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By Staff Report
Apr. 19, 2004
This template allows human resources managers and employees to view alternative health care plans at a glance. The variables include the office-visit copay, individual out-of-pocket maximums and variable drug benefits. After open enrollment, the column showing the previous year can be taken out.
| This Year | Next Year | |||
| HMO | 2004 | 2005 | ||
| Office Visit Copay | $15 | $20 | ||
| Routine Preventive Care | 100% after $15 Copay | 100% after $20 Copay | ||
| Annual Deductible | None | None | ||
| Annual Out-of-Pocket Maximum | None | None | ||
| Preexisting Condition Limitation | None | None | ||
| Lifetime Maximum | $1,000,000 | $1,000,000 | ||
| Prescription Drugs | Participating Pharmacy | Participating Pharmacy | ||
| Retail Generic (30-day supply) | $7 | $10 | ||
| Retail Brand Name (30-day supply) | $15 | $25 | ||
| Nonpreferred Brand Name | $35 | Not Covered | ||
| Generic Mail Order (90-day supply) | $10 | $20 | ||
| Brand Name Mail Order (90 days) | $20 | $50 | ||
| Nonpreferred Brand Mail Order | $40 | Not Covered | ||
| PPO | 2004 | 2005 | ||
| In Network | Out of Network | In Network | Out of Network | |
| Individual Annual Deductible | $250 | $500 | $250 | $1,000 |
| Family Annual Deductible | $500 | $1,000 | $500 | $2,000 |
| Annual Out-of-Pocket Maximum | ||||
| Individual | $1,500 | $3,000 | $1,500 | $3,500 |
| Family | $3,000 | $6,000 | $3,000 | $7,000 |
| Office Visit Copay | $15 | N/A | $25 | N/A |
| Coinsurance (plan pays) | 89% | 60% | 80% | 60% |
| Routine Preventive Care (children to age 13) | 100% after $15 | 60% | 100% after $20 Copay | 60% |
| Routine Preventive Care (adults age 14 and up) |
100% after $15 Copay | None | 100% after $20 Copay | None |
| Preexisting Condition Limitation | Yes | Yes | Yes | Yes |
| Lifetime Maximum | Combined in and out of network: $1,000,000 | |||
| Prescription Drugs | ||||
| Retail Generic (30-day supply) | $10 | Not Covered | $10 | Not Covered |
| Retail Brand (30-day Supply) | $20 | Not Covered | $25 | Not Covered |
| Retail Nonpreferred | N/A | N/A | $50 | Not Covered |
| Generic Mail (90-day supply) | $15 | Not Covered | $20 | Not Covered |
| Preferred Brand Mail (90 days) | $25 | Not Covered | $50 | Not Covered |
| Nonpreferred Brand Mail | N/A | N/A | $100 | Not Covered |
SOURCE: Excerpted from “The HR Answer Book: An Indispensable Guide for Managers and Human Resources Professionals,” by Shawn Smith and Rebecca Mazin. Copyright 2004; published by AMACOM Books, a division of the American Management Association.
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