Cost Sharing Benefits (In Network)
Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.
Deductible (Individual) |
$7,500 |
Deductible (Family) |
$15,000 |
Coinsurance |
Not applicable |
Out of Pocket Maximum (Individual) |
$7,900 |
Out of Pocket Maximum (Family) |
$15,800 |
Doctor Visits
Primary Care Visit |
Data Not Available |
Specialist Visit |
Data Not Available |
Inpatient Facility |
50% Coinsurance after deductible |
Inpatient Physician |
50% Coinsurance after deductible |
Emergency Room Services |
Data Not Available |
Tests and Imaging
Imaging (CT/PET Scans, MRIs) |
50% Coinsurance after deductible |
Laboratory Outpatient and Professional Services |
50% Coinsurance after deductible |
X-Ray and Diagnostic Imaging |
50% Coinsurance after deductible |
Health Management Programs
Asthma |
Available |
Depression |
Available |
Diabetes |
Available |
Heart Disease |
Available |
High Blood Pressure / High Cholesterol |
Available |
Lower Back Pain |
Not available |
Pain Management |
Not available |
Pregnancy |
Available |
Weight Loss |
Not available |
Other
Mental / Behavioral Health Inpatient |
50% Coinsurance after deductible |
Mental / Behavioral Health Outpatient |
Data Not Available |
Rehabilitative Speech Therapy |
50% Coinsurance after deductible |
Rehabilitative Occupational & Physical Therapy |
50% Coinsurance after deductible |
Outpatient Facility |
50% Coinsurance after deductible |
Outpatient Surgery |
50% Coinsurance after deductible |
Prescription Drugs
Generic Rx |
Data Not Available |
Preferred Brand Rx |
Data Not Available |
Non Preferred Brand Rx |
Data Not Available |
Specialty Drugs
| |
Other Plans in Illinois
Plan
Performance Gold Maintenance - Copay $40/$90
|
Deductible
$1,500 |
Coinsurance Not applicable |
Out of Pocket
$7,900 |
Plan
Performance Gold HSA 2000
|
Deductible
$2,000 |
Coinsurance Not applicable |
Out of Pocket
$6,650 |
Plan
Performance Catastrophic
|
Deductible
$7,900 |
Coinsurance Not applicable |
Out of Pocket
$7,900 |
Plan
Performance Silver HSA 5400
|
Deductible
$5,400 |
Coinsurance Not applicable |
Out of Pocket
$5,400 |
Plan
Performance Bronze HSA 6750
|
Deductible
$6,750 |
Coinsurance Not applicable |
Out of Pocket
$6,750 |
Plan
Performance Silver 4000 - Copay $45/$90
|
Deductible
$4,000 |
Coinsurance Not applicable |
Out of Pocket
$7,900 |
Plan
Performance Gold HSA 3000
|
Deductible
$3,000 |
Coinsurance Not applicable |
Out of Pocket
$3,000 |
Plan
Performance Gold 2000 - Copay $30/$70
|
Deductible
$2,000 |
Coinsurance Not applicable |
Out of Pocket
$7,900 |
Plan
Performance Silver 7900 - Copay $80/$160
|
Deductible
$7,900 |
Coinsurance Not applicable |
Out of Pocket
$7,900 |
Plan
Performance Bronze 7900 - Copay $50/$100
|
Deductible
$7,900 |
Coinsurance Not applicable |
Out of Pocket
$7,900 |
Plan
Performance Silver 5000 - Copay $50/$100
|
Deductible
$5,000 |
Coinsurance Not applicable |
Out of Pocket
$7,900 |