GetHealthHelp

A Patient Advocate's View

Open Enrollment is Oct.17-30, 2007

 

 

PLAN

 

50A.Empire MEP Indemnity

 

185. AetnaMEP PPO/Indemnity

 

814.Empire BCBS NY

 

21.Aetna

 HCN NY

 

847.Aetna HMO

 

822.HIP NY

 

838.HealthNet NY/CT

 

HOW DOCTORS & PATIENTS LIKE

 THIS PLAN

 

A+ BEST for Adults

Preventive Exams for children not covered

 

BEST, Some Problems Proving Medical Necessity

Well Baby In Network Only

 

 

Only doctors at participating hospitals will accept.

Bare Bones Coverage

 

Network Providers are

 good in this plan.

 

Only doctors at participating hospitals will accept.

Bare Bones Coverage

 

VERY GOOD for Preventive Services for children and women’s care.

 

Doctors compare this coverage to Medicare HMO’s. Small Network

 

 

CHANGES FROM

 LAST YEAR (2007)

 

Deductible raised from $200/500 to $250/625

Out Of Pocket max. increased to $700

 

 

Deductible raised from $200/500 to $250/625

Out of Pocket max. increased to $700

 

 

  $150 Hospital  co-pay

per admission added  

 

 

NONE

 

Replaces 803A. Aetna

  $150 Hospital  co-pay

per admission added

$50 emergency room

 

 

 $100 Hospital  co-pay

per admission added

 

 

 $150 Hospital  co-pay

per admission added

 

 

IN NETWORK

PRESCRIPTION

PLAN

 

Annual Out of Pocket

  max. raised to $300

70-85% covered with limits on co-pay

 

 

Annual Out of Pocket

  max. raised to $300

70-85% covered with limits on co-pay

 

 

 

In-Network Only

limited co-pays

 

 

70-85% covered with

 co-pay maximums

 

 

$5 co-pay 34 day supply

$10 mail order 90 days

 

Small co-pays for network and mail order generic & approved drugs. No Coverage for some drugs.

 

Small co-pays for network and mail order generic & approved drugs. No Coverage for some drugs

 

 

 

OUT OF NETWORK

PRESCRIPTION

PLAN

 

 

70-85% covered with same co-pay max as

 in-network except has a $50. deductible

 

 

 

70-85% covered with same co-pay max as

in-network except has a $50. deductible and patient pays then gets reimbursed

 

 

 

 

 

NONE

 

 

70-85% covered with same co-pay max as

 in-network except has a $50. deductible and patient pays then gets reimbursed

 

 

 

 

 

NONE

 

 

 

 

NONE

 

 

 

 

NONE

October 8, 2007 - Posted by | Uncategorized

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