Plan Benefit
Model Components HMo & PPo Models Comparison Plan variance SummaryKey opportunities
for ImprovementCopay $45 - $60 (Emergency); $100+ (Non-Emergency)
per use.
Coinsurance 15% or 25%+ per use
OOP Maximum Applies
v. laboratory, diagnostic, Assessment, and Testing Services
va. laboratory Services
Coverage (Y/N) Y
Covered Providers Inpatient hospital, outpatient hospital, clinic and
provider office.
Coverage Limits No limit
Inclusions All medically necessary care.
Exclusions All others as defined by the health plan.
Copay $0 - $100+
Coinsurance 10% - 25%
OOP Maximum Applies
vb. diagnostic, Assessment, and Testing (Medical and Psychological) Services
Coverage (Y/N) Y
Covered Providers Reference Plan Benefit list.
Coverage Limits No limits. Some services may require pre-au-
thorization.
Inclusions All medically necessary diagnostic and assess-
ment tests provided or ordered and billed by a
physician
Exclusions All others as defined by the health plan.
Copay $0 - $100+
Coinsurance 10% - 25%
OOP Maximum Applies