2018 Retiree Health Plan Comparison

There are four group plans available for eligible retired clergy members and their spouses. Medicare Parts A and B are required for the subscriber to join these plans. Below is a side by side comparison of each of the plans. 
 Benefits

 

HMO

 

PPO

 
Annual Deductible (Member/Family $1,000 Facility $2500/$5000 None None
Annual Copayment Maximum $3000/$6000$6350 $6,350/$12,700 $6700 $1500
Available Service Area Many, but not all areas of California Any State Some, but not all areas of California Some, but not all areas of California
Preventative Health Services
Annual Routine Physical Exam No Charge No Charge No Charge No Charge
Well Woman Exam No Charge No Charge No Charge  No Charge
Labs & X-rays No Charge No Charge No Charge No Charge
Physician Services
Inpatient hospital & Skilled nursing facility No Charge 20% of the allowable amount No Charge No Charge
Office Visits $20 per visit $25 $10 $15
Labs & X-rays No Charge 20% of the allowable amount No Charge No Charge
Diagnositc Tests No Charge 20% of the allowable amount No Charge No Charge
Mammogram and Pap test or other FDA-approved cervical screens No Charge 20% of the allowable amount No Charge No Charge
Hospital Services
Inpatient Services including semi-private room & board Facility deductible applies - $250/admission +25% 20% of negotiated amount No Charge No Charge
Outpatient services at an Ambulatory Surgery Center 25% 20% of allowable amount No Charge No Charge
Outpatient surgery (Hospital) $125/surgery + 25% 20% of allowable amount No Charge $15/surgery
Short Term Rehabilitation Services (Physical, Occupational, Speech or Respiratory Therapy)
Office $20/visit $25/visit $10/visit $15/visit
Hospital No Charge 20% of allowable amount No Charge No Charge
Skilled Nursing Facility No Charge 20% of allowable amount No Charge No Charge
Emergency Room
ER Services $100 per visit (waived if admitted) 20% of negotiated amount/$50 E.R. deductible applies $50 per visit (waived if admitted within 24 hours) $50 per visit (waived if admitted within 24 hours)
Emergency Ambulance Services $100 per occurrence 20% of allowable amount No Charge $50 per trip
Prescription Drugs
30-day Generic $15 $10 $10 $10
30-day Brand Name $30 $30 $20 $25
30-day Non-preferred Brand $45 $45 $35 N/A
90-day Mail Order Generic $30 $20 $20 $20
90-day Mail Order Brand Name $60 $60 $40 $50
90-day Mail Order Non-Preferred Brand $90 $90 $70 N/A
Psychiatric Care, Alcohol and Drug Abuse Services
Inpatient - 30 day max Facility Deductible, then $250/admission + 25% 20% of allowable amount No Charge No Charge
Outpatient Counseling Services $20/visit - no limit $25/visit - no limit $10/visit $15/visit
Home Health Care
Home health care agency including home visits by nurse, aide, therapist or hospice $20/visit- up to 100 visits/calendar year 20% of allowable amount- up to 100 visits/calendar year No Charge No Charge