Standard Plan (80/20 PPO)
The Standard Plan offers a combination of copayments (a set dollar amount) and coinsurance (a percentage of the service cost). Your out-of-pocket expenses are kept low by choosing in-network providers; however, you have the flexibility to choose out-of-network care for a higher cost.
The City pays 100% of the cost of the employee premium and subsidizes a portion of dependent care premiums.
Plan highlights include (for in-network providers):
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No deductible.
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$25 copay for primary care visits/$50 copay for specialists
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20% coinsurance for diagnostic tests (such as x-rays and blood work) and imaging (CT/PET scans, MRIs, etc.)
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20% coinsurance for outpatient surgery
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$50 copay per day for in-patient hospital stays
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If you choose out-of-network care, your cost will be 40% coinsurance for most services.
Out-of-Pocket Maximums:
These are the limits for the most you will pay during a coverage period (usually one year) for your share of the costs of covered services. If you reach this limit in a plan year, any remaining service costs will be covered 100% by the plan (not including premiums).
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$2,000 individual / $4,000 family for in-network care;
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$4,000 individual / $8,000 family for out-of-network care .
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Prescription Expenses: $1,000 individual / $3,000 for family.