AGING ICON

ADVANTAGE OF USING IN NETWORK DOCTORS

Doctors agree to a fee schedule which may lower your out of pocket cost

Pay only a $15 co-pay

 for office visits

Requires PCP Selection

Limits out of pocket cost

No out of Pocket for In Network doctors visits $15 co-pay for specialists

Requires PCP Selection

Pay only a $10 co-pay

 for office visits

Pay only a $10 co-pay

for office visits.

Pay only a $10 co-pay

for office visits.

CHIROPRACTIC COVERAGE

Same as Medical Coverage Out-of-Network

In-Network agrees to managed care limits

80% covered fees after deductible for both In and Out of Network with  medical necessity and fees subject to limits

$10 co-pay

Limited number of visits both in and out of network  Preauthorization and

 $1500 Annual Max.

Only limited in-network coverage with

 managed care  limits

Limited number of visits

in-network $10 co-pay

Limited number of visits

in-network $10 co-pay

OUT PATIENT MENTAL HEALTH

Good Plan Most Providers Accept In- Out Network

Good Plan Most Providers Accept In-Out Network

Approved Services

in-network $10 co-pay

Authorization Required

$15 in network 50% out

Approved Services

in-network $10 co-pay

60 visits limit

in-network $10 co-pay

Approved Services

in-network $10 co-pay

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