Page 45 - Benefits Book Tanner Manor 2020
P. 45

FRSD\PHQWV and  SODQV. Please  $3,500  30%  30%  30%   LQFOXGLQJ PHGLFDO VXSSOLHV    FUXWFKHV    SK\VLFDO WKHUDS\   $1,900  $1,600  $100  $0  $0  $1,700  Ŝȱ˜ȱŜ





                   SODQ. Use this information to compare the portion of costs you might pay under different health
                 FRVW VKDULQJ amounts (GHGXFWLEOHV, SODQ might cover medical care. Your actual costs will be different depending  Mia’s Simple Fracture (in-network emergency room visit and follow up care)  GHGXFWLEOH SODQ V overall  The  FRLQVXUDQFH Emergency room  FRLQVXUDQFH Hospital (facility)  FRLQVXUDQFH  Other  This EXAMPLE event includes services like:  Emergency room care   [ UD\  Diagnostic test  Durable medical equipment  Rehabilitation services  Total Example Cost  In this
















                 SURYLGHUV charge, and many other factors. Focus on the

                                        $3,500  $60  30%  30%               $7,400      $1,900  $1,400  $0  $60  $3,360


                           Managing Joe’s type 2 Diabetes (a year of routine in-network care of a well-controlled  condition)  GHGXFWLEOH  FRSD\PHQW  FRLQVXUDQFH  This EXAMPLE event includes services like: Primary care physician office visits (LQFOXGLQJ GLVHDVH   EORRG ZRUN    JOXFRVH PHWHU   &RVW 6KDULQJ  :KDW LVQ W FRYHUHG  SODQ would be responsible for the other costs of these EXAMPLE covered services.




              Treatments shown are just examples of how this














                                        The SODQ V overall  6SHFLDOLVW  Hospital (facility)  FRLQVXUDQFH  Other  HGXFDWLRQ   Diagnostic tests  Prescription drugs  Durable medical equipment  Total Example Cost  In this example, Joe would pay:  Deductibles  Copayments  Coinsurance  Limits or exclusions  The total Joe would pay is
                   H[FOXGHG VHUYLFHV under the on the actual care you receive, the prices your note these coverage examples are based on self-only coverage.  $3,500  $60  30%  30%  $12,700  $3,500  $100  $2,700  $60  $6,360  The













         About these Coverage Examples:  This is not a cost estimator.  FRLQVXUDQFH) and  Peg is Having a Baby (9 months of in-network pre-natal care and a hospital  delivery)  GHGXFWLEOH SODQ V overall  The  FRSD\PHQW  6SHFLDOLVW  FRLQVXUDQFH Hospital (facility)  FRLQVXUDQFH  Other  This EXAMPLE event includes services like: Specialist office visits (SUHQDWDO FDUH  Childbirth/Delivery Professional Services Childbirth/Delivery Facility Services Diagnostic tests (XOWUDVRXQGV DQG EORRG
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