Illusion wrote:HappyCat wrote: Хорошие страховки оплачивают частично любые процедуры. Не полностью, но оплачивают определенную часть. А если общая стоимость твоей части за год перевалила за определенную сумму (которая правда порядка нескольких тысяч) то и 100% начинают оплачивать. У меня PPO от UnitedHealthCare. Я выбираю любую процедуру какую хочу. Мне не требуется никакого преапрувала. Но я тоже плачу определенную часть.
Думаю, где это я уже видела это название сегодня...
http://www.msnbc.msn.com/id/28628880
Если очень интересно то вот мой план:
Your Medical Expenses
Annual deductible: Individual/Family In Network
$400 Individual; $1,200 Family
Out of Network
$800 Individual; $2,400 Family; separate from in-network
Primary doctor office visit In Network
$20 copay
Out of Network
70% covered after deductible is met
Specialist office visit In Network
$45 copay
Out of Network
70% covered after deductible is met
Out-of-pocket maximum: Individual/Family In Network
$2,400 Individual; $7,200 Family; includes deductible
Out of Network
$2,800 Individual; $8,400 Family; includes deductible; separate from in-network
Lifetime coverage limit In Network
Limit does not apply
Out of Network
Limit does not apply
Inpatient Care
Hospital copay In Network
Not applicable
Out of Network
Not applicable
Hospital semi-private room In Network
90% covered after plan deductible
Out of Network
70% covered after plan deductible
Inpatient physician and surgeon services In Network
90% covered; after plan deductible
Out of Network
70% covered; after plan deductible; subject to Reasonable and Customary limits
Inpatient lab and X-ray In Network
90% covered; after plan deductible
Out of Network
70% covered; after plan deductible
Outpatient Care
Outpatient surgery In Network
90% covered after deductible is met
Out of Network
70% covered after deductible is met
Outpatient laboratory services In Network
90% covered
Out of Network
70% covered after deductible is met
Outpatient X-ray In Network
90% covered for x-ray and non-high cost radiology; deductible does not apply; $75 copay for high cost radiology items such as MRI, MRA, CTA, CAT, PET, SPECT, or Nuclear Medicine
Out of Network
70% covered after deductible is met; subject to Reasonable and Customary limits
Emergency room (not followed by admission) In Network
$100 copay
Out of Network
$100 copay
Urgent care clinic visit In Network
$100 copay
Out of Network
$100 copay
Acupuncture In Network
$20 copay; PCP; $45 copay specialist; limited to $500 per calendar year; combined in-network and out-of-network
Out of Network
$20 copay; PCP; $45 copay specialist; limited to $500 per calendar year; combined in-network and out-of-network
Chiropractic In Network
$20 copay; PCP; $45 copay specialist; limited to $500 per calendar year; combined in-network and out-of-network
Out of Network
$20 copay; PCP; $45 copay specialist; limited to $500 per calendar year; combined in-network and out-of-network
Outpatient physical therapy In Network
$20 copay; PCP; $45 copay specialist; limited to 30 visits per year; combined in-network and out-of-network
Out of Network
70% covered after deductible is met; limited to 30 visits per year; combined in-network and out-of-network; subject to Reasonable and Customary limits
Outpatient speech therapy In Network
$20 copay; PCP; $45 copay specialist; limited to 30 visits per year; combined in-network and out-of-network
Out of Network
70% covered after deductible is met; limited to 30 visits per year; combined in-network and out-of-network; subject to Reasonable and Customary limits
Outpatient occupational therapy In Network
$20 copay; PCP; $45 copay specialist; limited to 30 visits per year; combined in-network and out-of-network
Out of Network
70% covered after deductible is met; limited to 30 visits per year; combined in-network and out-of-network; subject to Reasonable and Customary limits
Your Prescription Drug Expenses
Annual prescription deductible Not applicable
Retail Generic (Tier 1) $5 copay; 31 day supply; nonparticipating pharmacies reimbursed at contracted rate less appl copay; T1 of the HP Rx Drug Prgrm incl generic & brand name drugs
Retail Formulary (Tier 2) 70% cov; $30 min /$50 max; 31 day sup; nonparticipating pharmacies reimbrs at contract rate less apl copay; T2 of HP Rx Drug Prgrm incl gen & brand name drugs elig for cov & listed on UHC Rx Drug List
Retail Non-Formulary (Tier 3) 70% cov; $45 min/$65 max; 31 day sup; nonparticipating pharmacies reimbrs at contract rate less appl copay; T3 HP Rx Drug Program incl gen & brand name drugs that are not listed on UHC Rx Drug List
Mail Order Generic (Tier 1) $10 copay; 90 day supply; nonparticipating pharmacies not covered; T1 of the HP Rx Drug Prgrm incl generic & brand name drugs
Mail Order Formulary (Tier 2) 70% cov; $75 min/$125 max; 90 day supply; nonparticipating pharmacies not covered; T2 of HP Rx Drug Prgrm incl generic & brand name drugs elig for coverage & listed on UHC Rx Drug List
Mail Order Non-Formulary (Tier 3) 70% cov; $115 min/$165 max; 90 day supply; nonparticipating pharmacies not covered; T3 of HP Rx Drug Prgrm incl generic & brand name drugs that are not listed on the UHC Rx Drug List
Oral contraceptives Retail and mail order available; applicable prescription drug copay applies
Top
Coverage
UHC $400/20-45OV/30%Rx
Adult Preventive Care
Annual physical exam In Network
$20 copay; PCP; $45 copay specialist; limited to one exam per year
Out of Network
70% covered after deductible is met; limited to one exam per year
Well-woman exam (includes pap) In Network
$20 copay; PCP; $45 copay specialist
Out of Network
70% covered after deductible is met
Mammogram In Network
100% covered
Out of Network
70% covered after deductible is met
Cancer screenings In Network
$20 copay; PCP; $45 copay specialist
Out of Network
70% covered after deductible is met
Cardiovascular screenings In Network
$20 copay; PCP; $45 copay specialist
Out of Network
70% covered after deductible is met
Well Baby/Well-Child Preventive Care
Pediatric exams In Network
$20 copay; PCP; $45 copay specialist
Out of Network
70% covered after deductible is met
Immunizations (child) In Network
$20 copay; PCP; $45 copay specialist
Out of Network
70% covered after deductible is met
Family Planning/Maternity Care
Fertility drugs Retail and mail order available; applicable prescription drug copay applies; limited to $5,000
Fertility services In Network
Covered after ded is met; check with Plan for details; ltd to $5,000/family/lifetime, incl artificial insem & in vitro fert; combined in/out of ntwk; a separate $5,000 lifetime max applies to Rx drugs
Out of Network
Covered after ded; check w/ Plan for details; ltd to $5,000/family/lifetime, incl artificial insem & in vitro fert; combined in/out ntwk; subj to R&C limits; separate $5,000 lifetime max applies to Rx
Artificial insemination In Network
Covered after ded is met; check with Plan for details; ltd to $5,000/family/lifetime, incl fertility services & in vitro fert; combined in/out of ntwk; separate $5,000 lifetime max applies to Rx drugs
Out of Network
Covered after ded; check w/ Plan for details; ltd to $5,000/family/lifetime, incl fertility srvcs & in vitro fert; combined in/out ntwk; subj to R&C limits; separate $5,000 lifetime max applies to Rx
In vitro fertilization In Network
Covered after ded is met; check with Plan for details; ltd to $5,000/family/lifetime, incl fertility services & artificial insem; combined in/out of network; separate $5,000 lifetime max applies to Rx
Out of Network
Covered after ded; check w/ Plan for details; ltd to $5,000/family/lifetime, incl fert services & artificial insem; combined in/out ntwk; subj to R&C limits; separate $5,000 lifetime max applies to Rx
Female tubal ligation In Network
Covered; benefit based on location of services rendered; check with Plan for details
Out of Network
70% covered after deductible is met; subject to Reasonable and Customary limits
Male vasectomy In Network
Covered; benefit based on location of services rendered; check with Plan for details
Out of Network
70% covered after deductible is met; subject to Reasonable and Customary limits
Office visit: Pre/postnatal In Network
$20 copay initial visit only; PCP; $45 copay initial visit only specialist
Out of Network
70% covered after deductible is met
Doctor's services In Network
90% covered after deductible is met
Out of Network
70% covered after deductible is met; subject to Reasonable and Customary limits
Newborn nursery services In Network
90% covered after deductible is met
Out of Network
70% covered after deductible is met
Mental Health Care
Mental Health: Combined with substance abuse In Network
Yes
Out of Network
Yes
Mental Health: Outpatient coverage In Network
$15 copay; unlimited visits
Out of Network
50% covered; limited to 20 visits per year; subject to Reasonable and Customary limits
Mental Health: Inpatient coverage In Network
$250 copay per episode of care; unlimited days
Out of Network
$250 copay per episode of care; then 50% covered; limited to 20 days per year; subject to Reasonable and Customary limits
Substance Abuse Care
Rehab: Outpatient coverage In Network
$15 copay; unlimited visits
Out of Network
50% covered; limited to 20 visits per year; subject to Reasonable and Customary limits
Rehab: Inpatient coverage In Network
$250 copay per episode of care; unlimited days
Out of Network
$250 copay per episode of care; then 50% covered; limited to 20 days per year; subject to Reasonable and Customary limits
Vision Care
Routine vision exams In Network
Covered; limited to eye screening as part of preventive care program; to age six
Out of Network
Covered; limited to eye screening as part of preventive care program; to age six
Regular lenses and frames In Network
Not covered
Out of Network
Not covered
Contact lenses In Network
Not covered
Out of Network
Not covered
Hearing Care
Hearing evaluations In Network
Covered; limited to screening as part of preventive care program to age six
Out of Network
Covered; limited to screening as part of preventive care program to age six
Hearing aids In Network
90% covered after deductible is met; must be related to illness, injury, or congenital defect
Out of Network
70% covered after deductible is met; must be related to illness, injury, or congenital defect
Other Services
Noncustodial home health care In Network
90% covered after deductible is met; limited to 120 visits per year; combined in-network and out-of-network
Out of Network
70% covered after deductible is met; limited to 120 visits per year; combined in-network and out-of-network
Prescribed care in noncustodial skilled nursing facility In Network
90% covered after deductible is met; limited to 120 days per year; combined in-network and out-of-network
Out of Network
70% covered after deductible is met; limited to 120 days per year; combined in-network and out-of-network
Hospice care In Network
90% covered after deductible is met
Out of Network
70% covered after deductible is met
Ambulance services 90% covered after deductible is met
Allergy tests and treatments In Network
$20 copay; PCP; $45 copay specialist
Out of Network
70% covered after deductible is met
Durable medical equipment In Network
90% covered after deductible is met; limited to $5,000 per year excluding prosthesis; combined in-network and out-of-network; repair and maintenance covered
Out of Network
70% covered after deductible is met; limited to $5,000 per year excluding prosthesis; combined in-network and out-of-network; repair and maintenance covered
Other Plan Provisions
Second surgical opinion In Network
$20 copay; PCP; $45 copay specialist
Out of Network
70% covered after deductible is met; subject to Reasonable and Customary limits
Inpatient surgery In Network
90% covered; after plan deductible
Out of Network
70% covered; after plan deductible; subject to Reasonable and Customary limits
Midwives, licensed and certified, are eligible providers 90% covered after deductible is met; in-network; 70% covered after deductible is met out-of-network
Default PCP assigned (if none chosen) No
Domestic partner benefits Same sex only
Special dependent eligibility rules No special rules apply
Top
Access
UHC $400/20-45OV/30%Rx
Access
Out-of-area dependent coverage Yes
Out-of-area participant coverage Yes
Top
Ease of Use
UHC $400/20-45OV/30%Rx
Ease of Use
Need to file claims In Network
No
Out of Network
Yes
Number of PCP changes allowed/year Not Applicable
Ability to self-refer to OB/GYN Yes
Ability to self-refer to specialists Yes
Меня очень устраивает. В прошлом году муж пользовался и тоже был очень доволен.
Любой план идет со своими ограничениями. До сих пор оплачивали свою часть страховка не спрашивая что и зачем. Я очень довольна. В статье ничего не понятно. У UHC есть и HMO, где могут по любому поводу отказать. Ну если несправедливо отказали то и нарвались на lawsuit.
Pishu levoj nogoj s oshibkami. sorry
) - к сожалению, я нигде не видела как SEL и другие рекомендовали вам начинать рассчеты ни с магической цифрой 1600, ни с 800. Это была ислючительно ваша инициатива. Люди совсем о другом писали. А вы на этом построили, то что лично вы хотели построить. Только и всего.
их окружающий.
