Page 11 - National General 2021 Annual Benefits Enrollment
P. 11
2021
www.mynatgenbenefits.com
Basic Plan with HSA Enhanced Plan with HSA
In-Network Out-of-Network In-Network Out-of-Network
Calendar Year Calendar Year
$2,000/$4,000 1 $4,000/$8,000 1 $1,500/$3,000 1 $3,000/$6,000 1
20% after deductible 40% after deductible 10% after deductible 40% after deductible
$5,500/$11,000 $11,000/$22,000 $4,000/$8,000 $8,000/$16,000
Unlimited Unlimited
No cost 40% after deductible No cost 40% after deductible
20% after deductible 40% after deductible 10% after deductible 40% after deductible
20% after deductible 40% after deductible 10% after deductible 40% after deductible
20% after deductible 10% after deductible
20% after deductible 40% after deductible 10% after deductible 40% after deductible
20% after deductible 40% after deductible 10% after deductible 40% after deductible
20% after deductible 40% after deductible 10% after deductible 40% after deductible
20% after deductible 40% after deductible 10% after deductible 40% after deductible
20% after deductible 40% after deductible 10% after deductible 40% after deductible
Tier 1: $5 copay 2 Tier 1: $5 copay 2
Tier 2: 25% coinsurance to a $250 maximum Tier 2: 25% coinsurance to a $250 maximum 2
2
Tier 3 and Tier 4: 50% coinsurance Tier 3 and Tier 4: 50% coinsurance
to a $250 maximum 2 to a $250 maximum 2
Tier 1: $10 copay 2 Tier 1: $10 copay 2
Tier 2: 25% coinsurance to a $500 maximum 2 Tier 2: 25% coinsurance to a $500 maximum 2
Tier 3 and Tier 4: 50% coinsurance Tier 3 and Tier 4: 50% coinsurance
to a $500 maximum 2 to a $500 maximum 2
Accumulates to medical out-of-pocket maximums Accumulates to medical out-of-pocket maximums
(1) Family deductible must be satisfied first before coinsurance starts to apply.
(2) Copays and coinsurance apply after the plan deductible is satisfied.
11
www.mynatgenbenefits.com
Basic Plan with HSA Enhanced Plan with HSA
In-Network Out-of-Network In-Network Out-of-Network
Calendar Year Calendar Year
$2,000/$4,000 1 $4,000/$8,000 1 $1,500/$3,000 1 $3,000/$6,000 1
20% after deductible 40% after deductible 10% after deductible 40% after deductible
$5,500/$11,000 $11,000/$22,000 $4,000/$8,000 $8,000/$16,000
Unlimited Unlimited
No cost 40% after deductible No cost 40% after deductible
20% after deductible 40% after deductible 10% after deductible 40% after deductible
20% after deductible 40% after deductible 10% after deductible 40% after deductible
20% after deductible 10% after deductible
20% after deductible 40% after deductible 10% after deductible 40% after deductible
20% after deductible 40% after deductible 10% after deductible 40% after deductible
20% after deductible 40% after deductible 10% after deductible 40% after deductible
20% after deductible 40% after deductible 10% after deductible 40% after deductible
20% after deductible 40% after deductible 10% after deductible 40% after deductible
Tier 1: $5 copay 2 Tier 1: $5 copay 2
Tier 2: 25% coinsurance to a $250 maximum Tier 2: 25% coinsurance to a $250 maximum 2
2
Tier 3 and Tier 4: 50% coinsurance Tier 3 and Tier 4: 50% coinsurance
to a $250 maximum 2 to a $250 maximum 2
Tier 1: $10 copay 2 Tier 1: $10 copay 2
Tier 2: 25% coinsurance to a $500 maximum 2 Tier 2: 25% coinsurance to a $500 maximum 2
Tier 3 and Tier 4: 50% coinsurance Tier 3 and Tier 4: 50% coinsurance
to a $500 maximum 2 to a $500 maximum 2
Accumulates to medical out-of-pocket maximums Accumulates to medical out-of-pocket maximums
(1) Family deductible must be satisfied first before coinsurance starts to apply.
(2) Copays and coinsurance apply after the plan deductible is satisfied.
11
