Page 8 - Future Steps
P. 8
2017 Benefits Enrollment
Medical Options Comparison Chart
Option 1
(California Residents Only) Option 2 Option 3 Option 4
HMO Plan Exclusive Classic PPO Plan HRA Plan HSA Plan
Network Only Network Non-Network Network Non-Network Network Non-Network
Employer Funding
Individual None None $750 $750
Family None None $1,500 $1,500
Calendar Year Deductible Non-Embedded Non-Embedded Non-Embedded
Individual $0 $0 $3,500 $1,500 $3,000 $2,500 $5,000
Family $0 $0 $7,000 $3,000 $6,000 $5,000 $10,000
Out-of-Pocket Maximum Embedded Embedded Embedded Embedded
Individual $3,000 $2,500 $10,000 $3,500 $7,000 $5,000 $10,000
Family $6,000 $5,000 $20,000 $7,000 $14,000 $10,000 $20,000
Physician Ofice Visits
Primary Care $20 copay $30 copay 50% after deductible $20 copay* 70% after deductible $20 copay** 70% after deductible
Specialist $40 copay $30 copay 50% after deductible $20 copay* 70% after deductible $20 copay** 70% after deductible
Wellness/Preventive Services 100%, no cost share 100%, 50% after deductible 100%, 70% after deductible 100%, 70% after deductible
no cost share no cost share no cost share
Hospital Services
Inpatient $250 copay per day (3 day $500 copay 50% after deductible 90% after deductible 70% after deductible 100% after deductible 70% after deductible
max)
Outpatient $125 copay per admission $250 copay 50% after deductible 90% after deductible 70% after deductible 100% after deductible 70% after deductible
Emergency Room $150 copay $100 copay $100 Copay 90% after deductible 90% after deductible 100% after deductible 100% after deductible
Urgent Care Facility $20 copay $30 copay 50% after deductible $20 copay* 70% after deductible $20 copay** 70% after deductible
Prescription Medications
Retail
Tier 1 $15 copay $10 copay Copay + 50% $10 copay* 30% of allowed + excess $10 copay** 30% of allowed + excess*
Tier 2 $30 copay $30 copay Copay + 50% $30 copay* 30% of allowed + excess $30 copay** 30% of allowed + excess*
Tier 3 $50 copay $50 copay Copay + 50% $50 copay* 30% of allowed + excess $50 copay** 30% of allowed + excess*
Tier 4 30% to $150 max 30% to $150 max Copay + 50% 30% to $150 max* 30% of allowed + excess 30% to $150 max** 30% of allowed + excess*
Home Delivery
Tier 1 $15 copay $10 copay Not covered $10 copay* Not covered $10 copay** Not covered
Tier 2 $60 copay $60 copay Not covered $60 copay* Not covered $60 copay** Not covered
Tier 3 $100 copay $100 copay Not covered $100 copay* Not covered $100 copay** Not covered
Tier 4 30% to $300 max 30% to $300 max Not covered 30% to $300 max* Not covered 30% to $300 max** Not covered
Preventive care is an integral part of a comprehensive healthcare plan which
includes preventive drug therapies. Preventive medications are those used for the
prevention of conditions such as high blood pressure, high cholesterol, asthma, and
stroke. Effective January 1, 2017, VER will cover preventive medications at 100%
under all plan options.
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Medical Options Comparison Chart
Option 1
(California Residents Only) Option 2 Option 3 Option 4
HMO Plan Exclusive Classic PPO Plan HRA Plan HSA Plan
Network Only Network Non-Network Network Non-Network Network Non-Network
Employer Funding
Individual None None $750 $750
Family None None $1,500 $1,500
Calendar Year Deductible Non-Embedded Non-Embedded Non-Embedded
Individual $0 $0 $3,500 $1,500 $3,000 $2,500 $5,000
Family $0 $0 $7,000 $3,000 $6,000 $5,000 $10,000
Out-of-Pocket Maximum Embedded Embedded Embedded Embedded
Individual $3,000 $2,500 $10,000 $3,500 $7,000 $5,000 $10,000
Family $6,000 $5,000 $20,000 $7,000 $14,000 $10,000 $20,000
Physician Ofice Visits
Primary Care $20 copay $30 copay 50% after deductible $20 copay* 70% after deductible $20 copay** 70% after deductible
Specialist $40 copay $30 copay 50% after deductible $20 copay* 70% after deductible $20 copay** 70% after deductible
Wellness/Preventive Services 100%, no cost share 100%, 50% after deductible 100%, 70% after deductible 100%, 70% after deductible
no cost share no cost share no cost share
Hospital Services
Inpatient $250 copay per day (3 day $500 copay 50% after deductible 90% after deductible 70% after deductible 100% after deductible 70% after deductible
max)
Outpatient $125 copay per admission $250 copay 50% after deductible 90% after deductible 70% after deductible 100% after deductible 70% after deductible
Emergency Room $150 copay $100 copay $100 Copay 90% after deductible 90% after deductible 100% after deductible 100% after deductible
Urgent Care Facility $20 copay $30 copay 50% after deductible $20 copay* 70% after deductible $20 copay** 70% after deductible
Prescription Medications
Retail
Tier 1 $15 copay $10 copay Copay + 50% $10 copay* 30% of allowed + excess $10 copay** 30% of allowed + excess*
Tier 2 $30 copay $30 copay Copay + 50% $30 copay* 30% of allowed + excess $30 copay** 30% of allowed + excess*
Tier 3 $50 copay $50 copay Copay + 50% $50 copay* 30% of allowed + excess $50 copay** 30% of allowed + excess*
Tier 4 30% to $150 max 30% to $150 max Copay + 50% 30% to $150 max* 30% of allowed + excess 30% to $150 max** 30% of allowed + excess*
Home Delivery
Tier 1 $15 copay $10 copay Not covered $10 copay* Not covered $10 copay** Not covered
Tier 2 $60 copay $60 copay Not covered $60 copay* Not covered $60 copay** Not covered
Tier 3 $100 copay $100 copay Not covered $100 copay* Not covered $100 copay** Not covered
Tier 4 30% to $300 max 30% to $300 max Not covered 30% to $300 max* Not covered 30% to $300 max** Not covered
Preventive care is an integral part of a comprehensive healthcare plan which
includes preventive drug therapies. Preventive medications are those used for the
prevention of conditions such as high blood pressure, high cholesterol, asthma, and
stroke. Effective January 1, 2017, VER will cover preventive medications at 100%
under all plan options.
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