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Table of Contents
Executive Summary v
Introduction vii
Results i
Conclusion xxi Recommendations xxiii Works Cited xxv Glossary xxvii Index xxix
Executive Summary
Have you ever struggled with finding which healthcare plan is right for you? Traveling from one company to another trying to find a good healthcare plan can be expensive and time-consuming. This manual is designed to put the information of various Texas healthcare insurance plans into one convenient place to help you decide which one is right for you. Each plan is summarized into a table and includes links to company websites that will direct you to pages where you can attain all the information you need in making your final decision. There are personal recommendations included in order to help you with your decision further.
I spent many hours looking up the information on this manual, editing it, and creating the finished product. This manual will help anyone who reads it and save them a lot of time and money.
Introduction
This manual contains information about various healthcare insurance companies in Texas. The purpose of this information is to help people find the right healthcare plan for them and/or their family. As the creator of this manual, one day I will need to find my own healthcare plan and when that time comes I will refer back to this manual. This report mainly contains tables of information summarizing various healthcare plans from different companies and also contains recommendations for most plans. Website links have been provided so that all of the information pertaining to a plan can be reached.
Methods
To make the tables I visited each company’s website and directly typed the information that was provided into a table format. I chose table format because it was the best way to summarize the important information about each plan and it is a quicker and more categorized way for readers to browse through different plans. To write the recommendations I compared the prices of each plan and determined who would probably benefit the most from that plan.
Results
The results shown are summaries of various plans for various companies. All of the information comes from the actual company websites.
Aetna
* Aetna Open Access Managed Choice (OAMC) and PPO 2500
The following is a table summary of the plan features.
|Benefits |Member’s Responsibility |
|Annual deductible |$2,500 individual; $5,000 family |
|Coinsurance |20% after deductible up to out-of-pocket maximum |
|Out-of-pocket maximum |$5,000 individual; $10,000 family |
|Office visit co-pay |$35 non specialist; $50 specialist |
|Prescription drug deductible |$500 (does not apply to generic brand) |
|Prescription drug co-pay |$15-$35-$65 |
|Hospitalization |20% after deductible |
|Skilled nursing |20% after deductible |
|Physical/occupational therapy |20% after deductible |
|Home health care |20% after deductible |
For more information about Aetna’s health insurance plan choices visit
For a PDF summary of the Aetna TX PPO 2500 plan visit
For a PDF summary of the Aetna TX Open Access Managed Choice 2500 plan visit
Blue Cross Blue Shield
* Series V Products
The following table represents the Network benefits of the Series V Products.
|Benefit Highlight |PPO Select Blue Advantage |PPO Select Choice |PPO Select Saver |
|Participation Providers |BlueChoice or BlueCard PPO |BlueChoice or BlueCard PPO |BlueChoice or BlueCard PPO |
|Individual Deductible |
|$250 |( |( | |
|$500 |( |( |( |
|$1,000 |( |( |( |
|$1,500 |( |( |( |
|$2,500 |( |( |( |
|$3,500 |( |( |( |
|$5,000 |( |( |( |
|$10,000 |( |( |( |
|Individual Out-of-Pocket Expense |Deductible plus $3,000 |Deductible plus $3,000 |Deductible plus $3,000 |
|Limit | | | |
|Preventive Care |100% of Allowable Amount (no |100% of Allowable Amount (no |100% of Allowable Amount (no |
| |Deductible) |Deductible) |Deductible) |
|Office Visit Co-pay |$25 (Includes Lab Work) |$25 |Deductible and Coinsurance |
|Childhood Immunizations |100% of allowable amount to 8 |100% of allowable amount to 8 |100% of allowable amount to 8 |
| |years of age |years of age |years of age |
|Coinsurance |Plan pays 85% of allowable amount|Plan pays 80% of allowable amount|Plan pays 75% of allowable amount|
| |of member pays 15% after |and member pays 20% after |and member pays 25% after |
| |deductible |deductible |deductible |
|Optional Dental Coverage |$50 |$50 |$50 |
|Deductible | | | |
|Prescription Drugs |Co-pay - $10 generic, $30 |Co-pay - $10 generic, $30 |Co-pay - $10 generic, $40 |
| |preferred, $45 non-preferred |preferred, $45 non- preferred |preferred, $55 non-preferred |
|Prescription Drug Deductible |None |$200 |$200 |
For an outline of the PPO Select Blue Advantage plan visit
For an outline of the PPO Select Choice plan visit
For an outline of the PPO Select Saver plan visit
* BlueEdge Individual HSA Plan
The following table represents the Network benefits of the BlueEdge Individual HSA Plan.
|Benefit Highlight |BlueEdge Individual HSA (75/60) |BlueEdge Individual HSA (90/70) |Blue Edge Individual HSA |
| | | |(100/100) |
|Participating Provider |BlueChoice or BlueCard |BlueChoice or BlueCard |BlueChoice or BlueCard |
|Individual Deductible | | | |
|$1,200 |( |( | |
|$1,750 |( |( | |
|$2,500 |( |( | |
|$3,500 | | |( |
|$5,000 | | |( |
|Individual Out of Pocket Expense |$3,000 |$3,000 |Equal to deductible amount |
|Limit | | |selected |
|Preventive Care |100% of Allowable Amount (no |100% of Allowable Amount (no |100% of Allowable Amount (no |
| |Deductible) |Deductible) |Deductible) |
|Childhood Immunizations |100% to six years of age |100% to six years of age |100% to six years of age |
|Coinsurance |Plan pays 75% of allowable amount|Plan pays 90% of allowable amount|Plan pays 100% of allowable |
| |and member pays 25% |and member pays 10% |amount and member pays 0% |
|Optional Dental Coverage |$50 |$50 |$50 |
|Deductible | | | |
|Prescription Drugs |Medical deductible plus co-pay: |Medical deductible plus co-pay: |100% after medical deductible |
| |$10 generic, $50 preferred, $65 |$10 generic, $50 preferred, $65 | |
| |non- preferred |non-preferred | |
For an outline of the BlueEdge Individual HSA plan visit
* SelecTEMP PPO (Short-term Health Insurance)
The following table represents the benefit highlights of SelecTEMP PPO plan.
|Benefit Highlight |SelecTEMP PPO |
|Participating Providers |BlueChoice |
|Individual Deductible | |
|$500 |( |
|$1,000 |( |
|$1,500 |( |
|$2,000 |( |
|$2,500 |( |
|Individual Out-of-Pocket Expense Limit |Deductible plus $1,000 |
|Preventive Care |Not Covered |
|Childhood Immunizations |100% of allowable amount to 8 years of age |
|Coinsurance |We pay 80% of allowable amount and you pay 20% after deductible |
|Optional Dental Coverage Deductible |Dental coverage not available |
|Prescription Drugs |Co-pay: $10 generic, $40 preferred, $55 non-preferred; $750 |
| |calendar year max |
|Prescription Drug Deductible |$200 |
For an outline of the SelecTEMP PPO plan visit
Cigna
* Health Savings Plan
The following table represents a summary of the individual and family plans
|Individual and Family |Health Savings 3000 |Health Savings 5000 |
|Plan Features- Coinsurance percentage shown |In-Network |Out-Of-Network |In-Network |Out-Of-Network |
|in and out-of-network is the percentage | | | | |
|CIGNA pays. Combined annual medical/pharmacy| | | | |
|deductible applies unless otherwise noted. | | | | |
|Annual Individual Deductible- Individual |$3,000 |$6,000 |$5,000 |$10,000 |
|deductible is applicable when only one | | | | |
|person is enrolled in the plan, and is | | | | |
|satisfied when that individual meets the | | | | |
|annual individual deductible amount. | | | | |
|Annual Family Deductible- Family deductible |$6,000 |$12,000 |$10,000 |$20,000 |
|is applicable when there are two or more | | | | |
|family members enrolled in the plan, and is | | | | |
|satisfied when one, or any combination of | | | | |
|enrolled family members, meet the annual | | | | |
|family deductible amount (For a family of | | | | |
|two or more, the annual individual | | | | |
|deductible is not applicable). | | | | |
|Annual Out-of-Pocket Maximum- |$3,000/$6,000 |$9,000/$18,000 |$5,000/$10,000 |$15,000/$30,000 |
|Individual/Family deductible and pharmacy | | | | |
|charges apply to the out-of-pocket maximum. | | | | |
|Lifetime Maximum Benefit |Unlimited |Unlimited |Unlimited |Unlimited |
|Physician Services- Primary Case Physician |CIGNA pays 100% |CIGNA pays 60% |CIGNA pays 100% |CIGNA pays 60% |
|and Specialist Office Visits | | | | |
|Preventive Care for All Ages- Routine |CIGNA pays 100% |CIGNA pays 70% |CIGNA pays 100% |CIGNA pays 70% |
|physicals and other routine preventive | | | | |
|services. | | | | |
|Immunizations for All Ages |CIGNA pays 100% |CIGNA pays 100% |CIGNA pays 100% |CIGNA pays 100% |
|Ambulance |CIGNA pays 100% |CIGNA pays the same |CIGNA pays 100% |CIGNA pays the same |
| | |level as In-Network | |level as In-Network if|
| | |if “true” emergency | |“true” emergency as |
| | |as defined in your | |defined in your plan, |
| | |plan, otherwise CIGNA| |otherwise CIGNA pays |
| | |pays 60% | |60% |
|Emergency Room |CIGNA pays 100% |CIGNA pays the same |CIGNA pays 100% |CIGNA pays the same |
| | |level as In-Network | |level as In -Network |
| | |if “true” emergency | |if “true” emergency as|
| | |as defined in your | |defined in your plan, |
| | |plan, otherwise CIGNA| |otherwise CIGNA pays |
| | |pays 60% | |60% |
|Urgent Care Services |CIGNA pays 100% |CIGNA pays the same |CIGNA pays 100% |CIGNA pays the same |
| | |level as In-Network | |level as In-Network if|
| | |if “true” emergency | |“true” emergency as |
| | |as defined in your | |defined in your plan, |
| | |plan, otherwise CIGNA| |otherwise CIGNA pays |
| | |pays 60% | |60% |
|Impatient Hospital Services- Faculty |CIGNA pays 100% |CIGNA pays 60% |CIGNA pays 100% |CIGNA pays 60% |
|changes, physician services, and all | | | | |
|in-hospital care | | | | |
|Surgery in an Outpatient Hospital or |CIGNA pays 100% |CIGNA pays 60% |CIGNA pays 100% |CIGNA pays 60% |
|Ambulatory Surgical Center | | | | |
|Lab, X-Ray, Ultrasound, CT/PET Scan, and MRI|CIGNA pays 100% |CIGNA pays 60% |CIGNA pays 100% |CIGNA pays 60% |
|Short-Term Rehabilitative Therapy (Including|CIGNA pays 100% |CIGNA pays 60% |CIGNA pays 100% |CIGNA pays 60% |
|Physical and Occupational Therapy)- Calendar| | | | |
|year maximum of 24 visits, combined in- and | | | | |
|out-of-network | | | | |
|Durable Medical Equipment |CIGNA pays 100% |CIGNA pays 60% |CIGNA pays 100% |CIGNA pays 60% |
|Mental Health Impatient- Calendar year |CIGNA pays 100% |CIGNA pays 60% |CIGNA pays 100% |CIGNA pays 60% |
|maximum of 20 days, combined in- and | | | | |
|out-of-network | | | | |
|Mental Health Outpatient- Calendar year |CIGNA pays 100% |CIGNA pays 60% |CIGNA pays 100% |CIGNA pays 60% |
|maximum of 24 visits, combined in- and | | | | |
|out-of-network | | | | |
|Retail Pharmacy (per 30 day supply) | | | | |
|Prescription Drug Deductible (Combined |Subject to combined |Subject to combined |Subject to combined |Subject to combined |
|retail and home delivery) |medical and pharmacy |medical and pharmacy |medical and pharmacy |medical and pharmacy |
| |deductible |deductible |deductible |deductible |
|Generic/Brand Name/Non-Preferred Brand Name |CIGNA pays 100% |CIGNA pays 50% |CIGNA pays 100% |CIGNA pays 50% |
|Self-Administered Injectable Drugs |CIGNA pays 100% |CIGNA pays 50% |CIGNA pays 100% |CIGNA pays 50% |
|Home Delivery Pharmacy (per 90 day supply) | | | | |
|Generic/Brand Name/Non-Preferred Brand Name |CIGNA pays 100% |Not available |CIGNA pays 100% |Not available |
|Self-Administered Injectable Drugs |CIGNA pays 100% |Not available |CIGNA pays 100% |Not available |
For more information about the Health Savings plans visit
Humana
* Co-pay Plans
Enhanced Co-pay 80% Plan
Co-pays for doctor’s office visits, plus treatment coverage
- Annual medical deductible options (per covered member): $1,000 | $1,500 | $2,000 | $2,500 | $3,500 | $5,000
- For family coverage, once three family members meet their individual deductibles, the family deductible will be met for all other family members.
- Diagnostic illness/injury in-network doctor’s office visits, and urgent care visits for a co-pay per visit.
- Preventive care services covered at 100%, when you use an in-network provider.
- In-network inpatient and outpatient hospital services are paid 80% after deductible for most covered medical expenses.
- Includes prescription coverage.
The following tables represent a summary of the Enhanced Co-pay 80% plan.
|In-Network |Out-of-Network |
|Individual |Family |Individual |Family |
|$1,000 |$3,000 |$2,000 |$6,000 |
|$1,500 |$4,500 |$3,000 |$9,000 |
|$2,000 |$6,000 |$4,000 |$12,000 |
|$2,500 |$7,500 |$5,000 |$15,000 |
|$3,500 |$10,500 |$7,000 |$21,000 |
|Coinsurance- The percentage of covered healthcare costs you have |You pay 20% of covered expenses |You pay 40% of covered expenses |
|to pay while covered under this plan. |after you pay your deductible. |after you pay your deductible. |
|Your out-of-pocket coinsurance maximum- The amount you’re required|Individual: $2,500 |Individual: $10,000 |
|to pay toward the covered cost of your healthcare; premium, |Family: $5,000 |Family: $20,000 |
|deductibles, access fees and co-pays don’t apply | | |
|Lifetime maximum- The total amount your plan will pay for covered |Unlimited |Unlimited |
|expenses in your lifetime. | | |
Co-pay 80% Plan
Co-pays for up to six doctor’s office visits, plus treatment coverage
- Annual medical deductible options (per covered member): $3,500 | $5,000
- For family coverage, once three family members meet their individual deductibles, the family deductible will be met for all other family members.
- Up to six diagnostic illness/injury in-network doctor’s office visits, and urgent care visit for a co-pay per visit.
- Preventive care services covered at 100%, when you use an in-network provider.
- In-network inpatient and outpatient hospital services are paid at 80% after deductible for most covered medical expenses.
- Includes prescription coverage.
The following tables represent a summary of the Co-pay 80% plan.
|In- Network |Out-of-Network |
|Individual |Family |Individual |Family |
|$3,500 |$10,500 |$7,000 |$21,000 |
|Coinsurance- The percentage of covered healthcare costs you have |You pay 20% of covered expenses |You pay 40% of covered expenses |
|to pay while covered under this plan. |after you pay your deductible. |after you pay your deductible. |
|Your out-of-pocket coinsurance maximum- The amount you’re required|Individual: $3,500 |Individual: $12,000 |
|to pay toward the covered cost of your healthcare; premium, |Family: $7,000 |Family: $24,000 |
|deductibles, access fees and co-pays don’t apply. | | |
|Lifetime maximum- The total amount your plan will pay for covered |Unlimited |Unlimited |
|expenses in your lifetime. | | |
Co-pay 70% Plan
Co-pays for up to three doctor’s office visits, plus treatment coverage
- Annual medical deductible (per covered member): $1,500 | $2, 500 | $5,000 | $7,500
- For family coverage, once three family members meet their individual deductibles, the family deductible will be met for all other family members.
- Up to three diagnostic illness/injury in-network doctor’s office visits, and urgent care visit for a co-pay per visit.
- Preventive care services covered at 100%, when you use an in-network provider.
- In-network inpatient and outpatient hospital services are paid at 70% after deductible for most covered medical expenses.
- Includes prescription coverage.
The following table represents a summary of the Co-pay 70% Plan.
|In-Network |Out-of-Network |
|Individual |Family |Individual |Family |
|$1,500 |$4,500 |$3,000 |$9,000 |
|$2,500 |$7,500 |$5,000 |$15,000 |
|$5,000 |$15,000 |$10,000 |$30,000 |
|Coinsurance- The percentage of covered |You pay 30% of covered expenses after you |You pay 50% of covered expenses after you |
|healthcare costs you have to pay while |pay your deductible. |pay your deductible. |
|covered under this plan. | | |
|Your out-of-pocket coinsurance maximum- The |Individual: $5,000 |Individual: $20,000 |
|amount you’re required to pay toward the |Family: $10,000 |Family: $40,000 |
|covered cost of your healthcare; premium, | | |
|deductibles, access fees and co-pays don’t | | |
|apply. | | |
|Lifetime maximum- The total amount your plan|Unlimited |Unlimited |
|will pay for covered expenses in your | | |
|lifetime. | | |
For more information about any of the previously stated Co-pay plans visit
* 100% After Deductible Plans
Value 100% Plan
Lower-cost, high-deductible plan with treatment coverage
- Annual medical deductible options (per covered member): $5,000 | $7,500 | $10,000
- For family coverage, once three family members meet their individual deductibles, the family deductible will be met for all other family members.
- Diagnostic illness/injury doctor’s office visits, inpatient hospital, and outpatient hospital services are paid at 100% after deductible for most covered medical expenses, when you use an in-network provider.
- Preventive care services covered at 100%, when you use an in-network provider
- Includes prescription coverage.
The following tables represent a summary of the Value 100% plan.
|In-Network |Out-of-Network |
|Individual |Family |Individual |Family |
|$5,000 |$15,000 |$10,000 |$30,000 |
|$7,500 |$22,500 |$15,000 |$45,000 |
|$10,000 |$30,000 |$20,000 |$60,000 |
|Coinsurance- The percentage of covered healthcare costs you have |Plan pays 100% of covered |You pay 25% of covered expenses |
|to pay while covered under this plan. |expenses after you pay your |after you pay your deductible. |
| |deductible. | |
|Your out-of-pocket coinsurance maximum- The amount you’re required|Individual: $0 |Individual: $5,000 |
|to pay toward the covered cost of your healthcare; premium, |Family: $0 |Family: $10,000 |
|deductibles, access fees and co-pays don’t apply. | | |
|Lifetime maximum- The total amount your plan will pay for covered |Unlimited |Unlimited |
|expenses in your lifetime. | | |
Enhanced HSA 100% Plan
HSA-qualified plan treatment coverage
- Individual coverage annual deductible options (combined medical/prescription): $1,500 | $2,500 | $3,500 | $5,000
- Family coverage annual deductible options (combined medical/prescription): $3,000 | $5,000 | $7,000 | $10,000 | $11,900
- For family coverage, all covered members’ covered expenses apply to the family deductible; for example, if the expenses for one member are enough to meet the family deductible, the rest of the family doesn’t need to meet an individual deductible.
- In-network illness/injury doctor’s office visits, inpatient hospital, and outpatient hospital services are paid at 100% after deductible for most covered medical expenses.
- Includes prescription coverage.
The following table represents a summary of the Enhanced HSA 100% Plan
|In-Network |Out-of-Network |
|Individual |Family |Individual |Family |
|$1,500 |$3,000 |$3,000 |$6,000 |
|$2,500 |$5,000 |$5,000 |$10,000 |
|$3,500 |$7,000 |$7,000 |$14,000 |
|$3,500 |$7,000 |$7,000 |$14,000 |
|$5,000 |$10,000 |$10,000 |$20,000 |
|$5,950 |$11,900 |$11,900 |$23,800 |
|Coinsurance- The percentage of covered healthcare costs you have |Plan pays 100% of covered |You pay 30% of covered expenses |
|to pay while covered under this plan. |expenses after you pay your |after you pay your deductible. |
| |deductible. | |
|Your out-of-pocket coinsurance maximum- The amount you’re required|Individual: $0 |Individual: $7,500 |
|to pay toward the covered cost of your healthcare; premium, |Family: $0 |Family: $15,000 |
|deductibles, access fees and co-pays don’t apply. | | |
|Lifetime maximum- The total amount your plan will pay for covered |Unlimited |Unlimited |
|expenses in your lifetime. | | |
HSA 100% Plans
HSA-qualified plan
- Individual coverage annual medical deductible options: $1,500 | $2,500 | $3,500 | $5,000 | $5, 950
- Family coverage annual medical deductible options: $3,000 | $5,000 |$7,000 | $10,000 | $11,900
- For family coverage, all covered members’ covered expenses apply to the family deductible; for example, if the expenses for one member are enough to meet the family deductible, the rest of the family doesn’t need to meet an individual deductible.
- Diagnostic illness/injury doctor’s office visits, inpatient hospital, and outpatient hospital services are paid at 100% after deductible for most covered medical expenses, when you use an in-network provider.
- Preventive care services covered at 100%, when you use an in-network provider.
- Does not include prescription coverage.
The following tables represent a summary of the HSA 100% plan
|In-Network |Out-of-Network |
|Individual |Family |Individual |Family |
|$1,500 |$3,000 |$3,000 |$6,000 |
|$2,500 |$5,000 |$5,000 |$10,000 |
|$3,500 |$7,000 |$7,000 |$14,000 |
|$,5000 |$10,000 |$10,000 |$20,000 |
|$5,950 |$11,900 |$11,900 |$23,800 |
|Coinsurance- The percentage of covered healthcare costs you have |Plan pays 100% of covered |You pay 30% of covered expenses |
|to pay while covered under this plan. |expenses after you pay your |after you pay your deductible. |
| |deductible. | |
|Your out-of-pocket coinsurance maximum- The amount you’re required|Individual: $0 |Individual: $7,500 |
|to pay toward the covered cost of your healthcare; premium, |Family: $0 |Family: $15,000 |
|deductibles, access fees and co-pays don’t apply. | | |
|Lifetime maximum- The total amount your plan will pay for covered |Unlimited |Unlimited |
|expenses in your lifetime. | | |
For more information about any of the previously stated 100% After Deductible plans visit
* Short Term Medical Plans
Short Term 100/75
100% coverage after the deductible, plus treatment coverage
Note: For this plan, you’ll have an option to make monthly payments or a one-time payment of your full premium amount. Coverage is available for up to six or twelve months depending on your state. Coverage isn’t renewable. This plan doesn’t cover pre-existing conditions or complication from pre-existing conditions.
- Annual medical deductible options (per covered member): $1,000 | $2,500 | $5,000
- For family coverage, once two family members meet their individual deductibles, the family deductible will be met for all other family members.
- In-network illness/injury doctor’s office visits, inpatient hospital, and outpatient hospital services are paid at 100% after deductible for most covered medical expenses.
- Includes prescription coverage.
- This plan has a lifetime maximum benefit of $2 million per covered person.
The following table represents a summary of the Short Term 100/75 plan.
|This plan is available for a minimum of 30 days and a maximum of |Plan pays for services from |Plan pays for services from |
|twelve months Pre-existing conditions or complications from |Network providers. |Non-Network providers. |
|pre-existing conditions are not covered under this plan. | | |
|Deductible options |- Individual |- $1,000, $2,500, or $5,000 |- $2,000, $5,000, or $10,000 |
|-Per benefit period |- Family (two family members must|- $2,000, $5,000, or $10,000 |- $4,000, $10,000, or $20,000 |
| |each meet their individual | | |
| |deductible) | | |
|Coinsurance out-of-pocket limit |- Individual |- Not applicable |- $5,000 |
|- Per benefit period |- Family |- Not applicable |- $10,000 |
|- Deductibles do not apply | | | |
|Preventive care |- Child immunizations (birth to |- 100% |- 100% |
| |age 6) | | |
| | | | |
| |- Child hearing screening & | | |
| |follow-up care (birth through 24 |- 100% |- 70% |
| |months) | | |
| | | | |
| |- Colorectal screening (age 50 | | |
| |and older) | | |
| | | | |
| |- Pap smear and HPV screening |- 100% after deductible |- 70% after deductible |
| |(age 18 and older) | | |
| | | | |
| |- Mammogram (age 35 and older) | | |
| | | | |
| |- Prostate screening (age 40 and | | |
| |older) | | |
| | | | |
| |- Preventive office visits | | |
| | | | |
| |- Child immunizations (age 6 to | | |
| |18) | | |
| | | | |
| |- Preventive lab and X-ray |- Not covered |-Not covered |
|Physician services |- Office visits (including |- 100% after deductible |- 75% after deductible |
| |allergy injections) | | |
| | | | |
| |- Diagnostic lab and X-ray | | |
| | | | |
| |- Allergy testing | | |
| | | | |
| |- Allergy serum | | |
| | | | |
| |- Inpatient and outpatient | | |
| |services | | |
| | | | |
| |- Surgery | | |
|Facility services |- Inpatient and outpatient |- 100% after deductible |- 75% after deductible |
| |services | | |
| |- Outpatient surgery | | |
| |- Emergency services | | |
|Prescription drug |- Deductible per individual |- Integrated with medical |- Integrated with medical |
|- Mail order not available |- Benefit per prescription or |-100% after deductible |- 75% after deductible |
| |refill | | |
|Other medical services |- Skilled nursing facility (up to|- 100% after deductible |- 75% after deductible |
|- Prior authorization required in|30 days per benefit period) | | |
|order to be eligible for these | | | |
|benefits |- Home health care (up to 40 | | |
| |visits per benefit period) | | |
| | | | |
| |- Durable medical equipment | | |
| | | | |
| |- Pregnancy complications and | | |
| |sick baby services (no prior | | |
| |authorizations required) | | |
| | |- Not covered |- Not covered |
| |- Hospice | | |
| | | | |
| |- Transplant services | | |
| | | | |
| | | | |
| | |- 100% after deductible when |- 75% after deductible covered |
| | |services are received from a |expenses are limited to a maximum|
| | |Humana Transplant Network |allowance of $35,000 per |
| | |provider |transplant. |
|Lifetime maximum benefit | |$2,000,000 per covered person |$2,000,000 per covered person |
|Mental health, chemical, and |- Inpatient services |- Not covered |- Not covered |
|alcohol dependency |- Outpatient and office therapy | | |
|- Other than demonstrable organic|sessions | | |
|disease | | | |
|Mental Health |- Inpatient services |- 100% after deductible |75% after deductible |
|- With demonstrable organic |- Outpatient and office therapy | | |
|disease |sessions | | |
Short Term 80/60
80% coverage after the deductible, plus treatment coverage.
Note: For this plan, you’ll have an option to make monthly payments or a one-time payment of your full premium amount. Coverage is available for up to six or twelve months depending on your state. Coverage is not renewable. This plan doesn’t cover pre-existing conditions or complications from pre-existing conditions.
- Annual medical deductible options (per covered member): $1,000 | $2,500 | $5,000
- For family coverage, once two family members meet their individual deductibles, the family deductible will be met for all other family members.
- In-network illness/injury doctor’s office visits, inpatient hospital, and outpatient hospital services are paid at 80% after deductible for most covered medical expenses.
- Includes prescription coverage.
- This plan has a lifetime maximum benefit of $2 million per covered person.
The following table represents a summary of the Short Term 80/60 plan.
|This plan is available for a minimum of 30 |Plan pays for services from Network |Plan pays for services from Non-Network |
|days and a maximum of twelve months. |providers. |providers. |
|Pre-existing conditions or complications | | |
|from pre-existing conditions are not covered| | |
|under this plan. | | |
|Deductible options |-Individual |- $500, $1,000, $2,500, or $5,000|- $1,000, $2,000, $5,000 or |
|- Per benefit period | |- $1,000, $2,000, $5,000 or |$10,000 |
| |-Family (two family members must |$10,000 |- $2,000, $4,000, $10,000 or |
| |each meet their individual | |$20,000 |
| |deductible) | | |
|Coinsurance out-of-pocket limit |- Individual |- $2,000 |$8,000 |
|- Per benefit period | | | |
|- Deductibles do not apply |- Family |- $4,000 |$16,000 |
|Preventive Care |- Child immunizations (birth to |- 100% |- 100% |
| |age six) | | |
| | | | |
| |- Child hearing screening and | | |
| |follow-up care (birth through 24 |- 80% |- 50% |
| |months) | | |
| | | | |
| |- Colorectal screening (age 50 | | |
| |and older) | | |
| | | | |
| |-Pap smear and HPV screening (age|- 80% after deductible |- 50% after deductible |
| |18 and older) | | |
| | | | |
| |- Mammogram (age 35 and older) | | |
| | | | |
| |- Prostate screening (age 40 and | | |
| |older) | | |
| | | | |
| |- Preventive office visits | | |
| | | | |
| |- Child immunizations (age 6 to | | |
| |18) | | |
| | | | |
| |- Preventive lab and X-ray |- Not covered |- Not covered |
|Physician services |- Office visits (including |- 80% after deductible |- 60% after deductible |
| |allergy injections) | | |
| | | | |
| |- Diagnostic lab and X-ray | | |
| | | | |
| |- Allergy testing | | |
| | | | |
| |- Allergy serum | | |
| | | | |
| |- Inpatient and outpatient | | |
| |services | | |
| | | | |
| |- Surgery | | |
|Facility services |- Inpatient and outpatient |- 80% after deductible |- 60% after deductible |
| |services | | |
| | | | |
| |- Outpatient surgery | | |
| | | | |
| |- Emergency services | | |
|Prescription drug |- Deductible per individual |- Integrated with medical |- Integrated with medical |
|(Mail order not available) | | | |
| |- Benefit per prescription or |- 80% after deductible |- 60% after deductible |
| |refill | | |
|Other medical services |- Skilled nursing facility (up to|- 80% after deductible |- 60% after deductible |
|- Prior authorization required in|30 days per benefit period) | | |
|order to be eligible for these | | | |
|benefits. |- Home health care (up to 40 | | |
| |visits per benefit period) | | |
| | | | |
| |- Durable medical equipment | | |
| | | | |
| |- Pregnancy complications and | | |
| |sick baby services | | |
| | | | |
| |- Hospice | | |
| | | | |
| |-Transplant services | | |
| | | | |
| | |- Not covered |- Not covered |
| | | | |
| | |- 80% after deductible when |- 60% after deductible covered |
| | |services are received from a |expenses are limited to a maximum|
| | |Humana Transplant Network |allowance of $35,000 per |
| | |provider. |transplant |
|Lifetime maximum benefit | |$2,000,000 per covered person |$2,000,000 per covered person |
|Mental health, chemical, and |- Inpatient services |- Not covered |- Not covered |
|alcohol dependency | | | |
|- Other than demonstrable organic|-Outpatient and office therapy | | |
|disease |sessions | | |
| | | | |
| | | | |
|Mental Health |- Inpatient services |- 80% after deductible |- 60% after deductible |
|-With demonstrable organic | | | |
|disease |- Outpatient and office therapy | | |
| |sessions | | |
For more information about any of the previously stated Short Term Medical plans visit
Conclusion
In conclusion, each plan varies in price and benefits and when determining which one is right for you it depends on your budget and needs. For example, CIGNA has the most expensive plan option but has the best benefits for In-Network service. CIGNA pays 100% of all the healthcare services it covers for In-Network and pays 60-70% for Out-of-Network services. The information has been provided but it is up to you to decide which plan will benefit you the most while staying in your budget range.
Recommendations
Aetna has several plans to offer on their website but generally the deductible ranges from $5,000 to $10,000 with the customer paying around 20% after the deductible for healthcare services. I recommend looking at other companies first before choosing Aetna because there are other companies like Blue Cross Blue Shield or Humana that may be a better option.
Blue Cross Blue Shield generally has individual plans that are a reasonable price for good benefits. If you are searching for individual healthcare insurance then I recommend looking at Blue Cross Blue Shield first and then comparing with other companies.
CIGNA has both individual and family plans. The deductibles are expensive but CIGNA pays 100% for all of the In-Network services it covers in each plan. Also, CIGNA covers 60-70% for Out-of-Network services in each plan. I recommend looking at CIGNA plans for people who can afford it and have a frequent need for medical services and products.
Humana offers both individual and family plans. Humana presents their information in a different manner than the other companies so I recommend visiting their website first and looking at their plans in depth before considering them. It appears that the deductibles range in expense but don’t get too expensive. Humana does offer the most plans for various circumstances including short-term medical insurance. Humana does have a lot to offer so I recommend going the Humana plans that fit your life situation and then compare the prices.
Works Cited
"Health Insurance Glossary." Health Insurance Glossary. , 2011. Web. 28 Nov. 2012. .
"You and AetnaAetna Provides You with Online Tools and Information to Help You Make Confident Health Care Decisions." Aetna. N.p., n.d. Web. 30 Nov. 2012. .
"Blue Cross Blue Shield of Texas - Health Insurance Texas - BCBSTX." Blue Cross Blue Shield of Texas - Health Insurance Texas - BCBSTX. N.p., n.d. Web. 30 Nov. 2012. .
"Need Individual Health Insurance?" Cigna, a Global Health Insurance and Health Service Company. N.p., n.d. Web. 30 Nov. 2012. .
"The Medicare Annual Enrollment Period Is Ending Soon!" HUMANA. N.p., n.d. Web. 30 Nov. 2012. .
assets.creative/qw/v4/images/top_banner_health_01.jpg
Digital image. N.p., n.d. Web. .
Glossary
Coinsurance: Refers to money that an individual is required to pay for services, after a deductible has been paid. Coinsurance is often specified by a percentage. For example, the employee pays 20 percent toward the charges for a service and the employer or insurance company pays 80 percent.
Deductible: The amount an individual must pay for health care expenses before insurance (or a self-insured company) covers the costs.
Family Health Insurance: Coverage through an employer or other entity that covers all individuals in the family.
In-Network: Refers to providers or health care facilities that are part of a health plan’s network of providers with which it has negotiated a discount. Insured individuals usually pay less when using an in-network provider because those networks provide services at lower cost to the insurance companies with which they have contracts.
Individual Health Insurance: Health insurance coverage on an individual, not group, basis. The premium is usually higher for an individual health insurance plan than for a group policy, but you may not qualify for a group plan.
Out-of-Network: Usually refers to physicians, hospitals, or other health care providers who are considered no participants in an insurance plan (usually an HMO or PPO). Depending on an individual’s health insurance plan, expenses incurred by services provided by out-of-network health professionals may not be covered, or covered only in part by an individual’s insurance company.
Out-of-Pocket Maximum: A predetermined limited amount of money that an individual must pay out of their own savings, before an insurance company or (self-insured employer) will pay 100 percent for an individual’s health care expenses.
Short-Term Health Insurance: Short-term major medical health insurance policies were designed to provide coverage for individuals who need temporary health insurance coverage for a short period of time, usually from 30 days to six months. The policies - offered by private health insurance companies - are intended to provide a safety net in the event of a health crisis that might otherwise cause a serious financial hardship.
Index
Aetna, i, xxiii
Annual deductible, i
Blue Cross Blue Shield, ii, xxiii
Childhood Immunizations, ii, iv
Cigna, v
Coinsurance, i, ii, iii, iv, v, ix, x, xi, xii, xiii, xiv, xv, xvii, xxvii
healthcare plan, v, vii
Home health care, i, xvi, xix
Hospitalization, i
Humana, viii, xvi, xix, xxiii
Individual Deductible, ii, iii, iv, v
Individual Out of Pocket Expense Limit, iii
Individual Out-of-Pocket Expense Limit, ii, iv
Office visit co-pay, i
Office Visit Co-pay, ii
Out-of-pocket maximum, i
Physical/occupational therapy, i
Prescription drug co-pay, i
Prescription drug deductible, i
Prescription Drug Deductible, iii, v, vii
Prescription Drugs, iii, iv
Preventive Care, ii, iv, vi, xviii
Recommendations, xxiii
Skilled nursing, i, xvi, xix
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