Español
Navigate to Facebook Navigate to Twitter
Log in or Register as new user  

Members

Compare Plans

The table below shows the amounts you would be responsible for according to each of the eBasics plans.

eBasics PPO 2000/80 eBasics PPO 4000/70 eBasics PPO 5000/70 eBasics HSA 3000Q/70

Deductible

$2,000 per member*
$4,000 per family*
$4,000 per member*
$8,000 per family*
$5,000 per member*
$10,000 per family*
$3,000 single coverage*
$6,000 family coverage*
* Per benefit period

Out of Pocket Maximum

When the out-of-pocket maximum is reached, benefits are paid 100% of the allowable amount until the benefit period ends.

$5,000 per member
$10,000 per family
$7,500 per member
$15,000 per family
$10,000 per member
$20,000 per family
$5,800 single coverage
$11,600 family coverage

Copayments

For general practitioners, family practitioners, internists, and pediatricians

$20 copayment
per visit
$25 copayment
per visit
$30 copayment
per visit
 

For all other professional providers

$40 copayment
per visit
$50 copayment
per visit
$60 copayment
per visit
 
Deductible applies to all services unless copayment is applied or otherwise noted. Office visits are subject to a 10 visit maximum per family per benefit period excluding preventive, mental health and substance abuse visits

Preventive Care (Network services are not subject to deductible)

Adult routine physical exams and preventive care (age 19 and over)

Covered in full Covered in full Covered in full Covered in full

Pediatric routine physical exams & preventive care (including well-baby care)

Covered in full Covered in full Covered in full Covered in full

Annual gynecological exam

Covered in full Covered in full Covered in full Covered in full

Childhood immunization

Covered in full Covered in full Covered in full Covered in full

Annual Mammogram (age 40 and over)

Covered in full Covered in full Covered in full Covered in full

Annual Pap test

Covered in full Covered in full Covered in full Covered in full

Office visits

Copayment applies Copayment applies Copayment applies 30% coinsurance

Maternity and newborn care

20% coinsurance 30% coinsurance 30% coinsurance 30% coinsurance

Lab tests, x-rays, inpatient visits, surgery, and anesthesia

20% coinsurance 30% coinsurance 30% coinsurance 30% coinsurance

Emergency Care

Emergency treatment for accident or medical emergency

Covered in full, $200 emergency room copayment (waived if admitted; deductible waived) Covered in full

Amublance Services for emergency care

20% coinsurance deductible waived 30% coinsurance deductible waived 30% coinsurance deductible waived Covered in full

Lifetime Maximum

None None None None

These descriptions are for illustrative purposes only. Please refer to your Certificate of Coverage for the plan you choose for a detailed description of all benefits, limitations, definitions of terms, and exclusions.

*Refer to your Certificate of Coverage