2020 Employee Benefits Book | Page 33

2020 Medical Plan Comparison
Standard Plan
Enhanced Plan
Limited Plan
Renown Preferred
Provider Non-
Preferred Renown Preferred
Provider Renown Preferred
Provider Non-
Preferred
Individual N/A N/A $2,000 N/A N/A N/A $2,500 $3,500
Family N/A N/A $4,000 N/A N/A N/A $6,500 $9,500
Inpatient Hospital $1,250/
Admit 25% 50% $1,000/
Admit $1,500/
Admit $2,500/
Admit 30% 50%
Same-Day Surgery $300 25% 50% $250 $350 $500 30% 50%
Routine Lab $0 25% 50% $0 $25 $0 30% 50%
X-Ray $25 25% 50% $25 $35 $35 30% 50%
MRI, CT Scan, PET Scan $250 25% 50% $200 $300 $300 30% 50%
Virtual Visits $0 $0 50% $0 $0 $0 30%
no ded. 50%
Primary Care Office Visit $10 $25 50% $15 $20 $25 30%
no ded. 50%
Specialty Care Office Visit $20 $50 50% $30 $40 $50 30% 50%
Preventive Services $0 0% 50% $0 $0 $0 0% 50%
Emergency Room $200 $200 $200 $200 $200 $250 $250 $250
Urgent Care Center $40 25% 50% $30 $50 $40 30% 50%
Ambulance N/A $100 50% N/A $100 N/A 30% 50%
$8,150 $8,150 N/A $8,150 $8,150 $8,150 $8,150 N/A
$16,300 $16,300 N/A $16,300 $16,300 $16,300 $16,300 N/A
Calendar Year Deductible
Type of Services
Out of Pocket Maximum
Individual
Family
Vision Care Coverage
Included
Included
Not Included
Note: Flat dollar amounts represent copays. Percentage represents coinsurance, which is a percent of the total bill. Coinsurance applies after the
deductible is met, unless otherwise specified.
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