OPEN ENROLLMENT 2017|2018 Consumer Driven Health Plan <CLIENT NAME> offers one medical plan—a Consumer Driven Health Plan (CDHP). You pay first-dollar costs for all physicians’ visits, medical services, and prescriptions until you meet your annual deductible. Once the applicable network or nonnetwork deductible has been met, coverage is shared with the company in a coinsurance arrangement until an out-of-pocket maximum is met.
Medical Plan at a Glance <CARRIER> Consumer Driven Health Plan (CDHP)
Network
Nonnetwork
Individual
$1,300
$2,600
Family
$2,600
$5,200
Individual
$2,600
$5,200
Family
$5,200
$10,400
Physician Office Services
80%
60%
Specialist Office Visit
80%
60%
Preventive Care (routine physical, well-child, pap smear, mammogram, prostate exam, and preventive diagnostic)
100%
60%
Outpatient Diagnostic Services: Lab and X-ray
80%
60%
Routine Eye Exams
80%
60%
Maternity Care
80%
60%
Outpatient Surgery
80%
60%
Inpatient Hospital Care
80%
60%
Emergency Care (hospital emergency room)
80%
80%
Urgent Care Center Use
80%
60%
Ambulance Service
80%
60%
Outpatient Rehab (physical, occupational, and speech therapy [60 visits per year combined], spinal manipulation)
80%
60%
—Preventive Medications
100%
Not Covered
—Other Prescriptions
80%
Not Covered
Mental Health and Chemical Dependency (in- and outpatient authorized services)
80%
60%
Annual Deductible (applies to out-of-pocket maximum)
Annual Out-of-Pocket Maximum (includes deductible)
Covered Services—Plan Pays
Prescription Drugs and Mail Order