Agenda - 05-13-2014 - 2 - Laserfiche WebLink

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k, 2014 Self -funde d Quotes Current HSA In-Network Deduct/20% Deduct /20% 100% $1,500 7 UHC Insured 2013 Renewal: LIHC 2014 Self-fun ed , Self -fun ed Current POS Current POS Current t Current HSA ECarEeP�Ehysician In-Network In-Network In-Network Primary Physician Visits $20 $20 Deduct/20% Specialist P 'Ir Specialist Physician Visits $40 $40 Deduct/20% Preventive Care 100% 100% 100% D Deductible $500 $500 _$1,500 $1,500 $4,500 $1,500 $3,000 $3,500 $5,000 Deductible - Family Maximum $1,500 $3,000 Out of Pocket Limit (includes deductible) $1,500 $3,500 Out of Pocket Limit - Family Max $4,500 $5,000 Deduct/20% Radiology Deduct/20% Deduct/20% Office Copay Deduct/20% Deduct/20% Minor Surgery in Office Office Copay Deduct/20% Deduct/20% Hospital Services Deduct/20% Deduct/20% $50 $150 $4/$25/$45 Not covered Deduct/20% Deduct/20% Deduct/20% Deduct/20% Not covered Urgent Care $50 Deduct/20% Emergency Room $150 Deduct/20% Pharmacy $4/$25/$45 Deduct/20% Vision Hardware Not covered Not covered HSA $1,237.20 Unlimited $1,237.20 Unlimited Lifetime Maximum Unlimited Unlimited Difference 0% k,