hmo medical plans

Take a quick look at key features of the 2016 HMO medical plans.

plan features

	Kaiser Permanente	UnitedHealthcare
	Network Only	Network Only
Annual Deductible	None	None
Out of-Pocket Maximum Employee Only Employee +One/Family	$1,500 $3,000	$2,000 $4,000

	Kaiser Permanente	UnitedHealthcare
	Network Only	Network Only
	What You Pay
Preventive Services	$0 copay	$0 copay
Office Visits
▪ Primary care	$30 copay	$30 copay
▪ Specialist	$30 copay	$40 copay
X-Ray and Lab work	$0 copay	$0 copay; $200 copay for specialized scans and imaging
Chiropractic Care	Not covered	Discounts available
Inpatient Hospital
▪ Room and board	$250 copay/admission	$250 copay/day; $2,000 annual maximum
▪ Ancillary charges	Covered 100% after inpatient hospital copay	Covered 100% after inpatient hospital copay
Surgery
▪ Inpatient	Covered 100% after inpatient hospital copay	Covered 100% after inpatient hospital copay
▪ Outpatient	$30 copay/procedure	$125 copay/visit
Alcohol and Chemical Dependency
▪ Detoxification
Inpatient	$250 copay	$0 copay
Outpatient	$30 copay/individual visit $5 copay/group visit	$0 copay
▪ Rehabilitation
Inpatient	$100 copay for Transitional Residential Recovery Services	$0 copay
Outpatient	$30 copay/individual visit $5 copay/group visit	$0 copay
Mental Health
▪ Inpatient	$250 copay	$0 copay
▪ Outpatient	$30 copay/individual visit; $15 copay/group visit	$40 copay/visit
Emergency Room	$100 copay/visit (waived if admitted)	$100 copay (must notify PCP within 24 hours if admitted)
Ambulance	$0 copay	$0 copay
Vision Care
▪ Routine eye exam	$0 copay	$0 copay
▪ Materials	Not covered	Discounts available

	Kaiser Permanente	UnitedHealthcare
	Network Only	Network Only
	What You Pay
Out-of-Pocket (OOP) Drug Limit	Applies to medical plan OOP limit	Applies to medical plan OOP limit
Retail (up to 30-day supply)	$15 Generic $35 Preferred/ Non-preferred brand	$10 Generic $30 Preferred brand $50 Non-preferred brand
Mail Order (up to 90-day supply)	$30 Generic $70 Preferred/ Non-preferred brand	$20 Generic $75 Preferred brand $135 Non-preferred brand

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