Medical Insurance
Who is Eligible and When: Employees that work 30 hours per week or more are eligible for health insurance. Coverage begins after 30 days of continuous employment
*Rates for this plan are on page 3 *
HRA OAPIN
HRA OAP Plan $3,000
Network
New England $3,000/$9,000
Deductible (single/ family)
None
Member Coinsurance after deductible
$6,500/$13,000 (Includes all member costs)
Your Max out of pocket (single/family)
No max
Lifetime Maximum
Office Visits
Preventive Care
Covered in full (100%)
PCP Primary Care / Specialist
$25 PCP / $ 25 SPC
$50/ visit
Urgent Care Facility Emergency Room Chiropractic Care
$250 copay /visit
$25/visit * 12 visits Per CY
Diagnostic X-Rays and Lab Tests Lab Tests
Covered In Full
X-rays
Subject to deductible Subject to deductible
MRI, CAT, PET Scans
$ 25 /Visit*
Short Term Therapy (PT, OT, ST)
Limitations
*60 visits combined per CY
Subject to deductible
Inpatient Hospital Care
Outpatient Surgery
Hospital/Surgical Day Care
$100 copay per visit
Mental Health/Substance Abuse Inpatient Care
Subject to deductible
Out-Patient Care
$25/Visit
$5/$15/$35 $10/$30/$70
Prescription Drug Copays – Retail
Prescription Drug Copays- Mail In
$25/Visit
Chiropractic Care 12 Visits/CY
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