March 18, 2010

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Group Health Plan – POS 100-60 2000 NM – MISSOURI

A comparison of the POS 100-60 2000 NM offered by Group Health Plan is detailed out below for both Network and Non-Network coverage.

  Network Non-Network
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Network See Provider See Provider
Application POS 100-60 2000 NM Application POS 100-60 2000 NM Application
Brochure POS 100-60 2000 NM Brochure POS 100-60 2000 NM Brochure
Copay
  • Primary Care Provider Office Visit: $25
  • Specialist Office Visit: $25
  • N/A
    Office Visit
  • Primary Care Provider Office Visit: $25
  • Specialist Office Visit: $25
  • Primary Care Provider Office Visit: 60% after deductible
  • Specialist Office Visit: 60% after deductible
  • Deductible $2,000 $6,000
    Coinsurance 100% 60%
    Coinsurance Limit N/A $6,000
    Out-of-Pocket Maximum N/A $12,000
    Lifetime Maximum POS 100-60 2000 NM POS 100-60 2000 NM
    Prescription Drugs Pharmacy -
    • Tier One: $15
    • Tier Two: $40
    • Tier Three: $65
    • Mail Order (90-day supply): 2x
    Pharmacy -
    • Tier One: $15
    • Tier Two: $40
    • Tier Three: $65
    • Mail Order (90-day supply): 2x
    Emergency Room
  • Urgent Care: $50
  • Emergency Department: $200
  • Urgent Care: $50
  • Emergency Department: $200
  • Adult Preventative Care POS 100-60 2000 NM POS 100-60 2000 NM
    Child Preventative Care POS 100-60 2000 NM POS 100-60 2000 NM
    Lab / X-Ray POS 100-60 2000 NM POS 100-60 2000 NM
    Maternity Not covered Not covered
    Physical Therapy Not covered Not covered
    Skilled Nursing Not covered Not covered
    Home Health Care POS 100-60 2000 NM POS 100-60 2000 NM
    Mental Health Not covered Not covered
    Hospital Care Inpatient/Outpatient Surgery: 100% after deductible Inpatient/Outpatient Surgery: 60% after deductible
    Optional Benefits N/A N/A