Snapshot of the Standard Small Employer Health Benefits Plans (with Network Features)

Snapshot of the Standard Small Employer Health Benefits Plans (with Network Features)
	Plan A	Plan B	Plan C	Plan D	Plan E	HMO	HMO POS
Covered services (before riders)	hospital, limited medical	hospital, medical, therapies, home health, prescription drugs	hospital, medical, therapies, home health, prescription drugs	hospital, medical, therapies, home health, prescription drugs	hospital, medical, therapies, home health, prescription drugs	hospital, medical, therapies, home health, prescription drugs	hospital, medical, therapies, home health, prescription drugs
Deductible 1 IN-NETWORK	medical - $250/ individual; $500 or $750/family	$250 to $2500/ individual; family = 2x or 3x indiv.	$250 to $2500/ individual; family = 2x or 3x indiv.	$250 to $2500/ individual; family = 2x or 3x indiv.	$150 to $2500/ individual; family = 2x indiv.	$250 to $2500/ individual; family = 2x individual	$250 to $2500/ individual; family = 2x or 3x individual
Deductible OUT-OF-NETWORK	medical - $250/ individual; $500 or $750/family	up to 3x in-network individual; family = 2x out-of-network individual	up to 3x in-network individual; family = 2x out-of-network individual	up to 3x in-network individual; family = 2x out-of-network individual	up to 3x in-network individual; family = 2x out-of-network individual	n/a	up to 3x in-network individual; family = 2x or 3x out-of-network individual
Coinsurance 2 IN-NETWORK	hospital: 100% medical: 70%	60%	70%	80%	90%	n/a OR 50% on Rx AND/OR 50%-90% when copays do not apply	varies
Coinsurance 2 OUT-OF-NETWORK	hospital: 20% medical: 50%	60%	70%	80%	90%	n/a	varies
Copayments 3 IN-NETWORK	n/a	may use the HMO copayment options	may use the HMO copayment options	may use the HMO copayment options	may use the HMO copayment options	Office: $5/10/15/20/30/40/50; Prenatal: same as above OR $25; Rx: $15; ER: $50/75/100; Hospital: $75/100/150/200/300/ 400/500 daily to max of $750 to $5000 yearly	Office: $5/10/15/20/30/40/50; Prenatal: same as above OR $25; ER: $50/75/100; Hospital: $75/100/150/200/300/ 400/500 daily to max of $750 to $5000 yearly
Maximum Out of Pocket 1 IN-NETWORK	up to $7500 per individual	up to $7500 per individual; 2x or 3x individual per family	up to $7500 per individual; 2x or 3x individual per family	up to $7500 per individual; 2x or 3x individual per family	up to $7500 per individual; 2x or 3x individual per family	up to $7500 per individual; 2x individual per family (copay, deductible & coinsurance)	up to $7500 per individual; 2x individual per family (copay, deductible & coinsurance)
Maximum Out of Pocket OUT-OF-NETWORK	up to 3x the in-network MOOP	up to 3x the in-network individual; 2x or 3x out-of-network individual per family	up to 3x the in-network individual; 2x or 3x out-of-network individual per family	up to 3x the in-network individual; 2x or 3x out-of-network individual per family	up to 3x the in-network individual; 2x or 3x out-of-network individual per family	n/a	up to 3x the in-network individual; 2x or 3x out-of-network individual per family

1	Carriers may require family deductibles and the family MOOP to be satisfied by separate individuals (when 2x) or by the family in the aggregate (when 2x or 3x).
2	Coinsurance is shown as the percentage the carrier will pay. Either the in- or out-of-network coinsurance must be: 60% for B, 70% for C, 80% for D, and 90% for E.
3	For B, C, D and E, copays may substitute for the deductible on: practitioner visits, emergency room use and hospital admission. HMOs must offer a copay option; for pre-natal, the copay applies to the initial visit only; Rx is subject to a copay or coinsurance; ER copays are in addition to other required cost-sharing.