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Attachment 7 <br />~~ <br />HEALTH INSURANCE PLAN DESIGNS <br />Current, Renewal and No change <br />Option 1 (Buy Up) PPO HMO <br />Primary Care Provider Copay $15 $15 <br />Specialist Copay $30 $30 <br />Emergency Room Copay $150 $150 <br />Individual Deductible (IN / OON) $250 / 500 $250 <br />Coinsurance Maximum (IN / 00 $1,000 / 2,000 $0 <br />Family Maximums 3 times 3 times <br />Coinsurance (IN / OON) 90% / 70% 100% <br />OP Lab & Mammograms (IN / O 100% 100% <br />Preventive Care Program (IN / 100% / 0% 100% <br />Retail Drug Copay (30 Day Sup $5-15-30 $5-15-30 <br />Mail Order Drug Copay (90 Day $13-26-60 $13-26-60 <br />Vision - E e Exam Deductible $15 $15 <br />Option 2 One Plan PPO <br />Prima Care Provider Co a $15 <br />S ecialist Co a $30 <br />Emer enc Room Co a $150 <br />Individual Deductible IN / OON $250 <br />Coinsurance Maximum IN / 00 $500 <br />Famil Maximums 3 times <br />Coinsurance (IN / OON) 95% <br />OP Lab & Mammo rams IN / O 1 <br />Preventive Care Pro ram IN / O 1 <br />Retail Dru Co a 30 Da Su $5-15-30 <br />Mail Order Dru Co a 90 Da $13-26-60 <br />Vision - E e Exam Deductible $15 <br />