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i   844-935-4673
                                                                                                                                         plymouthrock.myaccesshope.org



            Medical Plan Comparison


                                                                                                     Open Access Plus
                                    Consumer Choice HSA Plan               Open Access Plus             In-Network                 Cancer Support Services
                                             (HSA)                              (PPO)
                                                                                                          (EPO)
                                   In-Network      Out-of-Network     In-Network     Out-of-Network   In-Network Only              Plymouth Rock is proud to partner with AccessHope to offer support if you or a family member is
                HSA Employer                                                                                                       facing a cancer diagnosis. AccessHope brings expertise from nationally ranked cancer treatment
                 Contribution               $250/$500                             $0                       $0                      and research centers across the country along with valuable oncology support services to employees
               Individual/Family
                                                                                                                                   and their families.
              Annual Deductible           $1,500 / $3,000                     $500/$1,000                  $0
               Individual/Family
                                                                                                                                   Expert Advisory Review
                Annual Out-of-            $3,400 / $6,800                   $2,000 / $4,000           $2,500 / $5,000
               pocket Maximum    Deductible, co-pays, coinsurance apply  Deductible, co-pays, coinsurance apply   Co-pays only apply  Given how rapidly the field of cancer is changing, you need experts who are up to date with new lifesaving discoveries
               Individual/Family      medical and prescriptions               medical only              medical only               and treatment options. Employees, their dependents and extended family members including siblings, parents and
                                                                                                                                   grandparents can have a physician from the Dana-Farber Cancer Institute review their unique case to make sure they’re
                Lifetime Plan               Unlimited                          Unlimited                 Unlimited
                 Maximum                                                                                                           receiving the best, most effective care.
                                                                                                                                   If you’ve received a rare or complex-cancer diagnosis, your case will be automatically sent to AccessHope. A Dana-
                                 Plan pays 100%
                                                   Plan pays 80%
                                                                                      Plan pays 70%
      PHYSICAL WELL-BEING  Well-Child Care  Plan pays 100%  after deductible  $20 Co-pay  after deductible  $20 Co-pay             To request an Expert Advisory Review call 844-935-4673. An oncologist from the Dana-Farber Cancer Institute, who
               PCP Office Visit
                                                                      $20 Co-pay
                                                                                                        $20 Co-pay
                                                                                                                                   Farber cancer specialist will then review your case and leverage leading cancer expertise to provide recommendations
                                                   after deductible
                                                                                      after deductible
                                 after deductible
                                                                                                                                   to your local oncologist.
                                                                                      Plan pays 70%
                                                   Plan pays 80%
                Specialist Visit
                                 after deductible
                                                                                                                                   specializes in your type of cancer, will review your diagnosis and treatment plan and work directly with your local doctor
                                                                                      Plan pays 70%
                                                   Plan pays 80%
                                                                                                                                   to provide the following:
                                                                                                        No Co-pay
                                   No Co-pay
                                                                      No Co-pay
                                                   after deductible
                                                                                      after deductible
                                                                                                                                     • A recommendation regarding the appropriateness of the planned treatment
                                                   Plan pays 80%
                                                                                      Plan pays 70%
              Routine GYN Exams
                                                                                                                                     • A recommendation regarding whether or not genetic testing is appropriate
                                                                                                                                     • Expert interpretation of a genetic test you’ve already taken
                Routine Adult      No Co-pay       after deductible   No Co-pay       after deductible  No Co-pay                    • A new treatment plan (if needed)                                                                          PHYSICAL WELL-BEING
                                                   Plan pays 80%
                                                                                      Plan pays 70%
                  Physicals        No Co-pay       after deductible   No Co-pay       after deductible  No Co-pay                    • A listing of appropriate clinical trials, if any, which may be suitable for you
                Chiropractic &    Plan pays 100%   Plan pays 80%                      Plan pays 70%
             Acupuncture Services  after deductible  after deductible  $20 Co-pay     after deductible  $20 Co-pay                   The services offered through AccessHope are available at no cost.
                               Plan pays 100% after   Plan pays 80%    Plan pays 90%    Plan pays 70%
               Lab and X-Rays                                                                           No Co-pay
                                   deductible      after deductible  after deductible  after deductible                            Cancer Support Line
              Advanced Radiology  Plan pays 100% after   Plan pays 80%    Plan pays 90%    Plan pays 70%    $20 Co-pay             Call the Cancer Support Line to get help when faced with a cancer diagnosis. A team of experienced oncology nurses is
                  Imaging          deductible      after deductible  after deductible  after deductible                            available by phone to help you or a family member:
                  Inpatient      Plan pays 100%    Plan pays 80%    Plan pays 90%     Plan pays 70%                                  • Understand your specific type of cancer
               Hospital Services  after deductible  after deductible  after deductible  after deductible  $500 Co-pay                • Find answers to questions that arise during your cancer journey
                                 Plan pays 100%    Plan pays 80%    Plan pays 90%     Plan pays 70%                                  • Understand the types of treatments typically provided for your type of cancer
              Outpatient Surgery                                                                        $250 Co-pay
                                 after deductible  after deductible  after deductible  after deductible                              • Gain access to interactive webinars on cancer screening, prevention and treatment
                                                                                                                                     • Navigate to nearby facilities where you can obtain an appropriate second opinion
                  MDLive            Plan pays 100% after deductible           $20 Co-pay                $20 Co-pay
                                                                                                                                      regarding your diagnosis and treatment
              Urgent Care Facility  Plan pays 100% after deductible           $20 Co-pay                $20 Co-pay                   • Prepare for your appointments with an oncologist
                                                                                                                                     • Access trusted educational materials
                                                                                                       $100 Co-pay,
               Emergency Room       Plan pays 100% after deductible    $100 Co-pay, waived if admitted                               • Learn about the importance of clinical trials
                                                                                                      waived if admitted
                Mental Health    Plan pays 100%    Plan pays 80%    Plan pays 90%     Plan pays 70%
                Inpatient Care   after deductible  after deductible  after deductible  after deductible  $500 Co-pay                  To contact AccessHope call 844-935-4673.
                                                                                                                                      Oncology nurses are available from 9 am to 9 pm.
                Mental Health    Plan pays 100%    Plan pays 80%      $20 Co-pay      Plan pays 70%     $20 Co-pay
                 Office Visit    after deductible  after deductible                   after deductible
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