Which Medical Plan is Right?
Medical coverage offers healthcare protection for you and your family. You may visit any medical provider you choose, but in-network providers offer the highest level of benefits and lower out-of-pocket costs. Network providers charge members reduced, contracted fees instead of their typical fees. Providers outside the plan’s network set their own rates, so you may be responsible for the difference if a provider’s fees are above the Reasonable and Customary (R&C) limits.
Preventive Care – like physical exams, flu shots, and screenings – is always covered 100% when you use in-network providers. The key difference between the plans is your cost share each pay period and when you need care.
Each plan has different:
- Annual deductible amounts – the amount you pay each year for eligible in-network and out-of-network charges before the plan begins to pay.
- Out-of-pocket maximums – the most you will pay each year for eligible network services and/or prescriptions. After you reach your out-of-pocket maximum, the plan picks up the full cost of covered medical care for the remainder of the year.
- Copays – A copay is a fixed amount you pay for a health care service. Copays do not count toward your deductible but do count toward your annual out-of-pocket maximum.
- Coinsurance – Once you’ve met your deductible, you and the plan share the cost of care, which is called coinsurance. For example, you pay 20% for services and the plan will pay 80% of the cost until you have reached your out-of-pocket maximum.
Medical Plan Comparison
Meyers Nave gives you a choice between two medical plans through Kaiser Permanente and three plans through Aetna.
| Kaiser HMO | Kaiser HDHP | Aetna HMO | Aetna Open Access PPO | Aetna Open Access HDHP | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| In-Network | In-Network | In-Network | In-Network | Out-Of-Network | In-Network | Out-Of-Network | ||||||||
| Annual Deductible | None | Individual: $3,300 Family: $3,300 for individuals, $6,600 for family |
None | $500 per individual, up to $1,000 per family | $1,500 per individual, up to $3,000 per family | Individual: $1,650 Family: $3,300 for individuals, $3,300 for family |
Individual: $3,300 Family: $3,300 for individuals, $6,600 for family | |||||||
| Annual Out-of-Pocket Max | $1,500 per individual, up to $3,000 per family | Individual: $3,300 Family: $3,300 for individuals, $6,600 for family |
$2,000 per individual, up to $4,000 per family | $3,000 per individual, up to $6,000 per family | $6,000 per individual, up to $12,000 per family | Individual: $3,300 Family: $3,300 for individuals, $6,600 for family |
Individual: $8,000 Family: $8,000 for individuals, $16,000 for family | |||||||
| Lifetime Max | Unlimited | Unlimited | Unlimited | Unlimited | Unlimited | Unlimited | Unlimited | |||||||
| Office Visit | ||||||||||||||
| Primary Provider | $20 copay | No charge after deductible | $15 copay | $20 copay | You pay 40% after deductible | You pay 20% after deductible | You pay 40% after deductible | |||||||
| Specialist | $20 copay | No charge after deductible | $30 copay | $25 copay | You pay 40% after deductible | You pay 20% after deductible | You pay 40% after deductible | |||||||
| Preventive Services | No charge | No charge | No charge | No charge | You pay 40% after deductible | No charge | You pay 40% after deductible | |||||||
| Chiropractic Care | Not covered | Not covered | $15 copay (coverage limited to 20 visits per calendar year) | $25 copay , (coverage limited to 20 visits per calendar year; combined with out- of-network) |
You pay 40% after deductible (coverage limited to 20 visits per calendar year; combined with in- network) |
You pay 20% after deductible (coverage limited to 20 visits per calendar year; combined with out-of- network) | You pay 40% after deductible (coverage limited to 20 visits per calendar year; combined with in- network) | |||||||
| Lab and X-ray | No charge | No charge after deductible | No charge | You pay 20% after deductible | You pay 40% after deductible | You pay 20% after deductible | You pay 40% after deductible | |||||||
| Inpatient Hospitalization | $500 copay per admission | No charge after deductible | $250 copay per admission | You pay 20% after deductible | You pay 40% after deductible | You pay 20% after deductible | You pay 40% after deductible | |||||||
| Outpatient Surgery | $20 copay per procedure | No charge after deductible | $100 copay | You pay 20% after deductible | You pay 40% after deductible | You pay 20% after deductible | You pay 40% after deductible | |||||||
| Emergency Room | $50 copay | No charge after deductible | $150 copay (waived if admitted) | You pay 20% + $250 copay (waived if admitted) | You pay 20% + $250 copay (waived if admitted) | You pay 20% after deductible | You pay 20% after deductible | |||||||