Advocate Benefits - Advocate Health Care

Bottom line: More tax free dollars, more
protection for you
If you take full advantage of Healthe Measures,
you can have total tax-free dollars from
Advocate—through a combination of Advocate’s
DRA contribution and Healthe Measures reward—
equal to:
$1,200—if you have single coverage
$1,800—if you have associate + child(ren)
coverage, or
$2,400—if you have associate + spouse/
domestic partner or family coverage.
That’s more tax-free dollars than ever before
to pay medical expenses that apply against
your annual deductible before you have to start
spending any money of your own. And even
with higher annual deductibles in 2011 (see PPO/
DRP annual deductibles for 2011), the amount
you would actually pay out of your own pocket
toward the annual deductible—the “deductible
gap”—will be the same amount as in 2010:
$400—if you have single coverage, or
$800—if you have any other coverage level.
HMO
The HMO coverage option—administered by
Humana—pays:
90% of the cost (through coinsurance) for
certain services—inpatient hospital, outpatient
surgery and outpatient diagnostic imaging
tests (such as MRIs, CAT scans and PET scans)
and you pay 10% of the cost of these services
100% of the cost of office visits after you pay a
copayment, and
100% of the cost of covered services once you
reach the annual out-of-pocket expense limit.
The annual out-of-pocket expense limit is:
$2,000—if you have single coverage, or
$4,000—if you have any other coverage level.
Important! This plan will pay benefits only for
services received from—or provided based
on a referral from—a Primary Care Physician.
Except in an emergency, no benefits will be
paid for services received without your PCP’s
authorization or from a provider who is not a
participant in the HMO network.
PPO/DRP annual deductibles for 2011
The PPO/DRP annual deductibles will be:
$1,600—if you choose single coverage
$2,600—if you choose associate + child(ren)
coverage, or
$3,200—if you choose associate + spouse/
domestic partner or family coverage.
If you go to… Advocate will… You will …
A non-Advocate facility Pay 80% Pay 20%
An Advocate facility Pay 80% and waive 10% Pay 10%
* Does not apply if treatment is unavailable or the hospital is
on bypass.
Don’t overlook the Advocate advantage: If you elect coverage under either PPO/DRP plan and use
Advocate facilities for health care services for yourself and your covered family members, Advocate
will waive 10% of the cost of covered services* (except emergency services) and you will be
responsible for only the remaining 10%.
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