Page 4 - Lansing Regional Chamber of Commerce Booklet

LANSING REGIONAL CHAMBER OF COMMERCE - MEDICAL, DENTAL, AND VISION RENEWAL
Effective January 1, 2021

Delta/VSP Delta/VSP
Current Renewal Alt # 1 Alt # 2
BCN HMO PCP Focus BCN HMO PCP Focus PHP HMO Exclusive
PHP PPO Platinum $500
Employees Platinum $500 Platinum $500 Platinum $500
Dan Rials and Child Marchelle $676.80 $691.62 $692.45 $838.58
Rzepka $615.38 $655.87 $639.05 $782.60
Amanda Emmert & Spouse Michelle
$816.40 $842.64 $838.15 $1,020.24
Rahl and Child Christine Zarkovich $685.60 $700.55 $699.61 $847.50
and Spouse John Pompei
Tim Daman and children Ashley $799.28 $825.22 $823.85 $1,002.41
Sandborn $394.62 $407.17 $414.39 $502.50
Kelsey Teribery $1,341.84 $1,400.01 $1,417.49 $1,721.88
$404.99 $415.55 $421.54 $511.41
Est. Monthly Premium
$337.26 $349.90 $362.55 $437.86
Est. Annual Premium
Includes Taxes and Fees Change in
$6,072.17 $6,288.53 $6,309.08 $7,664.98
Premium
$72,866.04 $75,462.36 $75,708.96 $91,979.76
3.56% INCREASE 3.9% INCREASE 26.2% INCREASE
Benefits
Deductible
In network $500/$1000 $500/$1000 $500/$1000 $500/$1000
Out Network No Benefit No Benefit No Benefit $1000/$2000
Prescription drug copay $4/$15/$40/$80/20%/20%$20 $4/$15/$40/$80/20%/20%$20 $5/$15/$40/$80/20%/20%$15 $5/$15/$40/$80/20%/20%$15
Office visit copay Urgent PCP/$30 SPEC PCP/$30 SPEC PCP/$30 SPEC PCP/$30 SPEC
care copay Emergency $35 $35 $50 $50
Room Copay $150 after deductible $150 after deductible $150 $150

Hospitalization
In patient 100% after deductible 100% after deductible 90% after deductible 90% after deductible
Out patient 100% after deductible 100% after deductible 90% after deductible 90% after deductible

Lab & X-ray
100% after deductible 100% after deductible 90% after deductible 90% after deductible
Embedded Coinsurance Max.
N/A N/A $500/$1000 $500/$1000
Maximum copayment
In network
Out network $1500/$3000 $1500/$3000 $3000/$6000 $3000/$6000
No Benefit No Benefit No Benefit $6000/$12,000
2020 By moving to the BCN Focus program, rates increased 4.7% (instead of 13%), 2019 rates increased 2% on the BCN and 6% on the SB HDHP 2017 - 2018 gropu was
C4C, Rneweed 2016 @ 10.1%, then changed renewal to Jan and rates increased 2.1%, 2015 rates decreased 2.68%2014 rates increased 3.1%, 2013 rates increased
2.6%, 2012 rates increased 2.2% by increasing ded., 2011 rates increased 5%
The above premiums include BLUES dental ($25/$75 ded., 100/80/50 $1000, 50% Ortho $1000 Lifetime and vision
VSP 12: $5/$10 Copays, $130 Allowance
Prepared November 2020