Page 5 - Tetra Renewal 2020
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The Tetra Corporation: June 2020 Medical Analysis



 Current  Renewal  Option 1      Option 2                   Option 3
 BCBSM  BCBSM  BCBSM              BCBSM                Blue Care Network

 CB Platinum $500  CB Platinum $500  CB Gold $1500  SB Gold $500  Platinum $500 0%
 Plan Type  PPO  PPO  PPO           PPO                        HMO
 Plan Year  2019  2020  2020        2020                       2020
 In-Network  In-Network  In-Network  In-Network             In-Network
 Deductible
      Individual  $500  $500  $1500  $500                      $500
      Couple/Family  $1,000  $1000  $3000  $1000              $1000
 Coinsurance  10%  10%  20%         20%                         0%
 Coinsurance Max
      Individual  $500  $500  $4500  $4500                 Not Applicable
      Couple/Family  $1,000  $1000  $9000  $9000           Not Applicable
 Annual Out of Pocket Max
      Individual  $6,600  $6600  $8150  $8150                 $1500
      Couple/Family  $13,200  $13200  $16300  $16300          $3000
 Physician Copays
      Preventive Care  Covered 100%  No Charge  No Charge  No Charge  No Charge
      Office Visit  $20  $20  $30   $30                         $20
      Specialty Office Visit  $20  $20  $30  $50                $30
      Virtual Visits  $20  $20  $30  $30                        $20
 Hospital Services
      Urgent Care  $60  $60  $60    $60                         $35
      Emergency Room  $150  $150  $250  $250         $150 Copay after deductible
      Inpatient Hospital  10% after deductible  10% after deductible  20% after deductible  20% after deductible  0% after deductible
      Outpatient Hospital  10% after deductible  10% after deductible  20% after deductible  20% after deductible  0% after deductible
 Diagnostic Services
      Imaging/CT/PET/MRI  10% after deductible  10% after deductible  20% after deductible  20% after deductible  $150 Copay after deductible
      Labs  10% after deductible  10% after deductible  20% after deductible  20% after deductible  No Charge
      X-Rays  10% after deductible  10% after deductible  20% after deductible  20% after deductible  0% after deductible
 Mental Health  $20  10% after deductible  20% after deductible  20% after deductible  $20
 Chiropractic  $20  $20  $30        $30                         $30
 Prescription Drugs
      Generic  $5  $5  $10          $20                       $4/$15
      Preferred Brand  $40  $40  $40  $60                       $40
      Non-Preferred Brand  $80  $80  $80  $80 or 50% $100 max   $80
      Preferred Specialty  $40  $40  $40  20%/$200 max     20%/$200 max
      Non-Preferred Specialty  $80  $80  $80  25%/$300 max  20%/$300 max
 Effective Date  7/1/2019  7/1/2020  7/1/2020  7/1/2020      7/1/2020
 Total Number of Employees  12  12  12  12                      12
 Monthly Total Medical Premium  $14,903.55  $15,892.19  $13,126.01  $12,537.59  $12,777.24
 Annual Total Medical Premium  $178,842.60  $190,706.28  $157,512.12  $150,451.08  $153,326.88
 Percentage Change From Current  6.63%  -11.93%  -15.88%      -14.27%
 Annual Dollar Change From Current  $11,863.68  ($21,330.48)  ($28,391.52)  ($25,515.72)





 Illustrative purposes only. Rates are subject to DIFS and carrier approval.
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