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<br />Current Plans
<br />United Healthcare
<br />Option 1
<br />2013 Fully Insured Renewal
<br />United Healthcare - Both Plans
<br />$4 Copay for Generic - POS
<br />Office Surgery Subject to Copay - POS
<br />In- Network Simple Labs at 100% - POS
<br />POS: S5E -P -M5
<br />2012
<br />HSA: C3Z -PM
<br />2012
<br />POS: S5E -P -M5
<br />2013
<br />HSA: C3Z -PM
<br />2013
<br />In- Network
<br />In- Network
<br />In- Network
<br />In- Network
<br />Primary Care Physician Visits
<br />$20
<br />80% after Ded.
<br />$20
<br />80% after Ded.
<br />Specialist Physician Visits
<br />$40
<br />80% after Ded.
<br />$40
<br />80% after Ded.
<br />Preventive Care
<br />100%
<br />100%
<br />100%
<br />100%
<br />Deductible
<br />$500
<br />$1,500
<br />$500
<br />$1,500
<br />Deductible - Family Maximum
<br />$1,500
<br />$3,000
<br />$1,500
<br />$3,000
<br />Coinsurance Limit
<br />$1,000
<br />$2,000
<br />$1,000
<br />$2,000
<br />Coinsurance Limit - Family
<br />Max
<br />$3,000
<br />$2,000
<br />$3,000
<br />$2,000
<br />In- patient Hospital Services
<br />80% after Ded.
<br />80% after Ded.
<br />80% after Ded.
<br />80% after Ded.
<br />Out - patient Hospital Services
<br />80% after Ded.
<br />80% after Ded.
<br />80% after Ded.
<br />80% after Ded.
<br />Emergency Room
<br />$150
<br />80% after Ded.
<br />$150
<br />80% after Ded.
<br />Pharmacy
<br />$8/$25/$45
<br />80% after Ded.
<br />$4/$25/$45
<br />80% after Ded.
<br />Lifetime Maximum
<br />Unlimited
<br />Unlimited
<br />Unlimited
<br />Unlimited
<br />Rates
<br />Subs
<br />Monthly
<br />Premium
<br />Subs
<br />Monthly
<br />Premium
<br />Monthly
<br />Premium
<br />Monthly
<br />Premium
<br />Employee Only
<br />464
<br />$578.59
<br />$268,465.76
<br />104
<br />$475.49
<br />$49,450.96
<br />$631.18
<br />$292,867.52
<br />$510.15
<br />$53,055.60
<br />Employee and Spouse
<br />72
<br />$1,220.83
<br />$87,899.76
<br />18
<br />$1,003.28
<br />$18,059.04
<br />$1,331.80
<br />$95,889.60
<br />$1,076.41
<br />$19,375.38
<br />Employee and Children
<br />163
<br />$937.32
<br />$152,783.16
<br />45
<br />$770.29
<br />$34,663.05
<br />$1,022.52
<br />$166,670.76
<br />$826.44
<br />$37,189.80
<br />Employee and Family
<br />49
<br />$1,735.77
<br />$85,052.73
<br />29
<br />$1,426.47
<br />$41,367.63
<br />$1,893.54
<br />$92,783.46
<br />$1,530.45
<br />$44,383.05
<br />Monthly Cost
<br />748
<br />$594,201.41
<br />196
<br />$143,540.68
<br />$648,211.34
<br />$154,003.83
<br />HSA Contribution
<br />$1,237.20
<br />$242,491.20
<br />HSA Contribution
<br />$1,237.20
<br />$242,491.20
<br />Annual
<br />$7,130,416.92
<br />$1,964,979.36
<br />$7,778,536.08
<br />$2,090,537.16
<br />Total
<br />$9,095,396.28
<br />109.09%
<br />$9,869,073.24
<br />106.39%
<br />Increase over current
<br />108.51%
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