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CDPHP - (EPO)
EPOCHAMB
Click here
for the detailed
plan summary. |
| This plan is
an EPO (Exclusive Provider Organization) with no out-of-network coverage
and no referrals needed. There is a $500
(single) $1,250 (family) in-network deductible with an
80% coinsurance. It has a $25 primary and specialist
office visit copay. With inpatient hospital you must
meet the deductible and coinsurance. There is a $200 copay for emergency room visits. The Prescription
coverage is $4/$30/$60 with no deductible but has a
$2,000 maximum. Full time dependant coverage to age 25. |
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Quarterly |
|
Sole Proprietor |
Small Group |
| Employee
|
$1,320.09 |
$1,159.80 |
| Employee
+ One |
$2,625.15 |
$2,304.60 |
|
Family |
$3,483.84 |
$3057.81 |
| |
Plan Selection |
Plan Selection |
| |
Instructions |
Instructions |
| |
Application |
Application |
|
CDPHP - HMO
HA6S07 -
Click here
for the detailed
plan summary. |
| This plan
option is a HMO (Health Maintenance Organization) with no out-of-network coverage and
referrals are required. There is a $25 primary and
specialist office visit copay. Inpatient hospital is a
$500 copay and an emergency room visit is a $100 copay.
The prescription coverage is 50% for all medications. Full
time dependant coverage to age 25. |
| |
Quarterly |
|
Sole Proprietor |
Small Group |
| Employee
|
$1,590.00 |
$1,396.59 |
| Employee
+ One |
$3,164.94 |
$2,778.15 |
|
Family |
$4,201.20 |
$3,686.91 |
| |
Plan Selection |
Plan Selection |
| |
Instructions |
Instructions |
| |
Application |
Application |
|
CDPHP - HMO
HA6S07 -
Click here
for the detailed
plan summary. |
| This plan
option is a HMO (Health Maintenance Organization) with no out-of-network coverage and
referrals are required. There is a $25 primary and
specialist office visit copay. Inpatient hospital is a
$500 copay and an emergency room visit is a $100 copay.
The prescription coverage is $4/$30/$60 with no
deductible but has a $2,000 maximum. Full time dependant
coverage to age 25. |
| |
Quarterly |
|
Sole Proprietor |
Small Group |
| Employee
|
$1,594.89 |
$1,400.88 |
| Employee
+ One |
$3,174.69 |
$2,786.70 |
|
Family |
$4,214.16 |
$3,698.28 |
| |
Plan Selection |
Plan Selection |
| |
Instructions |
Instructions |
| |
Application |
Application |
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