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2010 Medical Plan Comparisons
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Article Content
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| Full-time Medical Comparison |
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View as a PDF
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2010 PEBB Full-time Medical Plans Comparison
This is a summary, only. Any error or omission here is unintentional and will be resolved in favor of plan documents as required in PEBB contracts, or applicable federal or state law or rule. See plan documents for details.
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PEBB Statewide
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Kaiser Permanente1
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Providence Choice2
(Portland Metro area)
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Type of Provider or System
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In Network
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Out of Network
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HMO
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In Network
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Out of Network
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Individual Out-of-pocket Maximum
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$1,000
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$2,000
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$600
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$1,000
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$2,000
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Family Out-of-pocket Maximum
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$3,000
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$6,000
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$1,200
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$3,000
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$6,000
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Individual Lifetime Maximum
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$2 million
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$2 million
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No limit
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$2 million
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$2 million
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You pay
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You pay
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You pay
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You pay
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You pay
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General Office Visit
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15%
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30%
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$5
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$5
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30%
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Specialist Office Visit
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15%
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30%
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$5
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$5
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30%
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Imaging and Labs
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15%
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30%
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$0
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$0
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30%
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Preventive Care
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Health Appraisal
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$0
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30%
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$0
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$0
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30%
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Immunizations
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$0
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$0
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$0
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$0
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$0
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Hearing Exams
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15%
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30%
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$5
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$5
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30%
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Cancer Screenings
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$0
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30%
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$0
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$0
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30%
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Hospital
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Ambulance
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15%
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15%
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$75
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$75
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$75
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Hospital Inpatient/day
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15%
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30%
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$503
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$503
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30%
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Hospital Outpatient
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15%
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30%
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$5
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$5
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30%
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Hospital Emergency Dept.
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15%
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15%
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$75
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$75
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$75
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Surgery
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Surgery Inpatient/day
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15%
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30%
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$503
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$503
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30%
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Surgery Outpatient Office
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15%
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30%
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$5
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$5
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30%
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Maternity Care
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Childbirth (prenatal, delivery, postpartum)
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15%
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30%
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$0
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$0
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30%
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Mental Health, Chemical Dependency
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Mental Health Inpatient & Residential/day
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15%
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30%
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$503
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$503
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30%
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Mental Health Outpatient
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15%
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30%
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$5
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$5
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30%
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Other Medical
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Diabetic Supplies, Insulin
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$0
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$0
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$0
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$0
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$0
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Hearing Aids ($4,000 once in 4 years)
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10%
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10%
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10%
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10%
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10%
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Durable Medical Equipment
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15%
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30%
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$0
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15%
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30%
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Chiropractic, Acupuncture, Naturopathic
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30%
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30%
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$104
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$104
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$104
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Physical Therapy
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15%
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30%
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$5
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$5
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30%
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Routine Vision Services
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VSP
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Kaiser Permanente1
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VSP
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Provider
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VSP Network
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Out of Network
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Kaiser Providers Only
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VSP Network
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Out of Network
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You pay
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You pay
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You pay
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You pay
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You pay
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Exam
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$10
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$10 + amount above $42
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$5
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$10
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$10 + amount above $42
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Lenses and frames, contacts
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Amount above $200
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Amount above $200
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Amount above $200
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Amount above $200
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Amount above $200
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Frequency
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Every 12 months
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Every 12 months
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Every 24 months or with change of 0.5 diopter
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Every 12 months
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Every 12 months
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1 Available in Kaiser service area; plan pays nothing for non-emergency services accessed outside the HMO
2 Referral required from Medical Home to receive in-plan benefits for professional services
3 $250 max per admittance
4 Coverage limit $1,000 per year
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| Part-time Medical Comparison |
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View as a PDF
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2010 PEBB Part-time & Retiree Medical Plans Comparison
This is a summary, only. Any error or omission here is unintentional and will be resolved in favor of plan documents as required in PEBB contracts, or applicable federal or state law or rule. See plan documents for details.
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Medical Plan
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PEBB Statewide
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Kaiser Permanente1
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Providence Choice2 (Portland Metro area)
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Type of Provider or System
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Network
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Out of Network
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HMO
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Medical Home
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Out of Network
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Deductible
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50% of $1,000 then 20%
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50% of $1,000 then 50%
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$0
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$0
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$0
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Individual Out-of-Pocket Maximum
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$2,000
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$4,000
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$1,500
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$2,000
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$4,000
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Family Out-of-Pocket Maximum
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$6,000
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$12,000
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$3,000
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$6,000
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$12,000
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Individual lifetime maximum
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$2 million
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$2 million
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No limit
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$2 million
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$2 million
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You pay
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You pay
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You pay
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You pay
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You pay
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General office Visit
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20%
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50%
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$30
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$30
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50%
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Specialist office Visit
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20%
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50%
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$30
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$30
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50%
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Imaging and Labs
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20%
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50%
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$10
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20%
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50%
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Preventive Care
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Health Appraisal
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$0
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50%
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$0
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$0
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50%
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Immunizations
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$0
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50%
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$0
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$0
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50%
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Hearing exams
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15%
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50%
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$30
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$30
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50%
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Cancer screenings
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$0
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50%
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$0
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$0
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50%
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Hospital
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Ambulance
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20%
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20%
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$75
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$75
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$75
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Hospital Inpatient
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20%
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50%
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$500/admit
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$500/admit
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50%
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Hospital Outpatient
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20%
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50%
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$30
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$30
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50%
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Hospital Emergency Department
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20%
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20%
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$100
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$100
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$100
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Surgery
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Surgery Inpatient
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20%
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50%
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$500/admit
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$30
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50%
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Surgery Outpatient Office
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20%
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50%
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$30
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$30
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50%
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Maternity Care
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Childbirth (prenatal, delivery, postpartum)
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20%
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50%
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$0
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$0
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50%
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Mental Health, Chemical Dependency
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Mental Health Inpatient
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20%
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50%
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$500/admit
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$500/admit
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50%
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Mental Health Residential
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20%
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50%
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$50/day3
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$500/admit
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50%
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Mental Health Outpatient
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20%
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50%
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$30
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$30
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50%
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Other Medical
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Hearing Aids ($4,000 once in 4 years)
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10%
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10%
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10%
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10%
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10%
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Diabetic Supplies, Insulin
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$0
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$0
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20%, $0
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$0
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$0
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Durable Medical Equipment
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20%
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50%
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50% (except diabetic supplies)
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50%
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50%
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Chiropractic, Acupuncture, Naturopathic
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50%
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50%
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Not Covered
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50%
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50%
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Physical Therapy
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20%
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50%
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$30
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$30
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50%
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Routine Vision Services
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Not Covered
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Not Covered
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Exam only: $30
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Not Covered
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Not Covered
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1 Available in Kaiser service area; plan pays nothing for non-emergency services accessed outside the HMO
2 Referral required from Medical Home to receive in-plan benefits for professional services
3 $250 max per admittance
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| Prescription Drug Comparison |
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View as a PDF
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2010 Full-time/Part-time & Retiree Prescription Drug Comparison
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PEBB Statewide1
(FT/PT&R)
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Kaiser Permanente
(FT/PT&R)
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Providence Choice1
(FT/PT&R)
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Month Supply
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34-day
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30-day
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30-day
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Provider
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Retail Pharmacy
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Kaiser Permanente
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Retail Pharmacy
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Generic
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$5/$10
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$1/$10
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$5/$10
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Formulary Brand
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$15/20%
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$15/$25
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$15/$25
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Non-formulary
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Greater of $50 or 50% plus cost difference between generic and non-formulary brand
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Not Covered
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Greater of $50 or 50% plus cost difference between generic and non-formulary brand
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Extended Supply
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90-day
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90-day
(maintenance drugs only)
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90-day
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Provider
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Mail-order Pharmacy or Preferred Retail Pharmacy
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Kaiser Permanente Mail-order Pharmacy
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Mail-order Pharmacy or Preferred Retail Pharmacy
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Generic
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$12.50/$25
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$1/$20
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$5/$25
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Formulary Brand
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$37.50/$62.50
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$15/$50
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$37.50/$62.50
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Non-formulary
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Greater of $125 or 50% plus cost difference between generic and non-formulary brand/$125
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Not Covered
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Greater of $125 or 50% plus cost difference between generic and non-formulary brand/ $125
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1 Plan covers "Value Drugs" on the formulary at zero co-pay
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