Coverage
Policies
The plans members can enroll in. Each defines its own deductible and coverage rules — the same claim adjudicates differently depending on the plan.
Platinum Care
$250.00 annual deductible, $2000.00 out-of-pocket max. Cosmetic at 50% coinsurance; Diagnostic lab at 10% coinsurance (up to $3000.00/yr); Mri at 10% coinsurance; Office visit at $10.00 copay (up to $1000.00/yr); Physical therapy at 10% coinsurance (up to $5000.00/yr).
Standard PPO
$1000.00 annual deductible, $5000.00 out-of-pocket max. Cosmetic isn't covered; Diagnostic lab at 20% coinsurance (after deductible); Mri at 20% coinsurance (after deductible, needs review); Office visit at $30.00 copay; Physical therapy at 20% coinsurance (up to $2000.00/yr).
Bronze HDHP
$3000.00 annual deductible, $7000.00 out-of-pocket max. Cosmetic isn't covered; Diagnostic lab at 30% coinsurance (after deductible, up to $1500.00/yr); Mri at 30% coinsurance (after deductible, needs review); Office visit at 30% coinsurance (after deductible, up to $600.00/yr); Physical therapy at 30% coinsurance (after deductible, up to $1000.00/yr).