Page 4 - Prosecuting Attorney's Assoc of MI

PROSECUTING ATTORNEY'S ASSOCIATON OF MICHIGAN

JANUARY 1, 2021 BCBSM MEDICAL AND DENTAL RENEWAL

Includes Delta Dental
Current Renewal Alt # 1 Alt # 2 Alt # 3

Simply Blue PPO Simply Blue PPO Simply Blue Simply Blue PPO PHP PPO Platinum
Platinum $250 Platinum $250 PPO Gold $500 Gold $1000 PFH005

13 employees
Member Member Member Member Member
Level Level Level Level Level
Rating Rating Rating Rating Rating

Est. Monthly Premium $20,630.63 $21,224.14 $18,179.40 $17,971.97 $20,367.93
Est. Annual Premium $247,567.56 $254,689.68 $218,152.80 $215,663.64 $244,415.16
Includes ACA Taxes and Fees
Change in premium 2.88% INCREASE 11.9% DECREASE 12.9% DECREASE 1.3% DECREASE
Benefits
Deductible
In network $250/$500 $250/$500 $500/$1000 $1000/$2000 $250/$500
Out Network $500/$1000 $500/$1000 $1000/$2000 $2000/$4000 $1500/$3000

Prescription drug copay $10/$40/$80/15%/25% $10/$40/$80/15%/25%$20/$60/50%/20%/25%$20/$60/50%/20%/25% $5/$15/$40/$480/20%/20%

Office visit copay $20 PCP/$40 SPEC* $20 PCP/$40 SPEC* $30 PCP/$50 SPEC* $30 PCP/$50 SPEC* $20 PCP/$40 SPEC

Urgent care copay $60* $60* $60 $60 $50

Emergency Room Copay $150 $150 $250 $250 80% after deductible

Hospitalization
In patient 80% after deductible 80% after deductible 70% after deductible 80% after deductible 80% after deductible
Out patient 80% after deductible 80% after deductible 70% after deductible 80% after deductible 80% after deductible

Lab & X-ray 80% after deductible 80% after deductible 70% after deductible 80% after deductible 80% after deductible

Embedded Coinsurance Max $1000/$2000 $1000/$2000 $4500/$9000 $4000/$6000 N/A

Maximum copayment
In network $6600/$13,200 $6600/$13,200 $8150/$16,300 $8150/$16,300 $2200/$4400
Out network $13,200/$26,400 $13,200/$26,400 $16,300/$32,600 $16,300/$32,600 $4500/$9000
2020 moved all employees to one plan, SB PPO $250 - saved .04%, 2019 CB $250 rates decreased .34%, CB $500 increased 3.82%
2018 added CB $500 Platinum; CB Platinum $250 rates + 13.7%, 2017 rates + 5.1%, 2016 rates + .88%, 2015 rates + 2.8%, 2014 rates (-2.3%). 2013 rates +13.5%,
2012 rates + 12.1%, 2011 rates + 13.8%, 2010 rates decreased 2.4% (chgd to CB 3), 2009 rates + 7.5% - added dental, 2008 rates decreased 3.3%, 2007 rates
increased 5.8%, 2006 rates +4.8%
Premiums included: BCBSM Dental: $25/$75 deductible; 100/80/50 $1000 Yearly Maximum, 50% Orthodontics $1000 Lifetime Maxmum
Delta Dental quote is included with PHP Premiums: Their plan design is $50/$150 ded., 100/80/50 $1000, 50% Ortho $1000
Simply Blue and PHP's PPO apply deductible and coinsurance to services outside of the office visit and urgent care visit such as surgery, diagnostic and
therapeutic services.
Prepared Oct 2020