Page 7 - Busey Corporation 2022 Benefits Guide

2022 Benefits Guide
Medical

Choosing the right health plan is probably one of the most important decisions you can make for yourself and your family
members. Please carefully consider the plan information provided in this document.

Busey ofers three medical plans through either Health Alliance or UMR. The 2800 and 5000 CDHP’s and the 1500 PPO plan
designs will be identical with each provider. We understand paying the plan deductible up front under a CDHP may be
overwhelming. To help associates with this cost, Busey is providing two items which will be discussed later in this guide: HSA seed
money through B Well and a concierge vendor—Alight.

2800 CDHP 5000 CDHP 1500 PPO
In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network
Calendar Year Deductible (coinsurance applies after deductible is met)
Individual $2,800 $10,000 $5,000 $10,000 $1,500 $10,000
Family $5,600 $20,000 $10,000 $20,000 $3,000 $20,000
Out-of-Pocket Maximum
Individual $5,000 $15,000 $5,000 $15,000 $5,000 $15,000
Family $10,000 $30,000 $10,000 $30,000 $10,000 $30,000
Physician Oice Visits
Primary Care 20% coinsurance 50% coinsurance 0% coinsurance 50% coinsurance $25 copayment 50% coinsurance
Specialist 20% coinsurance 50% coinsurance 0% coinsurance 50% coinsurance $50 copayment 50% coinsurance
Wellness/Preventive
$0 50% coinsurance $0 50% coinsurance $0 50% coinsurance
Urgent Care
20% coinsurance 50% coinsurance 0% coinsurance 50% coinsurance $50 copayment 50% coinsurance
Lab Services/X-Ray
Physician Oice 20% coinsurance 50% coinsurance 0% coinsurance 50% coinsurance 20% coinsurance 50% coinsurance
Outpatient Facility 20% coinsurance 50% coinsurance 0% coinsurance 50% coinsurance 20% coinsurance 50% coinsurance
Outpatient 20% coinsurance 50% coinsurance 0% coinsurance 50% coinsurance 20% coinsurance 50% coinsurance
Hospital
Hospital Services
Inpatient 20% coinsurance 50% coinsurance 0% coinsurance 50% coinsurance 20% coinsurance 50% coinsurance
Outpatient 20% coinsurance 50% coinsurance 0% coinsurance 50% coinsurance 20% coinsurance 50% coinsurance
Emergency Room 20% coinsurance 20% coinsurance 0% coinsurance 0% coinsurance $300 copayment $300 copayment
Mental Health/Substance Abuse
Inpatient 20% coinsurance 50% coinsurance 0% coinsurance 50% coinsurance 20% coinsurance 50% coinsurance
Outpatient 20% coinsurance 50% coinsurance 0% coinsurance 50% coinsurance $25 copayment 50% coinsurance
Oice Visits 20% coinsurance 50% coinsurance 0% coinsurance 50% coinsurance $25 copayment 50% coinsurance
Chiropractic Care
20% coinsurance 50% coinsurance 0% coinsurance 50% coinsurance $20 copayment 20% coinsurance

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