This table compares family coverage for full-time employees (out-of-network charges were not included)
| |
Yale Health Plan |
Yale Aetna Network |
YNHH Advantage Plus |
YNHH Advantage |
Annual Medical
Premiums |
$0 |
$1,376 |
(Based on date of hire)
Before 1/1/00: $1,227
1/1/00-12/31/02: $1,783
1/1/03-12/31/05: $2,289
1/1/06- Present: $2,415 (Part-timers pay more) |
(Based on date of hire)
Before 1/1/00: $421
1/1/00-12/31/02: $979
1/1/03-12/31/05: $1,368
1/1/06- Present: $1,430 (Part-timers pay more) |
Annual Medical Care
Deductible |
None |
None |
None |
$400 decutible (limited to certain procedures, see below) |
Out-of-pocket
maximum (after deductible) |
None |
None |
None |
$5,000 |
Out-of-pocket
expenses |
|
|
|
|
| Prescription Drugs |
$600 family
deducitble; 20%
coinsurance up to
$700 out-of-pocket
maximum per
individual;
$25,000 maximum |
$10 copay for generics;
$15 copay for brand-name |
10% coinsurance for generics ($8 min/$23 max);
20% coinsurance for brand-name ($20 min/$45 max) |
Generics: 10% coinsurance ($8 min/$23 max);
Brand-name: 20% coinsurance ($20 min/$45 max) |
| Dental |
Anthem Dental Assistance Plan: $394 annual premium
($788 for employees
w/ less than 18 months
of service); no annual deductible; covers 100% of preventitive, 80% of restorative, and 50% of major services.
Cigna Dental Care Plan: $231 annual premium ($461 for employees w/ less than 18 months of service); no annual deductible; most preventitive care is 100% covered, restorative and major services are available for pre-set fees.
|
Anthem Dental Assistance Plan: $394 annual premium
($788 for employees
w/ less than 18 months
of service); no annual deductible; covers 100% of preventitive, 80% of restorative, and 50% of major services.
Cigna Dental Care Plan: $231 annual premium ($461 for employees w/ less than 18 months of service); no annual deductible; most preventitive care is 100% covered, restorative and major services are available for pre-set fees.
|
Delta Dental Basic: $265
premium, $100 family deductible; covers 100% of preventative, 80% of restorative services (does not cover major services).
Delta Dental Plus: $328 annual premium, $50 deductible; covers 100% of preventative, 80% of restorative, and 50% of major services. |
Delta Dental Basic: $265
premium, $100 family deductible; covers 100% of preventative, 80% of restorative services (does not cover major services).
Delta Dental Plus: $328 annual premium, $50 deductible; covers 100% of preventative, 80% of restorative, and 50% of major services. |
| Vision Exams |
100% coverage for exams (no frequency limit); no coverage for lenses or frames. |
$5 copay for eye exams
(1 per 12 months); no coverage for lenses or frames |
$236 annual premium,
$15 copay for exams (1 per 12 months),
$25 copay for lenses (1 pair per 12 months) and
allowance for frames. |
$236 annual premium,
$15 copay for exams (1 per 12 months),
$25 copay for lenses (1 pair per 12 months) and
allowance for frames. |
| Well Child Care |
100% coverage |
$5 copay |
$20 copay |
$20 copay |
Routine Adult
Exams |
100% coverage |
$5 copay |
$20 copay |
$20 copay |
| OB/GYN Exams |
100% coverage |
$5 copay |
$20 copay |
$20 copay |
| Mammography |
100% coverage |
$5 copay |
No copay |
No copay |
| Routine Hearing Exam |
100% coverage |
$5 copay (limit 1 visit
per 24 months |
$20 copay |
$20 copay |
| Physician Office Visits |
100% coverage |
$5 copay |
$20 copay |
$30 copay |
| Specialist Office Visits |
100% coverage |
$5 copay |
$20 copay |
$30 copay |
| Allergy Services |
100% coverage |
$5 copay |
$20 copay |
$30 copay |
| Diagnostic Services |
100% coverage |
100% coverage |
No copay |
80% coverage, subject
to deductible |
| High Cost Diagnostic Imaging |
100% covered |
100% coverage |
No copay at YNHH;
$100 copay at other Anthem PPO Provider |
80% coverage, subject
to deductible |
| Maternity Care (in office) |
100% coverage |
$5 copay |
No copay |
80% coverage, subject
to deductible |
| Infertility Services (Evaluation only) |
100$ coverage up to
$5,000 lifetime benefit, does not cover in-vitro |
$5 copay for diagnosis
and treatment; in-vitro
and advanced
reproductive technology
through Yale Medical
Group |
$20 copay |
$30 copay |
| Emergency Room |
100% coverage |
$50 copay (waived if
admitted) |
$70 copay (waived if
admitted) |
$70 copay (waived if admitted) |
| Urgent Care Facility |
100% coverage |
$35 copay |
$35 copay (waived if
admitted) |
$35 copay (waived if admitted) |
| Ambulance |
100% coverage |
100% coverage |
No copay |
No copay to YNHH (80% coverage to other hospital) |
| Inpatient Admissions |
100% coverage |
100% coverage |
No copay at YNHH; $700 copay per admission at other Anthem PPO Provider (max 3 copays per person per year) |
No copay at YNHH; 80% coverage at other Anthem PPO Provider, subject to deductible |
| Outpatient Surgery |
100% coverage |
100% coverage |
No copay at YNHH; $250
copay per procedure at other Anthem PPO Provider |
At YNHH, 100% coverage, subject to deductible; 80% coverage at other Anthem PPO Provider, subject to deductible. |
| Services of a Physician or Surgeon (other than medical office visit) |
100% coverage |
100% coverage |
No copay |
80% coverage, subject to deductible |
| Inpatient Mental Health |
No copay
60 days/year |
100% coverage |
No copay at YNHH; at other Anthem PPO Provider, $250 copay per admission |
100% coverage at YNHH, 80% coverage at other Anthem PPO Provider, subject to deductible |
| Outpatient Mental Health |
$100 deductible; $60
reimbursement per visit
(max of 30 visits per
plan year/150 visits
lifetime) |
$5 copayment; prior
authorization required
after 8 visits |
$20 copay |
$30 copay |
Chiropractic,
Occupational,
Physical and
Speech Therapy |
100% coverage for
Physical, Occupational and Speech Therapy;
Chiropractic not covered. |
$5 copay |
$20 copay |
80% coverage, subject to deductible |
