|
Essentials |
Essentials |
Prime |
HSA-Qualified |
HSA-Qualified |
LifeWise Health Plans
Effective starting 1/1/2011 |
Plan Summary
Plan Rates |
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|
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| Features |
A good option when you’re looking for a low rate and more up front coverage for routine care needs. This plan provides up front coverage for your first three office visits. |
A good option when you’re looking for a low rate and more up front coverage for routine care needs. This plan provides up front coverage for your first three office visits. |
A benefit-rich plan that includes coverage for generic and brand name prescriptions. A nice option if you’re looking to cover all your bases. |
• Tax-advantaged savings plan
• Lower monthly rates |
• Tax-advantaged savings plan
• Lower monthly rates |
| Individual Deductible |
$1,000 / $2,500 / $5,000 |
$7,500 / $10,000 |
$1,500 / $2,500 / $5,000 |
$3,000 individual
$6,000 family** |
$5,950 individual
$11900 family** |
Coinsurance
(what you pay) |
35% |
40% |
30% |
25% |
0% |
| Coinsurance Maximum |
$7,500 |
$7,500 |
$6,000 |
$2,950 Individual $5,900 Family |
$0 |
Out-of-Pocket Maximum
|
Annual deductible +
coinsurance maximum
|
Annual deductible +
coinsurance maximum |
Annual deductible +
coinsurance maximum |
Annual deductible +
coinsurance maximum |
Annual deductible +
coinsurance maximum |
| Office Visits, Urgent Care & Naturopathy |
$35 on first 3 visits PCY; additional visits subject to deductible, then 35%. |
$40 on first 3 visits PCY; additional visits subject to deductible,then 40%. |
$30 copay on first 4 visits PCY; additional visits subject to deductible, then 30%. |
Office Visits: Deductible
applies first, then you pay 25% |
Office Visits: Deductible, then covered in full |
Preventive Care & Preventive Screenings
(includes mammograms, colonoscopies, PAP & PSA screenings) |
Covered in full |
Covered in full |
Covered in full |
Covered in full |
Covered in full |
Alternative Care
|
Deductible waived, $35 copay |
Deductible waived, $40 copay |
Deductible waived, $30 copay |
Deductible, then 25% |
Deductible, then covered in full |
Pharmacy
(Retail 30-day supply) |
$20 copay |
$20 copay |
$20 generic; 50% brand ($500 deductible for brand - select drug list) |
Deductible, then 25% ($5,000 PCY limit) |
Deductible, then covered in full ($5,000 PCY limit) |
Pharmacy
(Mail Order 90-day supply) |
$60 copay |
$60 copay |
$60 generic; 50% brand ($500 deductible for brand - select drug list) |
Deductible, then 25% ($5,000 PCY limit) |
Deductible, then covered in full ($5,000 PCY limit) |
| Maternity |
Prenatal & Postnatal Care: Deductible, then 35% - Routine Delivery: Deductible, then 50% |
Prenatal & Postnatal Care: Deductible, then 40% - Routine Delivery: Deductible, then 50% |
Deductible, then 30% |
Deductible, then 25% |
Deductible, then covered in full |
Vision & Hearing Care—Routine Exam
(1 exam PCY) |
Deductible waived, $35 copay |
Deductible waived, $35 copay |
Deductible waived, $30 copay |
Deductible, then 25% |
Deductible, then covered in full |
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