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BCBS Original Proposal: Experience Through September Required
<br /> Current Plans B[BS Option 1: Single PPO Option Only BCBS Option 2: Alternate Plans
<br /> NCACC-PPO NCACC-HMO .PP0:3557039 PPO:3536197 HSA:167066
<br /> 2011 2011 2012 2012 2012
<br /> In-Network In-Network In-Network In-Network In-Network
<br />Primary Care
<br />Physcian
<br />visits $15 $15 $15 520 80%sfter0ed.
<br />Specialist
<br />Physician _
<br />Ysits 530 S30 $30 540 80%afterDed.
<br />Preventive
<br />Carc 100% 100% 100% 100% 100%
<br />Dedudibk $250 $250 $250 $750 51,500
<br />Oeductlble -
<br />Family
<br />Mazlmum $750 5750 $750 $2,250 $3,000
<br />Coinsurance
<br />Umit $1,000 - $0 $1,000 $1,000 $2,000
<br />Coinsurance
<br />Limit -Family
<br />Max $3,000 $0 $3,000 $3,000 $2,000
<br />In-patient
<br />Hospital
<br />Services 9096 afterDed. 100%afterDed. 90%afterDed. 80%afterDad. 80%afterDe'd.
<br />Out-patient
<br />Hospital
<br />Services 90%afterDed. 100%afterDed. 90%afterDed. 80%afterDed. 80%afterDed.
<br />Emergency
<br />Room $150 $150 $150 $200 80%afterDed.
<br />Pharmacy 50/8'15/830 SO/$15/$30 $4/$30/$45/25% $4/535/550/25% 8096after Ded.
<br />Ufetime
<br />Mazlmum Unlimited Unlimited Unlimited Unlimted Unlimited
<br />Rata Subs Monthly Pranlum Subs. Monthly Prcmlum Total Subs Monthly Premium Monthly Premium Monthly Premium
<br />Employee
<br />Onh/ 64 $SD9.02 $32,577.28 457 $531.44 $242,868.08 521 $701.49 $365,476.29 $636.11 $290,702.27 5474.23 $30,350.72
<br />Employee &
<br />spouse 12 51,074.02 $12,888.24 85 $1,121.32 $95,33L20 97 $1,461.45 $141,760.65 $1,325.45 $112,663.25 $940.23 $11,282.76
<br />Employee &
<br />Child 12 $712.62 $8551.44 115 $743.98 $85,557.70 127 $959.94 $121,912.38 $87052 $100,109.80 $573.55 $6,882.60
<br />Employee &
<br />Chiidrcn 30 $962.42 $9,824.20 77 $1,025.66 $78,975.82 87 $1,310.28 $113,994.36 $1,188.32 $91,500.64 $736.92 $7,369.20
<br />Employee &
<br />Family 19 $1,527.06 $29,01452 78 51$9418 $124,353.84 97 $2,096.88 5203,397.36 $1,901.78 $148,338.84 $1,363.98 $25,915.62
<br />Monthly Cost 117 $92,855.68 812 $627,067.64 929 $946,54L04 $743,314.80 $81,800.90
<br /> HSAContribution
<br /> $750 $87,750.00
<br />Annual $1,114,268.16 $7,524,811.68 $11,358,492.48 $8,919,777.60 $1,069,360.80
<br /> Total $8,639,079.84 $11,358,492.48 $9,989,138.40
<br />haease over
<br />arrcnc 13196 Not Firm 115.63%
<br />CQ
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