpatient hospital: $0 Out-of-network: Deductible & Coinsurance In-network outpatient visit: $12 copay/visit Out-of-network: Deductible & Coinsurance | Covers network providers only: $250 copay inpatient hospital; $0 inpatient psychiatrist; $25 per visit outpatient visits. | $0 inpatient hospital; 50% or $45 copay inpatient psychiatrist; $15 copay outpatient visits. |
| Alcohol/Substance Abuse – Inpatient | $0 copay; subject to pre-cert | Covers network providers only: $250 copay inpatient hospital; $0 $25 per visit outpatient visits. | $0 detoxification |
| Alcohol/Substance Abuse – Outpatient | $12 copay | Covers network providers only: $250 copay inpatient hospital; $0 $25 per visit outpatient visits. | $15 copay |
| Physical Therapy | $20 per visit up to 90 visits per year (covered in-network only) | $25 per visit up to 60 visits per year | $15 per visit up to 60 days |