Health Plan Comparison Chart: Faculty and Administrators

There is no requirement for a Non Participating Provider to accept payment directly from the Insurance. They may require you to pay upfront and seek reimbursement. They may also bill you for the difference between the insurance and their rate.

	Preferred Provider Organization (PPO)	Exclusive Provider Organization (EPO)	High Deductible Health Plan (HDHP)
Features	Network plus freedom of choice	Network only	Network only
Dependent Children Covered Until…	December 31 of the year the child turns 26 (whether or not s/he is a student)	December 31 of the year the child turns 26 (whether or not s/he is a student)	December 31 of the year the child turns 26 (whether or not s/he is a student)
Deductible, Individual	In Network: $0 for medical services; $200 for brand RX. Out of Network: $500 for medical services; $200 for brand RX.	$200 for retail brand RX only	$2,500
Deductible, Family	In Network: $0 for medical services; $200 for brand RX. Out of Network: $1,250 for medical services; $200 for brand RX.	$200 for retail brand RX only	$5,000
Coinsurance (the % you pay after deductible)	In Network: None. Out of Network: 20% (see plan for full details).	Not Applicable	Not Applicable
Maximum Out of Pocket, Individual	In Network: $5,080 (All In-Network copays). Out of Network (Deductible + coinsurance): $1,500.	$5,080 (All In-Network copays)	$2,500
Maximum Out of Pocket, Family	In Network: $12,700 (All In-Network copays). Out of Network (Deductible + coinsurance): $3,750.	$12,700 (All In-Network copays)	$5,000
Emergency Room	$75 waived if admitted inpatient within 24 hours. Out of Network: Paid at In Network Level.	$75 Copay	100% after deductible
Office Visit	In Network: $20 copay. Out of Network: 20% after deductible.	$25 copay	100% after deductible
Lab & Testing	In Network: $0 when performed at a standalone facility. Out of Network: 20% after deductible.	$0 copay when performed at a standalone facility	100% after deductible
Annual Physical	In Network: $0 copay. Out of Network: 20% after deductible.	$0 copay	$0 copay
Well-Woman Care (Annual gyn/pap, mammogram and bone density at certain age thresholds)	In Network: $0. Out of Network: 20% after deductible.	$0 copay	$0 copay
Well Child Care (To age 19, including necessary immunizations)	In Network: $0 copay. Out of Network: 20% after deductible.	$0 copay	$0 copay
Inpatient Hospitalization	In Network: $250 copay per admission. Out of Network: 20% after deductible.	$250 copay per admission	100% after deductible
Prescriptions: Optum RX	$10 copay for Generic. $25 for preferred brand after $200 deductible. $50 for non-preferred brand after $200 deductible.	$10 copay for Generic. $35 for preferred brand after $200 deductible. $70 for non-preferred brand after $200 deductible.	100% after deductible
Mail-Order Prescriptions	$20 copay for 3-month supply of generic RX (no deductible). $50 for 3-month supply of preferred brand-name RX (after deductible). $100 for 3-month supply of non-preferred brand-name RX (after deductible).	$20 copay for 3-month supply of generic RX (no deductible). $70 for 3-month supply of preferred brand-name RX (after deductible). $140 for 3-month supply of non-preferred brand-name RX (after deductible).	100% after deductible
Mental Health Care / Alcohol or Substance Abuse Treatment: Hospital And Inpatient Physician	In Network: $250 copay per admission. Out of Network: 20% after deductible.	$250 copay per admission	100% after deductible
Outpatient Physician	In Network: $20 copay/visit. Out of Network: 20% after deductible.	$25 copay/visit	100% after deductible
Physical Therapy	$20 per visit up to 60 visits per year (Covered In Network only)	$20 per visit up to 60 visits per year	100% after deductible
Chiropractor	In Network: $20 copay. Out of Network: Paid at In Network level of benefits.	$20 copay	100% after deductible