RightStart Plan, SaveRight Plan – Plan Benefits
| Plan Feature | RightStartSM Plan | SaveRightSM HSA Plan |
|---|---|---|
| Plan Design | Unless otherwise noted, all deductibles, maximums and benefit amounts are applied per person and are reset each January 1. | |
| Individual Deductible Amount you pay toward covered expenses before the plan pays benefits | $500, $1,000 or $2,500 | $2,000, $3,000 or $5,100 |
| Family Deductible | Family deductible maximum is three times the individual deductible and is met collectively by three or more persons. | Family deductible maximum is two times the individual deductible and is met collectively by two or more persons. |
| Benefit Percentage Percentage of covered expenses the plan pays after the deductible is met | 75% or 50% | 100%, 75%, or 50% |
| Coinsurance Percentage of covered expenses you pay after the deductible is met | 25% or 50% | 0%, 25% or 50% |
| Coinsurance Out-of-Pocket Maximum* After this maximum is met, the plan pays 100% of covered expenses | $2,000 with the 50% coinsurance plan $3,000 with the 25% coinsurance plan | $0 to $3,000 depending on coinsurance |
| Outpatient Services Maximum The annual maximum amount the plan pays toward outpatient services | $2,500, $5,000 or $10,000 (All outpatient benefits are subject to this maximum.) | $15,000 or $25,000 (All outpatient benefits are subject to this maximum.) |
| Annual Maximum The total annual maximum amount the plan pays | $50,000, $100,000 or $250,000 (All benefits are subject to this maximum.) | No Maximum>/b> – the plan pays inpatient benefits up to the lifetime benefit maximum. |
| Lifetime Benefit Maximum The total maximum amount the plan pays | $2 million | $2 million |
| Outpatient Benefits | Benefits are subject to deductible and coinsurance unless otherwise noted. | |
| Prescription Drugs – Generic | $15 copay (no deductible) – $2,000 maximum for brand and generic combined – Buy-up option: annual maximum amount for brand and generic combined | Covered (subject to deductible and coinsurance) – $2,000 maximum for brand and generic combined – Buy-up option: lifetime maximum amount for brand and generic combined |
| Prescription Drugs – Brand name | $500 deductible / $25 copay + 50% coinsurance (Family deductible maximum is $1,000 and is met collectively by two or more persons) – $2,000 maximum for brand and generic combined – Buy-up option: annual maximum amount for brand and generic combined | Covered (subject to deductible and coinsurance) – $2,000 maximum for brand and generic combined – Buy-up option: lifetime maximum amount for brand and generic combined |
| Preventive Services Mammograms, Pap smears and PSA screening | Covered after you have been insured for 12 months. | Covered after you have been insured for 12 months. |
| Other preventive services, office visits and immunizations | Up to $500 in benefits — after you have been insured for 12 months. – Copay, if selected, applies to office visits and immunizations | Covered after you have been insured for 12 months |
| Office Visits | Covered | Covered |
| Office Visit Copay Optional benefit | $25 copay for each of two network office visit per person – Visits for illness, injury and (after 12 months) preventive services are eligible – Additional visits are covered subject to deductible and coinsurance | Not available |
| Diagnostic Imaging and Laboratory Services | Covered | Covered |
| Outpatient Hospital, Surgical Center or Urgent Care Facility | Covered | Covered – Outpatient facility fee: $0 or $200 per outpatient surgery. |
| Professional Ground and Air Ambulance | Up to $1,000 for one trip | Up to $1,000 for one trip |
| Emergency Room | Covered – $75 emergency room fee — waived if admitted to the hospital. | Covered – $75 emergency room fee — waived if admitted to the hospital. |
| Health Care Practitioner Services | Covered | Covered |
| Outpatient Physical Medicine | $50 per visit for up to two visits – Chiropractic not covered | $50 per visit for up to two visits – Chiropractic not covered |
| Home Health Care | Not covered | Not covered |
| Inpatient Benefits | Benefits are subject to deductible and coinsurance unless otherwise noted. | |
| Inpatient Hospital | Covered | Covered |
| Inpatient Rehabilitation Facility | $100 per day for up to 50 days | $100 per day for up to 50 days |
| Subacute Rehabilitation and Skilled Nursing Facilities | Up to 30 days | Up to 30 days |
| Transplants | Covered | Covered |
| Behavioral Health and Substance Abuse | Not covered | Not covered |
| Optional Features | Optional features are available at an additional cost. | |
| Optional Benefits and Discount Programs Discount programs are not insurance | SuiteSolutions, Office Visit Copay, Accident Medical Expense and Dental/Vision Discount Card | SuiteSolutions, Accident Medical Expense and Dental/Vision Discount Card |
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