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

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TH~ · NOT A COiII'LIFI~ DI~CRIFYION OF BENIiFfI~o ~ M ABI'RR CONTRACT WILL OOVliB~, THB ADMINISTBATION OP ALL CLA1M~ COMPARISON OF BENEFITS IN GROUP HEALTH, PHYSICIANS HEALTH AND MEDCENTERS HEALTH PLANS (Effective January 1, 1984) GROUP HEALTH PHYSICIANS HEALTH MEDCENTERS HEALTH PLAN PLAN PLAN I ~. MAJOR MEDICAL · Limits Deductible Co-Insurance (You pay) Coverage Excluded under major medical IKidney dialysis and organ transplant J Reconstructive Surgery A. There is no specific A. There is no specific A. dollar limit on hospi- dollar limit on hospi- tal/surgical benefits, tal/surgieal benefits. A major medical benefit A major medical benefit is not specifically is not specifically included with GHP. Most included with PHP. Most items included under items included under major medical coverage major medical coverage are provided in GHP's are provided in PHP's basic coverage. Certain basic coverage. Certain supplemental services supplemental services are covered as authorized are covered as outlined below when prescribed by below when prescribed a GHP physician.. (No by a PHP physician. (No limit) limit) B. None B. See NOTE after #ii B. C. For specified supple- C. For specified ~upple- C. mental services, you mental services, you pay pay 10%, GHP pays 90~. 20-25%, PHP pays 75-80~. D, Supplemental services D. Supplemental services D, are: skilled nurses, are: ambulance expenses, hospital bed, crutches, accidental dental non-motorized wheelchair, expenses, private duty belts, truses, artifieal nursing services, limbs, eyes, or other prosthetic and durable removable prosthetic medieal equipment devices, orthopedic and expenses. ineontinenee appliances, oxygen and its equipment rental. E. Dental prosthetfes, E. Dental care is E. eye glasses, hearing Hmited to accidental aids, and anything injury to natural not specified above teeth. Dental pros- are excluded, theties and replace- ment of lost prosthe- tic devices are exclu- ded. Eye glasses and hearing aids are excluded. A. You pay 10~ of fair and A. Covered, subject to A. reasonable charges not normal contract paid by Medicare for limitations. chronic kidney failure, GHP pays B. Full eoverage for all ser- B. Full coverage for all ser- B. vices related to recon- vices related to recon- struetive surgery when struetive surgery when it such service is incidental is necessary to repair or to or follows surgery restore physiological rune- resulting from injury, ill- lion due to an injury whieh There is no specific dollar limit on hospi- pital/surgieal benefits. A major medical benefit ta not specifically included with MCHP; Most items included under major medical coverage are provided in MCHP~ basic coverage. A benefit of $250,000 per year is provided for supplemental ser- vices ordered by a MCHP physician and/or emer- gency services received at non-MCHP facilities. None Nor specified supple- mental services, you pay 20%, MCHP pays 80%. Supplemental services are: ambulance expenses, accidental dental expenses, private duty nursing services, pros- thetie and durable medieal equipment expenses. Dental care is limited to accidental injury to natural teeth. Dental pros- thetics and replace- ment of lost prosthe- tic devices are excluded Eye glasses and hearing aids are excluded. Covered, subject to normal contract limita- tions, extent no cover- age where the MCHP enrollee is the donor. Full coverage for ail services related to reconstructive surgery when such service is incidental to or follow- ing surgery resulting