Voluntary Hospitals House Staff Benefits Plan (VHHSBP)
Effective January 1, 2006 |
IN NETWORK |
If you elect to go with Empire Point of Service In-Network Plan, you get comprehensive, quality benefits to meet all your healthcare needs. Empire will provide you with customer-centered healthcare including such benefits as doctors’ office visits, preventive care including well-child and well-woman services, emergency care, maternity care and hospitalization coverage. |
Access to Doctors |
Unrestricted. You can see any licensed Primary Care Physician (PCP) within the Empire POS network. Empire’s tri-state network of physicians has more than 64,000 providers |
Referrals |
Not necessary. You control your own healthcare |
Co-payment |
$20 co-payment for physician office visits.
$25 co-payment for mental health visits (30 visits per plan year.)
$35 co-payment for ER visits only if you are not admitted to hospital.
There is no deductible when seeing an in-network provider. |
International Coverage |
Available for emergencies. You have the option of seeing any doctor or hospital for emergency care. Subject to out-of-network deductible and co-insurance. There is no change from the current plan. |
National Coverage |
Covered. Wherever you live, work or travel within the U.S., Empire’s POS plan provides access to medical professionals. Medical services rendered outside of the local POS network as subject to out-of-network deductible and co-insurance. |
Prescription drug payments |
$5 co-payments for generic drugs
$15 co-payment for brand name drugs
$30 co-payments for non-formulary drugs |
Full Coverage after $20
co-payment in-network |
Annual physical exams for adults; lab tests and X-rays; physical, occupational, speech, and vision therapies; durable medical equipment, prosthetics and orthotics; skilled nursing facility care; home infusion therapy; MRI exams hospice care |
EMPIRE Health Line |
To get immediate assistance 24/7, call Empire Help Line: 877-TALK-2-RN. To be sure that you are eligible for in-network benefits, and to verify that your medical professional or hospital participates with the Empire Blue Cross/Blue Shield POS network, call 800-553-9603 |
EMPIRE Website |
http;//www.empireblue.com |
|
OUT-OF-NETWORK |
There is no change in the maximum out-of-pocket provision or deductibles. |
Deductible |
$100 single; $200 family (United Healthcare deductibles will be carried over if they have already been met (first year only). |
Co-Insurance |
Plan pays 80% of reasonable and customary costs. You are responsible for your deductible and co-insurance. You may be required to pay in full and then submit a claim form to Empire |
Out-of-Pocket Maximum |
$500. When the 20% co-insurance for Major Medical Benefits, including the deductible, reaches $500 for any person in a Plan Year, benefits will be paid a t 100% of reasonable and customary charges for that person for the remainder of the Plan Year (July 1 through June 30). In-network co-payments do not count towards the $500 out-of-pocket maximum. |
International Coverage |
Available for emergencies. You have the option of seeing any doctor or hospital for emergency care. Subject to out-network deductible and co-insurance. There is no change from the current plan. |
Co-payment |
Member pays $35 co-pay for ER visits only if you are not admitted to hospital. |
Mental Health |
Plan pays 50% of the reasonable and customary charges; visits for each person each Plan Year. |
Prescription drug payments |
$5 co-payments for generic drugs
$15 co-payments for band name drugs
$30 co-payments for non-formulary drugs |
EMPIRE Website |
http://www.empireblue.com |
