Employee Benefit Guide 2012 - City of Oklahoma City
Employee Benefit Guide 2012 - City of Oklahoma City
Employee Benefit Guide 2012 - City of Oklahoma City
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Health Plan <strong>Benefit</strong>s Comparison<br />
Common<br />
Medical Event<br />
Services You May Need<br />
Group Indemnity Health<br />
Plan Network<br />
Group Indemnity Health<br />
Plan Non-Network<br />
HMO Plan<br />
If you have a<br />
hospital stay...<br />
Facility Fee (e.g. hospital<br />
room)<br />
Physician/Surgeon Fee<br />
$50 copayment + deductible<br />
+ 10% <strong>of</strong> eligible charges<br />
Deductible + 10% <strong>of</strong> eligible<br />
charges<br />
$50 copayment + deductible<br />
+ 30% <strong>of</strong> eligible charges<br />
Deductible + 30% <strong>of</strong> eligible<br />
charges<br />
$100 copayment per<br />
admission<br />
$0<br />
Mental/Behavioral Health<br />
Outpatient Services<br />
$15 copayment + deductible<br />
+ 10% <strong>of</strong> eligible charges<br />
$15 copayment + deductible<br />
+ 30% <strong>of</strong> eligible charges<br />
$15 copayment per visit<br />
If you have mental<br />
health, behavioral<br />
health, or substance<br />
abuse needs...<br />
Mental/Behavioral Health<br />
Inpatient Services<br />
Substance Use Disorder<br />
Outpatient Services<br />
$50 copayment + deductible<br />
+ 10% <strong>of</strong> eligible charges<br />
$15 copayment + deductible<br />
+ 10% <strong>of</strong> eligible charges<br />
$50 copayment + deductible<br />
+ 30% <strong>of</strong> eligible charges<br />
$15 copayment + deductible<br />
+ 30% <strong>of</strong> eligible charges<br />
$100 copayment per<br />
admission<br />
$15 copayment per visit<br />
Substance Use Disorder<br />
Inpatient Services<br />
$50 copayment + deductible<br />
+ 10% <strong>of</strong> eligible charges<br />
$50 copayment + deductible<br />
+ 30% <strong>of</strong> eligible charges<br />
$100 copayment per<br />
admission<br />
Home Health Care<br />
Rehabilitation Services<br />
Deductible + 10% <strong>of</strong> eligible<br />
charges<br />
(Maximum <strong>of</strong> 120 days)<br />
Deductible + 10% <strong>of</strong> eligible<br />
charges<br />
Deductible + 30% <strong>of</strong> eligible<br />
charges<br />
(Maximum <strong>of</strong> 120 days)<br />
Deductible + 30% <strong>of</strong> eligible<br />
charges<br />
$0<br />
$100 copayment per<br />
admission<br />
If you have recovery<br />
or other special<br />
health needs...<br />
If your child needs<br />
dental, eye care, or<br />
hearing services...<br />
Skilled Nursing Care<br />
Durable Medical<br />
Equipment<br />
Hearing Services (Adult)<br />
Deductible + 10% <strong>of</strong> eligible<br />
charges<br />
(Limited to 120 days)<br />
Deductible + 10% <strong>of</strong> eligible<br />
charges<br />
$500 <strong>Benefit</strong> for Hearing Aid<br />
every 24 months<br />
Deductible + 30% <strong>of</strong> eligible<br />
charges<br />
(Limited to 120 days)<br />
Deductible + 30% <strong>of</strong> eligible<br />
charges<br />
$500 <strong>Benefit</strong> for Hearing Aid<br />
every 24 months<br />
$0<br />
(Limited to 100 consecutive<br />
Inpatient days per disability)<br />
$0<br />
($5,000 maximum benefit per<br />
Calendar Year)<br />
$0 copayment<br />
(Limited to one hearing aid<br />
every 3 years)<br />
Eye Exam No benefit No benefit $15 copayment<br />
(One visit per year)<br />
Glasses No benefit No benefit Preferred pricing from<br />
network provider<br />
Dental Check-up No benefit No benefit No benefit<br />
Hearing Services<br />
Deductible + 10% <strong>of</strong> eligible<br />
charges on hearing aids for<br />
children age 17 and under<br />
Deductible + 30% <strong>of</strong> eligible<br />
charges on hearing aids for<br />
children age 17 and under<br />
No copayment on hearing<br />
aids for children age 17 and<br />
under<br />
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