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

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~ ~t NOT A COMPLIFI~ DR~-~RIPT'ION OF ~ M,A,f~'I~R CON'r'KACT COMPARISON OF BENEFITS IN GROUP HEALTH, PHYSICIANS HEALTH AND MEDCEN.TERS HEALTH PLANS (Effective January 1, 1984) GROUP HEALTH PHYSICIANS HEALTH MEDCENTERS HEALTH PLAN PLAN' · PLAN ~ non-acute (extended) ear. covered? (continued) I '~o HOSP1TAL 01rI~ATI]~ COYERAGE I. I I I. i' I I I I Diagnostic x-ray A. and laboratory. Full coverage if provided under order and care of GHP physician. Pot medi- cal emergencies outside GHP~s service area, you pay 20% of fair and . reasonable charges incurred while GHP pays 80%, Outpatient charges for exam and treatment of medical emergency within 72 hours of accident Be ~overed in full if under order and care of GHP physician. If treated in the outpatient dept. of a hospital for emer- gency care outside the service area, you pay 20% of fair and reasonable charges for emergency room, anesthetic, drugs dressing, x-ray, & lab work, GHP pays 80~. 8URGERY/MHDlCAL BEIgl~aTr8 Basis of allowances for surgery or medical benefits A. Covered in full if pro- vided by GHP physician. When emergency service is provided by non-GHP ~ physieian, out of the service area, you pay 20% of fair and reason- able charges, GHP pays 80~, is established with a 20~ enrollee copayment thereafter, up to a maximum out-of-pocket cost of $3000 per individual per calendar year. Certain pre-conditions-apply{ refer to PHP master contraet. (b): For a new memberb first year of coverage, surgical procedures related to PiLE-EXISTING CONDITIONS (diagnosed within the last 12 months) are subject to an enrollee copayment of 25% (hospital charges only) (maximum out- of-pocket expense: $?50 per confine- ment). A. Covered in fuU if hospi- talized in a PHP hospital; you pay $25 if not hospi- talized. Emergency payment applies if emergency sarviee is furnished by non- PHP provider. (#1G) A. Covered in fuU if hospitalized in a MCHP hospital; you pay $15 if not hospitalized. Emergency ac-payment applies ff service is furnished by a non-MCHP provider. (#IG) B. Covered in full if hospital- ~B.JiCovered in fuU if ized in a PHP hospital; you ~hospitalized in a MCHP pay $25 if not hospitalized, hospital~ you pay $25 Emergency ac-payment applies if not hospitalized. ff emergency service is fur- Emergency co-payment nished by non-PHP provider, applies if servide is (#lO) furnished by a non-MCHP provider (#lO)'. A. Covered in full if provided by a PHP physician. Emer- gency co-payment schedule applies if emergency ser- vice is provided by a non- PHP provider (#iG). For a new member~ first year of coverage, surgical procedures related to pre-existing conditions are subject to an enrollee co-payment of 2596 (hospital charges only) (maxi- mum out-of-pocket expense: $750 per confinement). A. Covered in full if ordered by a MCHP physician. Emergency co-payment schedule applies if emergency service is provided by non-MCHP provider. (#1G)