Page 4 - Kheder Davis & Associates - 2020 Renewal Information

KHEDER DAVIS AND ASSOCIATES

OCTOBER 1, 2020 RENEWAL

PRESENTED BY: GREGORY D. BROGAN

Current Mapped Renewal Alt # 1 Alt # 2 Alt # 3
BCBSM SB PPO Gold BCBSM SB PPO Gold BCBSM SB PPO Gold BCN HMO Gold BCN HMO Gold
HDHP/H.S.A. $1500 HDHP/H.S.A. $2000 HDHP/H.S.A. $2800 HDHP/H.S.A. $2000 HDHP/H.S.A. $2800

John Davis - Single $634.22 $648.11 $603.78 $533.15 $504.37
Kendra Basiga & Spouse $869.13 $872.41 $812.73 $717.67 $678.92

Est. Monthly Premium $1,503.35 $1,520.52 $1,416.51 $1,250.82 $1,183.29
Est. Annual Premium $18,040.20 $18,246.24 $16,998.12 $15,009.84 $14,199.48
Includes Taxes and Fees
Change in premium 1.14% INCREASE SAVE 5.8% SAVE 16.8% SAVE 21.3%
Benefits

Deductible
In network $1500/$3000 $2000/$4000 $2800/$5600 $2000/$4000 $2800/$5600
Out network $3000/$6000 $4000/$8000 $5600/$10,200 No Benefit No Benefit

Prescription drug copay $20/$60/50%/20%/25%/ded. $20/$60/50%/20%/25%/ded. $15/$50/50%/20%/25%/ded. $10/$30/$60/$80/20%/20%/ded $6/$25/$50/$80/20%/20%/ded

Office visit copay 100% after deductible 100% after deductible 100% after deductible 100% after deductible 100% after deductible

Urgent Care Copay 100% after deductible 100% after deductible 100% after deductible 100% after deductible 100% after deductible

Emergency Room Copay 100% after deductible 100% after deductible 100% after deductible 100% after deductible 100% after deductible

Hospitalization
In patient 100% after deductible 100% after deductible 100% after deductible 100% after deductible 100% after deductible
Out patient 100% after deductible 100% after deductible 100% after deductible 100% after deductible 100% after deductible

Lab & X-ray 100% after deductible 100% after deductible 100% after deductible 100% after deductible 100% after deductible

Coinsurance Maximum N/A N/A N/A N/A N/A

Max. out of pocket
In network $2500/$5000 $3000/$6000 $5000/$10,000 $3000/$6000 $5000/$10,000
Out network $5000/$10,000 $6000/$12,000 $10,000/$20,000 No Benefit No Benefit
2019 rates increased 5.7%, 2018 rates increased 4%, 2017 rates increased 1.4%, 2016 rates increased 16.3%, 2015 moved to BLUES with a 9.9% increase, 2014 moved to CMI,
2013 rates increased 5.9%, 2012 saved 12% by increasing deductible and tweaking copays, 2011 rates increased 18.9%, 2010 rates increased 8.8% ,
2009 rates increased 6.7%, 2008 rates increased 16.1% by moving to McLaren Health. Prepared July 2020