| PLAN | 1 Hospital BeneFits |
2 Hospital BeneFits Plus |
3 Hospital Benefits Preferred |
4 PPO $35 Copay GenRX |
5 Power Select HMO |
| Unique Value | A simple, affordable PPO Plan with Basic Hospital Coverage | A lower deductible PPO Plan combined with enhanced elements | Offers preferred protection and the richest benefits | Affordable PPO alternaive with generic only drug benefit | A compre-hensive HMO plan with unlimited coverage |
| Annual Deductible | $1250 2-member maximum | $1000 2-member maximum | $750 2-member maximum | $500 2-member maximm | $500 |
| Hospital | 30% After Deductible | 30% After Deductible | 30% After Deductible | 35% After Deductible | 10% After Deductible |
| Outpatient Facility | 30% | 30% | 30% | 35% | 20% |
| Annual Out of Pocket Maximum |
Annual Deducitble plus $2500 2-member maximum | Annual Deducitble plus $2500 2-member maximum | Annual Deducitble plus $2500 2-member maximum | $4000 per member 2-member maximum | $2250 per member; $4500 per family |
| Prescription Drugs | $15 Generic Only | $15 Generic Only | $15 Generic Only | $15 Generic Only | $15 Generic; $25 Brand after $150 brand deductible |
| Doctor Office Visits | No benefits for routine doctor visits | 50% co-insurance for first $1000 of covered expenses, and 100% after that (max Blue Cross payment $500/yr) including related services: lab, ex-ray, etc. | 50% co-insurance for first $1500 of covered expenses, and 100% after that (max Blue Cross payment $750/yr) including related services: lab, ex-ray, etc. | (not subject to deductible) $35 per visit first 12 visits; 45% for additional visits |
(not subject to deductible) (includes office visits for maternity) $25 for primary care physician visits $35 for specialist or referral care visits |
| Other Professoinal Services | 30% after deductible related to covered hospital charges only | 30% after deductible related to covered hospital charges only | 30% after deductible related to covered hospital charges only | 35% after deductible includes maternity, diagnostic lab and x-rays | Not subject to deductible, no charge, includes maternity diagnostic lab and x-rays |
| Healthy Check Screenings. Tests & Immunization s | Choose $25 or $75 Screening Option | Choose $25 or $75 Screening Option | Choose $25 or $75 Screening Option | Choose $25 or $75 Screening Option | Not Available |
| Emergency Room | 30% | 30% | 30% | 35% | No charge if admitted |
| Maximum Lifetime Benefits | $5 Million | $5 Million | $5 Million | $5 Million | Unlimited |