Oebb-ods medical plan comparison final.xls

Medical PPO Plan Comparisons
Plan 9 - HSA Compatible PPO
ODS Medical Plans
Plan 3 - PPO
Plan 4 - PPO
Plan 5 - PPO
Plan 6 - PPO
Plan 7 - PPO
Plan 8 - PPO
In Network
Out of Network
In Network
Out of Network
In Network
Out of Network
In Network
Out of Network
In Network
Out of Network
In Network
Out of Network
In Network
Out of Network
Lifetime Benefit Maximun
Individual Deductible (Plan Year)
Family Deductible (Plan Year)
Member Coinsurance
Individual Out of Pocket Maximum
Family Out of Pocket Maximum
Preventive Care Services
Routine adult exams (18 and above)
Routine mammograms
Men's prostate screening (age 50+)
Immunizations (child and adult)
Well-child exam (newborn through age 17)
Professional Services
Office, Home or Hospital Visits
Outpatient Rehabilitation (physical, occupational and speech
therapy- 30/60 days per plan year)
Maternity
Outpatient maternity care
Routine newborn nursery care
Physician or Midwife delivery (Midwife delivery only if also a
licensed nurse practitioner)
Hospital Inpatient
Inpatient Care (unlimited days)
Inpatient Rehabilitative Care (30 days per plan year/ 60 for spinal
or head injury)
Medical PPO Plan Comparisons
Plan 9 - HSA Compatible PPO
ODS Medical Plans
Plan 3 - PPO
Plan 4 - PPO
Plan 5 - PPO
Plan 6 - PPO
Plan 7 - PPO
Plan 8 - PPO
In Network
Out of Network
In Network
Out of Network
In Network
Out of Network
In Network
Out of Network
In Network
Out of Network
In Network
Out of Network
In Network
Out of Network
Skilled Nursing Facility
Skilled Nursing Facility Care (60 days/plan year)
Hospital Outpatient and Ambulatory
Outpatient Hospital/Ambulatory Facility
Diagnostic X-Ray and Lab
Specified Imaging (MRI, CT, CAT, PET scans)
Emergency Care
Ambulance
Emergency Room (co-pay waived if admitted)
Urgent Care Visit
Tobacco Cessation Program (Available to Members 18 and Over)
Telephone Consults
Phone Consults Through Web Coaching
Patch or Gum
Prescribed Medication
Chantix & Zyban - non-preferred Chantix & Zyban - non-preferred Chantix & Zyban - non-preferred Chantix & Zyban - non-preferred Alternative Care Services $2,500 Combined Max
Acupuncture
Chiropractic
Naturopathic
All benefits effective 10/01/2009.
All amounts reflect member responsibility.
After the maximum out-of-pocket costs have been paid, the plan will pay 100%* Plan 9 individual deductible applies if employee is enrolling in the plan with no other family members.
**Plan 9 family decuctible can be met by one or more family members. This deductible must be met before benefits will be paid.
For limitations and exclusions, visit www.odscompanies.com/oebb/members or refer to your member handbook.

Source: http://www.odscompany.net/pdfs/oebb/summaries2009/oebb_medical_comparison.pdf