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Medical Plan Comparison Grid

Medical Plan Comparison Grid for benefits starting January 1, 2021

Medical Plan Comparison Grid
Presbyterian Health Plan EPO (In Network)True Health EPO (In Network)Cigna Healthcare Open Access Plus PPO (In Network) Cigna Healthcare Open Access Plus PPO (Out-of-Network)BlueCross BlueSheild PPO (In Network) BlueCross BlueSheild PPO (Out-of-Network)
Primary Care Copay $20 $20 $30 Deductible/ Coinsurance $30 Deductible/ Coinsurance
Specialist Copay $50 $50 $60 Deductible/ Coinsurance $60 Deductible/ Coinsurance
Preventive Care Services Plan pays 100% Plan pays 100% Plan pays 100% Deductible/ Coinsurance Plan pays 100% Deductible/ Coinsurance
Lab / X-Rays / Ultrasound/ Other Basic Diagnostic Testing $20 copay/day $20 copay/day $30 copay/day Deductible/ Coinsurance $30 copay/day Deductible/ Coinsurance
Physical, Occupational and Speech Therapy (refer to complete Summary of Benefits) $20 copay per visit up to $320 annual maximum $20 copay per visit up to $320 annual maximum $30 copay per visit to $480 annual maximum Deductible/ Coinsurance $30 copay per visit to $480 annual maximum Deductible/ Coinsurance
Urgent Care $50 $50 $75 $75 $75 $75
Emergency Room $350 copay $350 copay $450 copay   $450 copay  
Ambulance Subject to deductible and coinsurance Subject to deductible and coinsurance Subject to in-network deductible and coinsurance   Subject to in-network deductible and coinsurance  
Inpatient Hospitalization Deductible and Coinsurance Deductible and Coinsurance Deductible and Coinsurance Deductible and Coinsurance Deductible and Coinsurance Deductible and Coinsurance
Autism Spectrum Disorder Services Deductible/ Coinsurance Deductible/ Coinsurance Deductible/ Coinsurance Deductible/ Coinsurance Based on place of treatment and type of service Based on place of treatment and type of service
Durable Medical Equipment, Supplies, Prosthetics (refer to complete Summary of Benefits) 20% coinsurance, deductible does not apply 20% coinsurance, deductible does not apply 20% coinsurance, deductible does not apply Deductible/ Coinsurance 20% coinsurance, deductible does not apply Deductible/ Coinsurance
Medical Plan Deductibles and Coinsurance
Presbyterian Health Plan EPO (In Network)True Health EPO (In Network)Cigna Healthcare Open Access Plus PPO (In Network) Cigna Healthcare Open Access Plus PPO (Out-of-Network)BlueCross BlueSheild PPO (In Network) BlueCross BlueSheild PPO (Out-of-Network)
Single Deductible $500 $500 $1,000 $5,000 $1,000 $5,000
Two-party Deductible $1,000 $1,000 $2,000 $10,000 $2,000 $10,000
Family Deductible $1,250 $1,250 $2,500 $15,000 $2,500 $15,000
Coinsurance 20% 20% 20% 50% 20% 50%
Single Out of Pocket Maximum $4,000 $4,000 $5,000 $8,500 $5,000 $8,500
Two-party Out of Pocket Maximum $8,000 $8,000 $10,000 $14,875 $10,000 $14,875
Family Out of Pocket Maximum $12,000 $12,000 $12,500 $21,250 $12,500 $21,250
Maternity Services – Medical Plan Comparison Grid
Presbyterian Health Plan EPO (In Network)True Health EPO (In Network)Cigna Healthcare Open Access Plus PPO (In Network) Cigna Healthcare Open Access Plus PPO (Out-of-Network)BlueCross BlueSheild PPO (In Network) BlueCross BlueSheild PPO (Out-of-Network)
Prenatal, postnatal care and OB delivery charges $50 copay - initial visit only, then plan pays 100% $50 copay - initial visit only, then plan pays 100% $60 copay - initial visit only, then plan pays 100% Deductible/ Coinsurance $60 copay - initial visit only, then plan pays 100% Deductible/ Coinsurance
Hospital Admission Deductible (on the mother) and Coinsurance Deductible (on the mother) and Coinsurance Deductible (on the mother) and Coinsurance Deductible (on the mother) and Coinsurance Deductible (on the mother) and Coinsurance Deductible (on the mother) and Coinsurance
Diabetes Coverage – Medical Plan Comparison Grid
Presbyterian Health Plan EPO (In Network)True Health EPO (In Network)Cigna Healthcare Open Access Plus PPO (In Network) Cigna Healthcare Open Access Plus PPO (Out-of-Network)BlueCross BlueSheild PPO (In Network) BlueCross BlueSheild PPO (Out-of-Network)
Office visit and diabetes education $10 copay/visit up to $260 annual maximum $10 copay/visit up to $260 annual maximum $10 copay/visit Deductible/ Coinsurance $10 copay/visit up to $260 annual maximum Deductible/ Coinsurance
Diabetic medications Refer to Prescription Drug Plan Refer to Prescription Drug Plan Refer to Prescription Drug Plan Refer to Prescription Drug Plan Refer to Prescription Drug Plan Refer to Prescription Drug Plan
Diabetic supplies, equipment, appliances and services Plan pays 100% Plan pays 100% Plan pays 100% Deductible/ Coinsurance Plan pays 100% Deductible/ Coinsurance
Behavioral/Mental Health and Substance Use Disorder Services
Presbyterian Health Plan EPO (In Network)True Health EPO (In Network)Cigna Healthcare Open Access Plus PPO (In Network) Cigna Healthcare Open Access Plus PPO (Out-of-Network)BlueCross BlueSheild PPO (In Network) BlueCross BlueSheild PPO (Out-of-Network)
Outpatient Services $10 copay/visit up to $260 annual maximum $10 copay/visit up to $260 annual maximum $10 copay/visit up to $260 annual maximum Deductible/ Coinsurance $10 copay/visit up to $260 annual maximum Deductible/ Coinsurance
Inpatient Services Deductible/ Coinsurance Deductible/ Coinsurance Deductible/ Coinsurance Deductible/ Coinsurance Deductible/ Coinsurance Deductible/ Coinsurance

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