REBNY Health Insurance Kit

April 1 st , 2013
INSURANCE PLUS Rose Gagliardi
15 West Main Street President
Oyster Bay, NY 11771
516-922-1200 / 212-268-4473
516-922-2801 fax
rose@insuranceplusny.com
www.insuranceplusny.com
INSURANCE OPTIONS
INDEPENDENT CONTRACTORS
EMBLEM EPO HDHP:
*RATES VALID UNTIL 5/31/2013
When using EMBLEM providers, you have a:
$5,800/$11,600 Deductible
100% Coinsurance after Deductible
Annual Checkup – Not Subject to Deductible
Immunizations and Well Bab y Care – Not Subject to Deductible
Lifetime Maximum – UNLIMITED
Plan includes a $0/$0/$0 drug card (AFTER SATISFYING DEDUCTIBLE)
*MONTHLY RATES: $390 Single/ $1,131 Family
Also available $10,000/$20,000 deductible plan: $269 Single/ $781 Family
P HYSICIAN DIRECTORY: WWW.EMB LEMHE ALTH.COM (EP O NETWORK)
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EMBLEM EPO:
*RATES VALID UNTIL 8/31/2013
When using EMBLEM providers, you have a:
$30 Office Co pay / $0 Co pay for Children under 19
Preventive Care
Well-Child – No Charge
MRI – $150
Chiropractic
Mental Health – Biologically Based - $30/Unlimited Visits
Mental Health - $30/30 Visits
Physical Therap y – 30 Visits/$25 Co pay
Emergency - $200 Co pay
Hospitalization - $500 per day w/$1,500 max per admission
NO REFERRALS REQUIRED
$15 generic only drug card
*MONTHLY RATES: $667 Single/ $1,729 Family
P HYSICIAN DIRECTORY: WWW.EMB LEMHE ALTH.COM (EP O NETWORK)
***HEALTHY NEW YORK – EMPIRE BCBS:
When using HEALTHY NEW YORK providers, you have a:
$20 Office Visit Copay
$1,250/$2,500 Deductible (shared Hospital, Medical, Rx)
$6,050/$12,100 Out of Pocket Maximum
Surgical Services – 20% or $200, (whichever is smaller) Prenatal
Services - $10 Copay Emergency -
$50 Copay Hospitalization – $500
Copay Preventive Services – NO
CHARGE
Well-Child Visits (including immunizations) – NO CHARGE
OPTIONAL Prescription Benefit - Member must first meet Plan Deductible
$10 Generic / $20 Brand copay**
**Note: If generic available, member must pay copay plus difference in cost between brand name and generic equivalent.
PHYSICIAN DIRECTORY: www.em pireblue.com
Monthly Rates * RATES ARE SUBJECT TO CHANGE
Plan T ype w/ drugs w/o drugs
Individual $376.77 $287.74
Two Adult $791.22 $604.26
Parent & Child(ren) $678.18 $517.93
Fam ily $1,141.61 $871.85
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***HEALTHY NEW YORK HDHP
OXFORD LIBERTY HSA – Referrals Required
When using Liberty providers, you have a:
$1,250/$2,500 Deductible
$6,050/$12,100 Out of Pocket Maximum
$20 Office Visit Copay
Preventive Services – No charge
Well child visit – No charge
Pre & Postnatal visits - $10 copay
Emergency Room – Deductible, then $50 copay
Surgical Services – Deductible, then 20% up to $200 per occurrence
Hospitalization – Deductible, then $500 copay per confinement
OPTIONAL Prescription Benefit - Member must first meet Plan Deductible
$10 Generic / $20 Brand copay**
**Note: If generic available, member must pay copay plus difference in cost between brand name and generic equivalent.
PHYSICIAN DIRECTORY: www.oxhp.com
Monthly Rates * RATES ARE SUBJECT TO CHANGE
Plan T ype w/ drugs w/o drugs
Individual $379.73 $318.90
Two Adult $835.41 $701.58
Parent & Child(ren) $744.27 $625.05
Fam ily $1,234.12 $1,036.43
***Pl an’s eligibility is based on NYS income requirements
Easy Choice NY (formerly Atlantis): (HMO - In-Netw ork-Only)
When using Easy Choice providers, you have a:
$25 Primary Copay
$40 Specialist Copay
Preventive Care
Chiropractic
Physical Therapy – 20 Visits/$40 Copay
Mental Health – 20 Visits/$40 Copay
Emergency - $50 Copay
Hospitalization - $500 Copay
Plan includes a $10 Generic Only drug card
*MONTHLY RATES: $510 Single / $1,020 Couple / $1,026 Single Parent / $1,570 Family
*RATES VALID UNTIL 6/30/2013
PHYSICIAN DIRECTORY: WWW.EASYCHOICENY.COM (HMO NETWORK)
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OXFORD SOLE-PROPRIETOR PROGRAM - NO REFERRALS NEEDED:
Network
Office Visit Copayment
In-network Deductible
In-network
Coinsurance
Out-of-network Ded
Out-of-network Co-ins
Hospital Inpatient
Outpatient Surgery
Pharmacy
Plan 1 Plan 2 Plan 3 Plan 4
Liberty Plan
Direct
Oxford Exclusive
Plan Metro
Oxford HSA
Direct
LIBERTY LIBERTY FREEDOM
$30/$50 $25/$50 Ded. & Co-ins
$2,000/$5,000 $2,000/$5,000 $2,850/$5,700
80% to $10K 90% to $10K 90% to $10K
$2,000 In-network only $2,850
60% to $10K In-network only 70% to $10K
Ded. & Co-ins Ded. & Co-ins Ded. & Co-ins
Ded. & Co-ins Ded. & Co-ins Ded. & Co-ins
$15/50% w/$100
Tier 2 ded
$15/50% w/$100
Tier 2 ded
$15/50%
Oxford HSA
Exclusive
FREEDOM
Ded. & Co-ins
$2,000/$4,000
100%
In-network only
In-network only
Ded. & Co-ins
Ded. & Co-ins
$15/50%
SECOND QUARTER RATES 2013 - MANHATTAN, RICHMOND, BRONX AND SUFFOLK COUNTY
Single $690.98 $576.16 $586.42 $610.40
Parent/Child(ren) $1,282.89 $1,070.33 $1,089.46 $1,133.67
Husband/Wife $1,520.16 $1,267.55 $1,290.12 $1,342.88
Family $2,191.17 $1,793.54 $1,860.76 $1,899.68
Mental Health Rider - Biologically Based Mental Health Services:
(30 days inpatient/20 days outpatient per calendar year)
Single $5.77 $3.31 $4.79 $3.42
Parent/Child(ren) $10.67 $6.12 $8.86 $6.33
Husband/Wife $12.69 $7.28 $10.54 $7.52
Family $18.23 $10.26 $15.14 $10.60
RATES VALID: 4/01/2013-6/30/2013 (Rates are held for one year after enrollment)
Queens, Brooklyn and Nassau Rates are approximately 3% higher
PROVIDERS DIRECTORY: WWW.OXHP.COM (LIBERTY OR FREEDOM NETWORK)

HIP Select PPO : No Referrals Needed
** Plan Option 1
In Network
When using HIP Prime providers, you have:
Office Visit - $30 Primary Copay/$50 Specialist Copay
Preventive / Well-Child – No charge
Mental Health – 40 Visits/$50 Copay
Physical Therapy – 30 Visits / $50 Copay
Emergency - $150 Copay
Hospitalization – Subject to Plan deductible & coinsurance**see Table below
When using YOUR OWN providers, you have:
Office visit – Subject to Plan Deductible & Coinsurance**
Mental Health – Subject to Plan Deductible & Coinsurance**
Physical Therapy – Subject to Plan Deductible & Coinsurance**
Emergency - $150 Copay
Hospitalization – Subject to Plan Deductible & Coinsurance**see Table below
In Network Out of Network Out of Network Prescription
Deductible Coinsurance Deductible Coinsurance Drug Card
$3,000/$6,000 20% $6,000/$12,000 40% No RX
Monthly Rates: $591 Single / $1,222 Couple / $1,121 Parent/Child / $1,811 Family
** Plan Option 2
In Network
Deductible
In Network
Coinsurance
Out of Network
Deductible
Out of Network
Coinsurance
Prescription
Drug Card
$2,000/$4,000 20% $4,000/$8,000 40% $10 Generic/$100
deductible
Monthly Rates: $660 Single / $1,368 Couple / $1,255 Parent/Child / $2,028 Family
** Plan Option 3
In Network In Network Out of Network Out of Network Prescription
Deductible Coinsurance Deductible Coinsurance Drug Card
$2,000/$4,000 20% $4,000/$8,000 40% $20/$30/$50/$300
deductible
Monthly Rates: $727 Single / $1,508 Couple / $1,384 Parent/Child / $2,236 Family
*RATES VALID UNTIL 03/31/2014
PHYS ICIAN DIRECTORY: WWW.HIPUSA.COM (HIP PRIME NETWORK)

SAMPLE PROGRAMS FOR A
CORPORATION/LLC
AETNA NYC COMMUNITY PLAN – REFERRALS REQUIRED:
*RATES VALID UNTIL 6/30/2013
When using AETNA HMO providers, you have a:
$30 Office/$50 Specialist co pay
$0 copay for dependent child
Unlimited Maximum Benefit
Routine Physical – NO CHARGE
Drug Card - $15/50%
*MONTHLY RATE: $373 Single/ $795 Couple/ $698 Single Parent/ $1,137 Family
PHYSICIAN DIRECTORY: WWW.AETNA.COM (HMO NETWORK)
EMBLEM COMPREHEALTH HMO – REFERRALS REQUIRED:
*RATES SUBJECT TO CHANGE
When using EMBLEM HMO providers, you have a:
$30 Office/$50 Specialist co pay
$0 copay for dependent child
Unlimited Maximum Benefit
Routine Physical – NO CHARGE
Drug Card – $15 Generic Only
MONTHLY RATE: $352 Single/ $827 Couple/ $676 Single Parent/ $1,096 Family
P HYSICIAN DIRECTORY: WWW.EMBLEMHE ALTH.COM
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OXFORD FREEDOM METRO EXCLUSIVE – NO REFERRALS:
When using FREEDOM providers, you have a:
$25 Primary co pa y
$50 Specialist copay Unlimited
Maximum Benefit Laboratory
Tests – NO CHARGE Routine
Physical – NO CHARGE
Drug Card - $15/$35/$75 AFTER $100 Annual Deductible
(Deductible waved for Tier 1drugs)
*MONTHLY RATE: $698 Single/ $1,537 Couple**/ $1,296 Single Parent / $2,172 Family**
*RATES VALID UNTIL 6/30/2013
PHYSICIAN DIRECTORY: WWW.OXHP.COM
** Rates may be reduce d for a family-owned business.
OXFORD LIBERTY HMO – REFERRALS REQUIRED:
When using LIBERTY providers, you have a:
$30 Primary co pa y
$50 Specialist co pay Unlimited
Maximum Benefit Laboratory
Tests – NO CHARGE Routine
Physical – NO CHARGE
Drug Card - $15/$35/$75 AFTER $100 Annual Deductible
(Deductible waived for Tier 1 drugs)
*MONTHLY RATE: $553 Single/ $1,217 Couple**/ $1,028 Single Parent / $1,723 Family**
*RATES VALID UNTIL 6/30/2013
PHYSICI AN DIRECTORY: WWW.OXHP.COM
** Rates may be reduce d for a family-owned business.
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OXFORD LIBERTY METRO POS – NO REFERRALS: (CAN USE
OXFORD LIBERTY DOCTORS OR DOCTORS OF CHOICE)
When using LIBERTY providers, you have a:
$30 Primary Copa y
$50 Specialist Copay Unlimited
Maximum Benefit Laboratory
Tests – NO CHARGE Routine
Physical – NO CHARGE
When using your own doctors, you have a:
$3,000/$9,000 Deductible
$6,000/$18,000 Out of Pocket Maximum
Unlimited Maximum Benefit
Drug Card - $15/50% AFTER $100 Annual Deductible
(Deductible waived for tier 1 drugs)
*MONTHLY RATE: $787 Single/ $1,732 Couple**/ $1,460 Single Parent /$2,447 Family**
*RATES VALID UNTIL 6/30/2013
PHYSICI AN DIRECTORY: WWW.OXHP.COM
** Rates may be reduce d for a family-owned business.
*** FREEDOM NETWORK PROGRAM is approx. 12% higher.
ADDITIONAL PROGRAMS OFFERED
AETNA
EASYCHOICE
EMBLEM
HIP
OXFORD
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DENTAL INSURANCE OPTIONS
CORPORATION / LLC
**OXFORD (OBM) – DENTAL / VISION PLAN
ELITE PLAN**
When using an Oxford Provider OR Provider of CHOICE, you have:
No Waiting Period on Basic and Major Services (optional)
$1,500 Annual Maximum ($1,000 optional)
Discounts include Wellness, Alternative Medicine, and Infertility
When using an Oxford PROVIDER, you have a:
$50/$100 Annual Deductible
100% Coverage for Preventative
80% Coverage after Deductible for Basic Restorative
50% Coverage after Deductible for Major Care
When using YOUR OWN DOCTOR, you have a:
80% Coverage after Deductible for Cleanings, X-rays, & Preventative
60% Coverage after Deductible for Basic Restorative
50% Coverage after Deductible for Major Care
VISION BENEFIT – Can use Oxford provider or provider of choice.
Benefits include eye exams, frames, lenses, contact lenses. Benefits are subject to co pays
and reimbursement schedule.
*MONTHLY RATES: $46 Single / $85 Couple / $88 Single Parent / $131 Family
*Rates are subject to change and to final underwriting.
**ADDITIONAL PROGRAMS ARE AVAILABLE.
PROVIDERS DIRECTORY: www.oxhp.com
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Dental Options
INDEPENDENT CONTRACTORS
(Programs are also available for corporations/LLC. Rates are based on group census information.)
Healthpass GUARDIAN DMO – (Referrals Needed) DENTAL PLAN
(Available with Oxford Sole Proprietor and Small Group Plans ONLY)
When using a GUARDIAN Managed DentalGuard Network dentist, you have a:
$0 Deductible
No Annual Maximum
No Benefit Waiting Periods
Office Visit - $5 (1 st visit includes checkup ,x-ray; 2 nd visit includes cleaning
only)
In-network fee schedule
Diagnostic/Preventive Services
Basic Restorative/Periodontal Services
Endodontic Services/Oral Surgery Services
Prosthetics Repairs
Crown and Bridges/Dentures
Major Periodontal Services
Orthodontia
*MONTHLY RATES: $17 Single / $34 Couple / $36 Single Parent / $53 Family
P ROV IDERS DIRECTORY: WWW. GU ARDI AN LIFE.COM (MAN AGED DEN TALGU ARD NETWORK)
*RATES VALID UNTIL 6/30/2013
SOLSTICE DMO DENTAL ‐(S700A):
*RATES VALID UNTIL 12/31/2013
When using a SOLSTICE DENTIST, you have a:
$0 Deductible
No Annual Maximum
No Benefit Waiting Periods
In-network fee schedule
Diagnostic/Preventive Services
Basic Restorative/Periodontal Services
Cosmetic and Orthodontia Services
Endodontic Services/Oral Surgery Services
Prosthetics Repairs
Crown and Bridges/Dentures
Major Periodontal Services
No Claim Forms to Submit
*MONTHLY RATES: $33 Single / $60 Emp + 1 / $79 Family
P ROV IDERS DIRECTORY: WWW. SOLSTICEBENEFITS>COM
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UNITED CONCORDIA – DENTAL PLAN:
*RATES VALID UNTIL 12/31/2013
When using a UNITED CONCORDIA DENTIST OR DENTIST OF YOUR CHOICE, you have:
No Waiting Period on Basic and Major Services
No Pre-Existing Condition Limitations
$1,500 Annual Maximum
In addition, when using a UNITED CONCORDIA provider, you have a:
$0 Deductible on Basic Procedures
$50/$150 Deductible on Restorative and Inlays
90% Coverage after Deductible for Basic Restorative
60% Coverage after Deductible for Inlays
Or, when using YOUR OWN DOCTOR, you have a:
100% Coverage after Deductible for Cleanings, X-rays, & Preventative
80% Coverage after Deductible for Basic Restorative
60% Coverage after Deductible for Inlays
*MONTHLY RATES: $56 Single / $117 Couple / $111 Single Parent / $149 Family
*All rates are subject to underwriting and final enrollm ent dates.
P ROV IDERS DIRECTORY: WWW.UNITEDCONCORDI A.CO M (ADV AN TAGE P LUS NETWORK)
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INSURANCE PROGRAMS
COMMERCIAL BUSINESS
SPECIALTY BUSINESS
HOMEOWNERS
AUTO
ERRORS & OMMISSIONS
HEALTH INSURANCE
MEDICARE SUPPLEMENTS
MEDICARE ADVANTAGE
LONG-TERM CARE
DISABILITY
LIFE INSURANCE
Insurance Plus 15 W. M ain Street Oyster Bay, NY 11771 516-922-1200 / 212-268-4473 516-922-2829 fax
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