Bus Driver Health Insurance Comparison Plan

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    Sevier County
    Wellness Clinic
    Base Plan
    In Network
    Base Plan
    Out of Network
    Standard Plan
    In Network
    Standard Plan
    Out of Network
    Premium Plan
    In Network
    Premium Plan
    Out of Network

    Office Visits

    • Primary Care Visit/Sick Visit

    Prescription Drugs

    Labwork

     

    No Charge

     

    No Charge

     

    No Charge

     

    No Charge

     

    No Charge

     

    No Charge

     

    Preventative Care Base Plan
    In Network
    Base Plan
    Out of Network
    Standard Plan
    In Network
    Standard Plan
    Out of Network
    Premium Plan
    In Network
    Premium Plan
    Out of Network

    Office Visits

    • Well child Care/Well Woman Exam
    • Mammogram/Cervical and Prostate Screening
    • Other Well Care Screenings
    • Immunizations

    Other

    • FDA-approved contraceptive methods for women

     

     

     

    No Charge

     

     

     

    Not Covered

     

     

     

    No Charge

     

     

     

    Not Covered

     

     

     

    No Charge

     

     

     

    Not Covered

      

    Practitioner's Office Service Base Plan
    In Network
    Base Plan
    Out of Network
    Standard Plan
    In Network
    Standard Plan
    Out of Network
    Premium Plan
    In Network
    Premium Plan
    Out of Network

    Primary Care Office Visits

    • Family/General/Internal Medicine Practice
    • Surgery in Office Setting
    • Maternity Visit (co-pay first visit only)

     

    $50 Copay

     

    60% After Deductible

     

    $30 Copy

     

     

    50% After Deductibe

     

     

    $25 Copay

     

     

    40% After Deductibe

     

    Specialist Office Visit

    • Specialist Visit
    • Surgery in Office Setting

     

     

    $80 Copay

     

    60% After Deductible

     

    $60 Copay

     

    50% After Deductible

     

    $50 Copay

     

    40% After Deductibe

     

    Diagnostic Services (X-Ray, Labwork, etc)

    • Allergy Testing/Injections
    • Maternity Care Diagnostic

     

    No Additional Copay

     

    60% After Deductible

     

    No Additional Copay

     

    50% After Deductible

     

    No Additional Copay

     

    40% After Deductible

    Non-Routine Diagnostic Service (MRI/CAT/PET)


    $50 Copay

    60% After Deductible

    $20 Copay

    50% After Deductible

    $25 Copay

    40% After Deductible

    All Other Diagnostic Services for Illness or Injury


    No Additional Copay

    60% After Deductible 

    No Additional Copay 

    50% After Deductible
     
    No Additional Copay 

    40% After Deductible 

    Chiropractor Services (25 visits)


    40% After Deductible

    60% After Deductible

    $60 Copay 

    50% After Deductible 

    $50 Copay

    40% After Deductible

      

    Pharmacy Base Plan
    In Network
    Base Plan
    Out of Network
    Standard Plan
    In Network
    Standard Plan
    Out of Network
    Premium Plan
    In Network
    Premium Plan
    Out of Network

    30 Day Supply

    $200 Brand Only Deductible

    Generic:  $20 Copay

    Preferred:  $60 Copay

    Non-Prefered:  $110 Copay

    Speciality:  $350

    $200 Brand Only Deductible

     

    Reimbursement Varies


    Generic:  $15 Copay

    Preferred:  $45 Copay

    Non-Prefered:  $100 Copay

    Specialty:  $300





    Reimbursement Varies


    Generic:  $10 Copay

    Preferred:  $35 Copay

    Non-Prefered:  $90 Copay

    Specialty:  $250





    Reimbursement Varies

       

    Convenience Clinics/Urgent Care Base Plan
    In Network
    Base Plan
    Out of Network
    Standard Plan
    In Network
    Standard Plan
    Out of Network
    Premium Plan
    In Network
    Premium Plan
    Out of Network

    Convenience Clinic


    $50 Copay

    60% After Deductible

    $30 Copay

    50% After Deductible

    $25 Copay

    40% After Deductible

    Urgent Care Facility


    $80 Copay

    60% After Deductible

    $60 Copay

    50% After Deductible

    $50 Copay

    40% After Deductible

     

    Emergency Room Base Plan
    In Network
    Base Plan
    Out of Network
    Standard Plan
    In Network
    Standard Plan
    Out of Network
    Premium Plan
    In Network
    Premium Plan
    Out of Network

    Emergency Room Visit


    40% After Deductible

    40% After Deductible

    $300 Copay

    $300 Copay

    $250 Copay

    $250 Copay

      

    Outpatient Services Base Plan
    In Network
    Base Plan
    Out of Network
    Standard Plan
    In Network
    Standard Plan
    Out of Network
    Premium Plan
    In Network
    Premium Plan
    Out of Network

    Outpatient Surgery Facility/Practioner


    40% After Deductible

    60% After Deductible

    30% After Deductible

    50% After Deductible

    20% After Deductible

    40% After Deductible

    Outpatient Diagnostic Services

    • Non-Routine Diagnositc Service (MRI/CAT/PET)


    40% After Deductible


    60% After Deductible


    30% After Deductible


    50% After Deductible


    20% After Deductible


    40% After Deductible

    Outpatient Diagnostic Services

    • All Other Diagnostic Services for Illness or Injury


    No Additional Charge


    60% After Deductible


    No Additional Charge


    50% After Deductible


    No Additional Charge


    40% After Deductible

    Other Outpatient Procedures and Services

    • Therapy Services
    • All Other Services


    40% After Deductible


    60% After Deductible


    30% After Deductible


    50% After Deductible


    20% After Deductible


    40% After Deductible

      

    Inpatient Facility Services Base Plan
    In Network
    Base Plan
    Out of Network
    Standard Plan
    In Network
    Standard Plan
    Out of Network
    Premium Plan
    In Network
    Premium Plan
    Out of Network

    Facility Charges


    40% After Deductible

    60% After Deductible

    30% After Deductible

    50% After Deductible

    20% After Deductible

    40% After Deductible

    Practioner Charges (including maternity)


    40% After Deductible

    60% After Deductible

    30% After Deductible

    50% After Deductible

    20% After Deductible

    40% After Deductible

      

    Other Services Base Plan
    In Network
    Base Plan
    Out of Network
    Standard Plan
    In Network
    Standard Plan
    Out of Network
    Premium Plan
    In Network
    Premium Plan
    Out of Network

    Ambulance


    40% After Deductible

    60% After Deductible

    30% After Deductible

    50% After Deductible

    20% After Deductible

    40% After Deductible

    Outpatient Hospice


    40% Coinsurance

    60% Coinsurance

    30% Coinsurance

    50% After Deductible

    20% Coinsurance

    40% After Deductible

      

    Deductible Base Plan
    In Network
    Base Plan
    Out of Network
    Standard Plan
    In Network
    Standard Plan
    Out of Network
    Premium Plan
    In Network
    Premium Plan
    Out of Network

    Individual


    $3,000

    $6,000

    $1,500

    $3,000

    $1,000

    $2,000

    Family


    $6,000

    $12,000

    $3,000

    $6,000

    $2,000

    $4,000

     

    Out of Pocket Maximum Base Plan
    In Network
    Base Plan
    Out of Network
    Standard Plan
    In Network
    Standard Plan
    Out of Network
    Premium Plan
    In Network
    Premium Plan
    Out of Network

    Individual


    $7,000

    $14,000

    $5,000

    $10,000

    $3,500

    $7,000

    Family


    $14,000

    $28,000

    $10,000

    $20,000

    $7,000

    $14,000