Table 1.2.1 HCA Current Plan Summary (as of 2016 Coverage Year) For UMP Plans UMP Classic Out-of-Pocket Provider Network Out-of-Network Prescription Facility/Hospital Premiums Deductibles Special Limits Networks Reimbursement Reimbursement Drugs Charges Highest of Medical: Medical: Currently Plan pays 85% of Plan pays 60% of Based on tier For preferred Only UMP UMP Plans $2,000/$4,000 Regence allowed amount, allowed amount. system; for facilities: Member plan that $250 per family BlueShield Member pays Member pays 40% most generic pays $200 per regularly person, $750 network within remaining, plus drugs, the Day, up to $600 offers maximum 15%. family Regence Service any amount billed Member annually for coverage to maximum for Medicare Preventive care: Area. BlueCard by the provider pay inpatient facility doesn’t three (3) or retirees Specific services affiliates outside over the allowed the charges. primary more covered in full, not service area amount. prescription Members. subject to medical For drug Prescription $2,500/$5,000 deductible Preventive care: primary Members: Emergency deductible. drug: family Not subject to The inpatient care: maximum medical Member pays copay is $200 per Members $100 per deductible, but still more for Day, with a pay a $75 person, $300 Prescription pay out-of-network certain maximum of $600 copay. family drugs: $2,000 coinsurance. generic per inpatient stay maximum for per person, no May and (up to the medical three (3) or family participate in out-of-pocket drugs. more maximum medical limit). flexible Professional spending providers bill arrangement separately from under the the facility, and PEBB. are paid according to the provider’s network status.
Table 1.2.1 HCA Current Plan Summary (as of 2016 Coverage Year) For UMP Plans UMP Classic Premiums Deductibles Out-of-Pocket Limits Provider Networks Network Reimbursement Out-of-Network Reimbursement Prescription Drugs Facility/Hospital Charges Special Highest of UMP Plans Medical: $250 per person, $750 family maximum for three (3) or more Prescription drug: $100 per person, $300 family maximum for three (3) or more Medical: $2,000/$4,000 family maximum Medicare retirees $2,500/$5,000 family maximum Prescription drugs: $2,000 per person, no family maximum Currently Regence BlueShield network within Regence Service Area. BlueCard affiliates outside service area Plan pays 85% of allowed amount, Member pays 15%. Preventive care: Specific services covered in full, not subject to medical deductible Plan pays 60% of allowed amount. Member pays 40% remaining, plus any amount billed by the provider over the allowed amount. Preventive care: Not subject to medical deductible, but still pay out-of-network coinsurance. Based on tier system; for most generic drugs, the Member doesn’t pay the prescription drug deductible. Member pays more for certain generic and drugs. For preferred facilities: Member pays $200 per Day, up to $600 annually for inpatient facility charges. For Members: The inpatient copay is $200 per Day, with a maximum of $600 per inpatient stay (up to the medical out-of-pocket limit). Professional providers bill separately from the facility, and are paid according to the provider’s network status. Only UMP plan that regularly offers coverage to Members. Emergency care: Members pay a $75 copay. May participate in medical flexible spending arrangement under the PEBB. primary primary