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• • <br /> 2012 Renewal — Fully Insured <br /> Orange County Medical Plan Prepared by Mark III Brokerage, Inc. August 2011 <br /> UnitedHealthcare Option 4: Alternate Plans <br /> POS: S5E-P-M5 HSA: C3Z-PM <br /> 2012 2012 <br /> In-Network In-Network <br /> Primary Care Physician Visits $20 80% after Ded. <br /> S p ecialist Ph y sician Visits z r q _ ,tr �, .;: _; 80% after Ded. <br /> Preventive Care 100% 100% <br /> Deductible $500 $1,500 <br /> Deductible - Family Maximum : ;.a $3,000 <br /> Coinsurance LimitLL $1,000 $2,000 <br /> Coinsurance Limit - Family Max $3,000 $2,000 <br /> In-patient Hospital Services 80% after Ded. 80% after Ded. <br /> Out-patient Hospital Services 80% after Ded. 80% after Ded. <br /> Emergency Room 04 80% after Ded. <br /> Pharmacy $8/$25/$45 <br /> Lifetime Maximum Unlimited Unlimited <br /> Rates Monthly Monthly <br /> Employee Only $578.59 $475.49 <br /> Employee and Spouse $1,220.83 $1,003.28 <br /> Employee and Child $937.32 $770.29 <br /> Employee and Children $937.32 $770.29 <br /> Employee and Family $1,735.77 $1,426.47 <br /> Monthly Cost <br /> HSA Contribution <br /> $1,237 <br /> Annual $9,385,469.52 <br /> Increase over current = <br /> 3 <br />