Agenda - Council - 11/22/1983 - Laserfiche WebLink

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TH~ lB NOT A COMPLKTE DESCRIPTION OF BENEFITS,, THE MASTER COHTRA~r WILL GOVERN'-TH~ AD~T'[OH OF ALL CLAIM~ COMPARISON OF BENEFITS IN GROUP HEALTH, PHYSICIANS HEALTH AND MEDCENTERS HEALTH PLANS (Effective January I, 1984) GROUP HEALTH PLAN IHOSPITAL INPATIENT COVERAGE k. Room and Board %,,.jFull payment of semi- private room for I, unlimited days. h Miscellaneous hospital supplies and services I;. Intensive Care I. T.B., Nervous, Mental Health B. Same QUnlimited days. D. For mental 'health. 30 day limit per contract year; if authorized by a GHP physician, you pay 0% & GHP pays 100%. On an outpatient basis, you pay 20%, GHP pays $0%. E. Alcoholism, Chemical I Depend.ney, or drug addle tion. Independently billed radiologist and pathologist Coverage world-wide? G. Does in-hospital coverage include maternity? ~ non-acute (extended) care covered? 73 day lifetime limit. If authorized by a GHP physician, you pay 20% & GHP pays 80%. (On an outpatient basis, you pay 0% and GHP pays 100%.) Fully covered ff patient under care of GHP physician. Yes but only for medical emergencies, subject to emergency co-payment schedule: you pay 20% of first $2,000 (GHP pays 80%). GHP pays 100% of remaining expenses up to$250,000 per calendar year. H. Same I. Yes, if ordered by GHP physician. PHYSICIANS HEALTH PLAN MEDCENTERS HEALTH PLAN A. Full payment of semi- private room for unlimited days. B, Same A. Full payment of semi- private room for unlimited days. B.' ~me Unlimited days 73 day limit per ealendar year except no limit for T.B. -You pay 20%, PHP pays 80% when approved by PHP psychiatric designee. C. Unlimited days D. 60 day limit per cal- endar year except no limit for T.B. You pay 20% of medically neces- sary expenses, MCHP pays balance. 73 days per calendar year. You pay 20%, PHP pays 80% when approved by PHP psychiatric designee. Ee 75 days per calendar year. You pay 20% of medically necessary expenses; MCHP pays balance. Ge Fully covered if patient is under eare of PHP physician. Yes but only for medical emergencies, subject to emergency co-payment schedule: you pay 20% of first $2,500 (PHP pays 80%).'PHP pays I0Ctt of remaining expenses up to $125,000 per calendar year per person. H. Same; Note (b) below may apply. Ge Fully covered if patient is under care of MCHP physician. Yes but only for medleal emergencies, sdbjeet to emergency co-payment schedule-' you pay a $50 deductible and 20% of next $2,000 (MCHP pays 80~). MCHP pays I00~ of remaining expenses up to $250,000 per calendar year.: H. Same I. Yes, if ordered by PHP physician and approved by' plan in advance. 'NOTE (a): For covered non- emergency hospital and physi- cian services (inpatient and/ or outpatient treatment) pro- vided outside the PHP service area (exeluding mental health & chemical dependency), choice of medical providers is expanded to inelude non-PHP physieians and hospitals in which ease a $200 deductible per enrollee per year Keep t~is Comparisoa Cha~t for Futm. e Rarer.nee I. Yes, if ordered by MCHP physician.