Medical Plan Comparison

The Authority offers three (3) health plan options including medical and prescription drug benefits. The medical portion of the plan is administered by Highmark Delaware.

All three (3) plans are supported by a Blue Cross/Blue Shield national network of medical providers and allow you to seek the care of any physician or facility without the need to choose a primary care physician (PCP) or seek referrals. You can choose a plan that best suits you and your family’s needs.

Welcome to PLANselect! Answer just 4 simple questions and PLANselect will help you pick the best value health plan option. Our proprietary algorithm provides a personalized financial analysis and recommendation, considering your premium, expected out-of-pocket costs (co-pays, etc.), and other important plan features.

Preferred Provider Organization (PPO)

Exclusive Provider Organization (EPO)

High Deductible Health Plan (HDHP)

  • The PPO will provide low out-of-pocket expenses at point-of-service but cost the employee more through payroll deductions.
  • Services provided by in-network providers are covered at higher rates than out-of-network providers.
  • The EPO will result in higher out-of-pocket expenses at point-of-service but costs less in payroll deductions, resulting in a greater take home pay.
  • If you use a doctor or facility that isn’t in the national network, you will have to pay the full cost of the services provided.
  • Members are covered for emergency care – even from non-network providers – in their local service area or when away from home.
  • The HDHP is also an EPO and will result in much higher out-of-pocket expenses at point-of-service but costs much less in payroll deductions, resulting in a greater take home pay.
  • If you use a doctor or facility that isn’t in the national network, you will have to pay the full cost of the services provided.
  • Members are covered for emergency care – even from non-network providers – in their local service area or when away from home.
Below is a side-by-side comparison of the Medical Plan options.

For more details, refer to the Benefit Summary and Summary of Benefits and Coverage (SBC) for each plan which you can find below.

If there is any discrepancy between the following comparison and the insurance summaries or booklets, the provisions in the insurance summaries and booklets will prevail.

BenefitsPPOEPOHDHP
In-NetworkOut-of-Network1In-Network Only2In-Network Only2special
Major Medical3sub
DeductibleN/A$300 IND / $900 FAM$200 IND / $400 FAM$2,800 IND / $5,400 FAM
Coinsurance Percent100%80%100%100%
Out-of-Pocket Maximum
(Medical & Pharmacy Copays Only)
N/AN/AN/A$2,200 IND / $4,600 FAM
Total Out-of-Pocket Maximum4
(Medical & Pharmacy Combined)
$8,700 IND / $17,400 FAMN/A$8,700 IND / $17,400 FAM$5,000 IND / $10,000 FAM
Lifetime Benefit MaximumUnlimitedUnlimitedUnlimitedUnlimited
Physician Office Visits$15 copay80%$15 copay$15 copay, after deductible
Specialist Office Visits$20 copay80%$35 copay$20 copay, after deductible
Diagnostic X-Raysub
Hospital Facility$80 copay80%$80 copay100%, after deductible
Non-Hospital Facility$20 copay80%$20 copay 100%, after deductible
Lab Servicessub
Hospital Facility$80 copay80%$80 copay100%, after deductible
Non-Hospital Facility$20 copay80%$20 copay 100%, after deductible
MRIs, CT scans, and PT Scanssub
Hospital Facility$225 copay80%$225 copay100%, after deductible
Non-Hospital Facility$75 copay80%$75 copay100%, after deductible
Wellness/Routine Caresub
Routine Annual Physical100%80%100% (no deductible)100% (no deductible)
Periodic Hearing Exam100%80%100%Not Covered
Well-Child Care (includes immunizations)100%80%100% (no deductible)100% (no deductible)
Annual Gyn. Exam (including Pap Test) 100%80%100% (no deductible)100% (no deductible)
Routine Mammograms100%80%100% (no deductible)100% (no deductible)
PSA Test$20 copayNot Covered$35 copayNot Covered
Periodic Vision Exam
Therapiessub
Physical, Occupational and Speech Therapy80% (60 visits per condition per calendar year)80% (60 visits per condition per calendar year)80% (no deductible) (60 visits per condition per calendar year)100%, after deductible (30 visits combined per cal. year)
Radiation Therapy and Chemotherapy100%80%100% (no deductible)100%, after deductible
Hospital Benefits5sub
Inpatient (including maternity/delivery)$75/day copay for four (4) days, $300 maximum copay80%100%, after deductible100%, after deductible
Outpatient100%80%100%, after deductible100%, after deductible
Emergency Room
(waived if admitted to the hospital for treatment)
$150 copay$150 copay$150 copay$150 copay, after deductible
Urgent Care Center/Medical Aid Unit$20 copay80%$35 copay100%, after deductible
Ambulance Service$25 copay$25 copay$25 copay100%, after deductible
Miscellaneous:sub
Maternity
(Prenatal and Postnatal)
100%80%100%, after deductible100%, after deductible
Inpatient Mental Health, Substance Abuse, and Intensive Outpatient Care$75/day copay for four (4) days, $300 maximum copay80%100%, after deductible100%, after deductible
Chiropractic Care
(Max of 30 visits per year)
$20 copay80%$35 copay100%, after deductible
  1. All Out-of-Network benefits are subject to balance billing. 80% Coinsurance, after the deductible is met.
  2. There are no Out-of-Network benefits in either the EPO or HDHP, such expenses are the sole responsibility of the member.
  3. All Deductibles and Out-of-Pocket Maximums are reset every January 1st.
  4. The in-network Total Maximum Out-of-Pocket (TMOOP) is mandated by the federal government. TMOOP must include medical and prescription drug deductibles, coinsurance, and copays.
  5. Most non-emergency hospital stays, and voluntary surgical procedures must be pre-authorized.
  6. All Out-of-Network benefits are subject to balance billing. 80% Coinsurance, after the deductible is met.
  7. There are no Out-of-Network benefits in either the EPO or HDHP, such expenses are the sole responsibility of the member.

BENEFIT SUMMARY

A Benefit Summary is intended purely as a reference of the many benefits available under each plan.

Preferred Provider Organization (PPO)

Exclusive Provider Organization (EPO)

High Deductible Health Plan (HDHP)

Summary of Benefits and Coverage (SBC)

A SBC shows you how you and the plan would share the cost for covered health care services.

Preferred Provider Organization (PPO)

Exclusive Provider Organization (EPO)

High Deductible Health Plan (HDHP)

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