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  • Van Wagner Medical Plans 2013

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    This document outlines the copay, deductible, and coverage details for two health insurance plans - HN Option (Plan 1) and FL MCOA 12 POS (Plan 2). For services like emergency room visits, inpatient care, and prescriptions, each plan specifies the copay amounts and whether the deductible applies for in-network or out-of-network care. Both plans also provide the annual deductible amounts, out-of-pocket maximums, and coinsurance percentages that apply individually and for families for in-network and out-of-network services.

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    VW Medical Plans 2013

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    This document outlines the copay, deductible, and coverage details for two health insurance plans - HN Option (Plan 1) and FL MCOA 12 POS (Plan 2). For services like emergency room visits, inpatient care, and prescriptions, each plan specifies the copay amounts and whether the deductible applies for in-network or out-of-network care. Both plans also provide the annual deductible amounts, out-of-pocket maximums, and coinsurance percentages that apply individually and for families for in-network and out-of-network services.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as XLS, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xls, pdf, or txt
    50 views1 page

    Van Wagner Medical Plans 2013

    Uploaded by

    res6250
    This document outlines the copay, deductible, and coverage details for two health insurance plans - HN Option (Plan 1) and FL MCOA 12 POS (Plan 2). For services like emergency room visits, inpatient care, and prescriptions, each plan specifies the copay amounts and whether the deductible applies for in-network or out-of-network care. Both plans also provide the annual deductible amounts, out-of-pocket maximums, and coinsurance percentages that apply individually and for families for in-network and out-of-network services.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as XLS, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xls, pdf, or txt
    of 1

    Plan

    Copay:

    HN Option (Plan 1)
    In-Network: $25 copay; deductible waived Out-of-Network: 50% after deductible In-Network: $300 copay; deductible waived Out-of-Network: Same as In-Network In-Network: 20% after deductible Out-of-Network: 40% after deductible In-Network: 100% deductible waived Out-of-Network: 40% after deductible In-Network: 100%; deductible waived Out-of-Network: 50% co-insurance In-Network: 20% co-insurance Out-of-Network: 50% co-insurance

    FL MCOA 12 POS (Plan 2)


    In-Network: $25 copay; deductible waived Out-of-Network: 50%; after deductible In-Network: $300 copay; deductible waived Out-of-Network: Same as In-Network In-Network: 20% co-insurance Out-of-Network: 50% co-insurance In-Network: 100%; deductible waived Out-of-Network: 50%; after deductible In-Network: 100%; deductible waived Out-of-Network: 50%; after deductible In-Network: 20% co-insurance Out-of-Network: 50% co-insurance

    Emergency Room:

    Inpatient Care:

    Child Wellness:

    Adult Routine Physicals:

    Outpatient Surgery:

    Prescription Drug
    30 day suply (retail) Generic: Select: Non-Select $10 $40 $60 30 day suply (retail) $5 $40 $60

    Annual Deductibles
    Individual:
    In-Network: $1,000 Out-of-Network: $2,000 In-Network: $2,000 Out-of-Network: $4,000 In-Network: $1,000 Out-of-Network: $2,000 In-Network: $2,000 Out-of-Network: $4,000

    Family:

    Annual Out-of-Pocket Maximum


    Individual:
    In-Network: $3,000 Out-of-Network: $6,000 In-Network: $6,000 Out-of-Network: $12,000 In-Network: 50% Out-of-Network: 50% In-Network: $3,000 Out-of-Network: $6,000 In-Network: $6,000 Out-of-Network: $12,000 In-Network: 20% Out-of-Network: 50%

    Family:

    Co-Insurance:

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